Peer-reviewed article
Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa
Bright Opoku Ahinkorah, Eugene Budu, Abdul‐Aziz Seidu, Obasanjo Afolabi Bolarinwa, Ebenezer Agbaglo et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined the relationship between child marriage and maternal healthcare use among young women aged 20–24 in sub-Saharan Africa, using data from 29 countries' demographic surveys conducted between 2010 and 2018. Women who were married as children were significantly less likely to attend four or more antenatal care visits and to use skilled birth attendance during delivery, compared to those who were not married as children. These differences persisted even after accounting for individual and community factors. The authors conclude that ending child marriage is essential to improving maternal health outcomes in the region.
Key points
- Young women with a history of child marriage were 40% less likely to have 4+ antenatal care visits (crude odds ratio 0.60)
- Child marriage was associated with 55% lower odds of using skilled birth attendance during delivery (crude odds ratio 0.45)
- After adjusting for individual and community-level factors, child marriage remained significantly associated with lower antenatal care and skilled birth attendance use
- The association between child marriage and postnatal care use became insignificant after controlling for confounding factors
- The study included 36,215 childbearing young women from 29 sub-Saharan African countries
Limitations
The study is cross-sectional and observational, so it cannot establish causation or rule out unmeasured confounding. The analysis is limited to women aged 20–24 who survived to the survey period, which may not represent the full population of girls who experienced child marriage.
Abstract
BACKGROUND: Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa. METHODS: We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval. RESULTS: Young women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors. CONCLUSION: Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.