Peer-reviewed article
The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016.
Kazutaka Sekine, Daniel J Carter ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how child marriage affects the use of maternal health services in Nepal using data from 3,970 women surveyed in 2016. Women who were married as children were significantly less likely to receive antenatal care, give birth with skilled attendance, deliver in a health facility, or receive postnatal care. The researchers suggest that restricted access to resources, limited decision-making power, social isolation, and domination by husbands and in-laws may explain why child marriage reduces use of maternal health services.
Key points
- Child marriage reduced likelihood of antenatal care visits by 26%
- Child marriage reduced likelihood of skilled attendance at delivery by 34%
- Child marriage reduced likelihood of facility-based delivery by 35%
- Child marriage reduced likelihood of postnatal care use by 20%
- Women's restricted autonomy and household resources may be key mechanisms linking child marriage to lower maternal health service use
Limitations
This is a cross-sectional study, so it cannot establish causality or the direction of effects. The analysis is based on survey data and cannot capture unmeasured confounding factors or the detailed mechanisms through which child marriage affects health-seeking behaviour.
Abstract
A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63-0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56-0.78), facility-based delivery (AOR 0.65; 95% CI 0.56-0.77), and postnatal care use (AOR 0.80; 95% CI 0.67-0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women's restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women's social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services.