Introduction
Child marriage, defined as marriage or union before the age of 18 years,
is an abrupt and immature transition from girlhood to womanhood. It
forces a girl to perform adult roles in the absence of the needed
physical or mental preparation. Such a precocious transition entailing
early sexual intercourse and subsequent childbearing can take a toll on
women’s health over the course of time. The literature on health
consequences of child marriage mostly examined its association with
immediate reproductive health outcomes including fertility, birth
intervals, adverse pregnancy outcomes, contraceptive use, and antenatal
care utilization.1 Health consequences of child
marriage over the life course, especially in the context of later-life
gynecologic health are comparatively less explored.
This paper examines the role of child marriage and subsequent
childbearing during adolescent age (i.e., by age 19 years) on having a
hysterectomy, one of the most common surgical procedures for women with
benign and malignant gynecological diseases,2 among
women in India, home to one third of the world’s child
brides.3
Studies on hysterectomies in India primarily assess prevalence
rates,4-6 spatial and regional
patterns,7, 8 sociodemographic
determinants,4, 9-11 preference for healthcare
facility to perform hysterectomy,12 and women’s
perception and decision on undergoing hysterectomy.13A few studies also explored the association between hysterectomy and
health outcomes such as hypertension, high cholesterol, diabetes,
etc.14, 15 Although some studies report a lower
prevalence of hysterectomy among women who were married after age 15
years,6, 8, 9 no studies have offered any critical
assessment of the relationship between gynecological disorders leading
to hysterectomy and child marriage and adolescent childbearing.
The aim of this paper is to assess the likelihood of hysterectomy in
general (i.e., all cause hysterectomy), and specific gynecological
problems (e.g., excessive menstrual bleeding, fibroids/cysts, uterine
rapture, cancer, and other) as reasons of hysterectomy in relation to
child marriage and adolescent childbearing among ever married women aged
20 to 49 years in India.