Peer-reviewed article
Drivers of Marriage and Health Outcomes Among Adolescent Girls and Young Women: Evidence From Sub-Saharan Africa and South Asia
Fatima Tu Zahra, Karen Austrian, Mukta Gundi, Stephanie R. Psaki, Thoai Dinh Ngo ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines how two factors that drive early marriage—premarital pregnancy and a girl's agency in choosing her partner—affect health outcomes for married adolescent girls and young women in Malawi, Zambia, and India. The researchers analysed data from three surveys tracking over 3,000 girls across these countries. They found mixed results: having choice in partner selection was associated with both increases and decreases in depression in India, and premarital pregnancy was linked to fewer antenatal visits and hospital births in Malawi, but not to worse child health outcomes.
Key points
- Having agency in marital partner choice in India showed conflicting associations with depressive symptoms—both increasing and decreasing reported symptoms
- Premarital pregnancy was associated with fewer antenatal visits and hospital-based deliveries in Malawi compared to pregnancy after marriage
- No evidence that premarital pregnancy was associated with worse child health outcomes than pregnancy after marriage in Malawi and Zambia
- The relationship between marriage drivers and health outcomes differs significantly across the three country contexts studied
- The study emphasises that marriage drivers must be interpreted within local cultural and social norms to understand their health impacts
Limitations
The study cannot determine causality due to its observational design using panel data rather than experimental methods. The mixed findings across contexts limit the ability to draw generalizable conclusions about how marriage drivers universally affect health outcomes.
Abstract
PURPOSE: Previous studies have examined the relationship between age at marriage and health outcomes, but few have explored how marriage drivers are associated with health outcomes. In this study, we examine the relationship between two marriage drivers, premarital pregnancy and agency, and several health outcomes (use of maternal health care services, child health outcomes, and change in depressive symptoms) among married adolescent girls and young women (AGYW) in sub-Saharan Africa and South Asia. METHODS: We use three panel data sets collected by the Population Council: the Adolescent Girls Empowerment Program from Zambia (N = 660), the Malawi Schooling and Adolescent Study from Malawi (N = 1,041), and Understanding the Lives of Adolescents and Young Adults from India (N = 894 in Bihar, N = 599 in Uttar Pradesh). Our analytical models use logistic and multinomial logistic regression. RESULTS: We find mixed evidence of the association between marriage drivers and health outcomes. Results show that having agency in marital partner choice in India is associated with both an increase and decrease in reported depressive symptoms. In addition, pregnancy before marriage is associated with fewer antenatal visits and hospital-based births in Malawi than pregnancy after marriage. However, we find no evidence that it is associated with worse child health outcomes than pregnancy after marriage in Malawi and Zambia. CONCLUSIONS: Overall, our study suggests that the relationship between marriage drivers and AGYW's health outcomes after marriage is not consistent across contexts. We highlight the importance of interpreting marriage drivers within prevailing norms to understand their impact on married AGYW's health.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Examination of two marriage drivers—premarital pregnancy and agency in partner choice—and their relationship to maternal health care use, child health outcomes, and depressive symptoms
- Population
- Married adolescent girls and young women in sub-Saharan Africa (Malawi, Zambia) and South Asia (India: Bihar and Uttar Pradesh); N=660 (Zambia), N=1,041 (Malawi), N=1,493 (India)