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Role of child marriage and adolescent childbearing on hysterectomy among married women in India: a cross-sectional and survival analysis

Biplab Kumar Datta, Ashwini Tiwari · 28 Aug 2024

Abstract

Objective : Child marriage forces a girl into adult roles before physical and psychological maturity, which can take a toll on women’s health over the life course. This paper aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynecologic disorders leading to hysterectomy. Design : Cross-sectional and survival analysis. Setting : India, nationally representative survey. Population : 528,816 ever married women, aged 20-49 years. Methods : Women were grouped in four mutually exclusive categories – i) married adult – not an adolescent mother (reference category), ii) married adult – adolescent mother, iii) married child – not an adolescent mother, and iv) married child – adolescent mother. Multivariable logistic regressions were fitted to assess the odds of hysterectomy for these groups. Non-parametric Kaplan-Meier survivor functions were estimated to evaluate survival rates across the groups. Main outcome measures : Whether had a hysterectomy and age when hysterectomy was performed. Results : Compared to women married as adult – not an adolescent mother, women married in childhood and who gave birth in adolescence were 1.87 (95% CI: 1.78–1.96) times more likely to have a hysterectomy and had the lowest survival rate for hysterectomy. Women married as children but not an adolescent mother also had higher odds of hysterectomy (AOR = 1.40, 95% CI: 1.31–1.50). These results were robust across sub-groups including geographic regions, urban/rural residence, education, and income. Conclusions : Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage and call for strengthening efforts to eradicate child marriage.