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.