Teen pregnancy in India linked to child undernutrition

Stunting and underweight prevalence were 10 per cent higher in children born to adolescent mothers than in children born to adult mothers.

Researchers at the International Food Policy Research Institute (IFPRI) have found that children born to teenage mothers were underweight as compared to children born to older women.

"Reducing adolescent pregnancy in India can hasten our progress towards achieving the United Nations' Sustainable Development Goals, particularly those related to poverty, health, nutrition, general wellbeing, equity, and education," said IFPRI Research Fellow and study co-author, Phuong Hong Nguyen.

"Our study sheds empirical light on pathways between teenage pregnancies and child undernutrition. People have talked about these pathways before, but this data allowed us to put some numbers to those pathways," explained study co-author Samuel Scott.

 

India is home to the more stunted children than any other country and is one of the ten countries with the largest burden of teenage pregnancy. Although marriage before the age of 18 years is illegal in India, the 2016 National Family and Health Survey (NFHS)-4 revealed that 27 per cent of girls are married before their 18th birthday and further, 31 per cent of married Indian women gave birth by the age of 18 years.

Compared to adult mothers, teenage mothers were shorter, more likely to be underweight and anaemic, less likely to access health services and had poorer complementary feeding practices. They also had lower education, less bargaining power and lived in poorer households with poorer sanitation.

"The strongest links between adolescent pregnancy and child stunting were through the mother's education, her socio-economic status, and her weight," said Scott.

The study, "Social, biological and programmatic factors link adolescent pregnancy to early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey", co-authored by IFPRI's Phuong Hong Nguyen, Samuel Scott, Sumanta Neupane, and Purnima Menon; and FHI360's Lan Mai Tran, was published in The Lancet Child and Adolescent Health.

The authors analysed data from 60,097 mother-child pairs and examined the extent to which teenage pregnancy is associated with a child under nutrition. Further, they explored potential social, biological, and programmatic factors linking early pregnancy to a child under nutrition.

Policies and programs to delay marriage can potentially help break the intergenerational cycle of under nutrition through many routes.

"Unfortunately, in India, early marriage and subsequent pregnancy is often not a deliberate choice, but rather the result of an absence of choices, and of circumstances beyond a girl's control," said IFPRI study co-author, Purnima Menon.

Indeed, the Teenage Girls Survey 2018 (TAG Survey) by Naandi Foundation, a direct conversation with girls across India, showed that 73.3 per cent of teenage girls want to marry only after the age of 21, which is heartening news, but also highlights the mismatch between their aspirations and the reality of early marriage.

"Continuing schooling, exploring employment opportunities, and delaying marriage and pregnancy are challenges for India's girls that are reinforced through patriarchy and social norms," Menon added.

"We are very encouraged by the decline in the prevalence of early marriage over the last decade but also puzzled by why it is high in states like Andhra Pradesh and Telangana", Menon said.

"Further investments in appropriate interventions targeting young people, both men, and women, can contribute to further declines in early marriage and early childbearing in India," Menon suggested.

Several strategies exist to reduce early marriage. A review of interventions to prevent child marriage in low and middle-income countries shows that interventions including unconditional cash transfers, cash transfers conditional on school enrolment or attendance, school vouchers, life-skills curriculum, and livelihood training had a positive impact on increasing age at marriage.

The Government of India has legal instruments in place to prevent early marriage. Central and state governments have also piloted different cash transfers conditional on education, with complementary programming meant to encourage investment in girls' human capital.

In addition, there are several ongoing adolescent health programs under different ministries in India. At the same time, the problem of early marriage in India isn't geographically uniform.

High variability between states and districts suggests that sub-national policies and programs that address local reasons for early marriage and early childbearing are still needed. These actions should account for differences in cultural practices and other context-specific conditions affecting early marriage and early childbearing.