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Understanding the role of child marriage on reproductive health outcomes: evidence from a multi-country study in South Asia. Deepali Godha, David Hotchkiss, and Anastasia Gage Tulane University. Background. Child marriage remains a pervasive problem in South Asia and sub-Saharan Africa

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Understanding the role of child marriage on reproductive health outcomes: evidence from a multi-country study in South Asia

Deepali Godha, David Hotchkiss, and Anastasia Gage

Tulane University


Background
Background health outcomes: evidence from a multi-country study in South Asia

  • Child marriage remains a pervasive problem in South Asia and sub-Saharan Africa

  • Increasingly recognized as a violation of human rights

  • Previous research has associated child marriage with a number of adverse health and social outcomes

  • But most studies to date have focused on India – very little research in other countries


Purpose of study
Purpose of study health outcomes: evidence from a multi-country study in South Asia

  • To assess the association of child marriage and reproductive health outcomes in four South Asian countries after controlling for individual-, and household- level factors

  • Prevalence of child marriage in South Asia is high

    • Among currently married women 20 to 24 years of age, percent married prior to age 15 ranged from 10 percent in Nepal to 38 percent in Bangladesh.


Data health outcomes: evidence from a multi-country study in South Asia

  • Most recent Demographic and Health Surveys in four countries

    • India (2005/6)

    • Bangladesh (2007)

    • Nepal (2006)

    • Pakistan (2006/7)

  • Sample: Ever-married women 20-24 years of age

    • Sample size ranged from 1,546 in Pakistan to 22,807 in India


Methods 1
Methods (1) health outcomes: evidence from a multi-country study in South Asia

  • Dependent variables

    • Fertility

      • Early fertility – childbirth within the first year of marriage

      • Multiple unwanted pregnancies

      • Having had at least one pregnancy termination

      • Having had at least one unwanted pregnancy

    • Fertility control

      • Lack of fertility control prior to the first birth

      • Low lifetime fertility control – history of rapid repeat childbirth

    • Maternal health care utilization


Methods 2
Methods (2) health outcomes: evidence from a multi-country study in South Asia

  • Independent variables

    • Age at marriage dummy variables

      • Married at 14 years of age or younger

      • Married at 15 to 17 years of age

    • Other individual- and household-characteristics

  • Statistical methods

    • Logistic regression models to examine the association between various outcome variables and age of marriage

    • Unit of analysis is individual woman


Descriptive results
Descriptive results health outcomes: evidence from a multi-country study in South Asia

Percent of women married as children ranges from 50% to 77%


Descriptive results1
Descriptive results health outcomes: evidence from a multi-country study in South Asia

Percent of women with various fertility and fertility control outcomes


Logistic regression results
Logistic regression results health outcomes: evidence from a multi-country study in South Asia

Odds ratios: comparison group is women married at 18 years and older

Blue font indicates statistical significance (p<0.05)


Logistic regression results1
Logistic regression results health outcomes: evidence from a multi-country study in South Asia

Odds ratios: comparison group is women married at 18 years and older

Blue font indicates statistical significance (p<0.05)


Conclusions
Conclusions health outcomes: evidence from a multi-country study in South Asia

  • In South Asia, child marriage is significantly associated with many negative fertility and fertility control outcomes (and maternal health care utilization)

  • Women married in early adolescence show a higher propensity towards most negative outcomes than women married in middle adolescence

  • Child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility related outcomes


Limitations
Limitations health outcomes: evidence from a multi-country study in South Asia

  • Outcomes are self-reported: may be prone to bias

  • Data are cross-sectional: difficult to attribute causality

  • High odds ratios and wide confidence intervals may be an indication of small cell sizes or small probabilities

  • Cannot distinguish between natural and induced pregnancy termination


MEASURE Evaluation PRH is a MEASURE project funded by health outcomes: evidence from a multi-country study in South Asia

the United States Agency for International Development

(USAID) through Cooperative Agreement GHA-A-00-08-00003-

00 and is implemented by the Carolina Population Center at

the University of North Carolina at Chapel Hill in partnership

with Futures Group International, Management Sciences for

Health, and Tulane University. Views expressed in this

presentation do not necessarily reflect the views of USAID or

the U.S. Government. MEASURE Evaluation PRH supports

improvements in monitoring and evaluation in population,

health and nutrition worldwide.


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