Abstract
Objective : Child marriage forces a girl into adult roles before
physical and psychological maturity, which can take a toll on women’s
health over the life course. This paper aims to assess whether child
marriage and adolescent childbearing are associated with elevated risk
of gynecologic disorders leading to hysterectomy.
Design : Cross-sectional and survival analysis.
Setting : India, nationally representative survey.
Population : 528,816 ever married women, aged 20-49 years.
Methods : Women were grouped in four mutually exclusive
categories – i) married adult – not an adolescent mother (reference
category), ii) married adult – adolescent mother, iii) married child –
not an adolescent mother, and iv) married child – adolescent mother.
Multivariable logistic regressions were fitted to assess the odds of
hysterectomy for these groups. Non-parametric Kaplan-Meier survivor
functions were estimated to evaluate survival rates across the groups.
Main outcome measures : Whether had a hysterectomy and age when
hysterectomy was performed.
Results : Compared to women married as adult – not an
adolescent mother, women married in childhood and who gave birth in
adolescence were 1.87 (95% CI: 1.78–1.96) times more likely to have a
hysterectomy and had the lowest survival rate for hysterectomy. Women
married as children but not an adolescent mother also had higher odds of
hysterectomy (AOR = 1.40, 95% CI: 1.31–1.50). These results were
robust across sub-groups including geographic regions, urban/rural
residence, education, and income.
Conclusions : Our results, showing a strong relationship between
child marriage and hysterectomy, contribute to the literature on
later-life health consequences of child marriage and call for
strengthening efforts to eradicate child marriage.