Peer-reviewed article
Role of Child Marriage and Adolescent Childbearing on Hysterectomy Among Married Women in India: A Cross‐Sectional and Time‐to‐Event Analysis
Biplab Kumar Datta, Ashwini Tiwari ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether child marriage and early childbearing increase the risk of hysterectomy among Indian women. Using data from over 528,000 ever-married women aged 20-49 years, researchers compared women married as children versus adults, and those who had children as adolescents versus adults. Women who experienced both child marriage and adolescent childbearing had the highest rates of hysterectomy and the worst health outcomes.
Key points
- Women married as children and who gave birth in adolescence were 1.87 times more likely to have had a hysterectomy compared to women married as adults
- The combined group of child marriage and adolescent childbearing had the lowest survival probability at all ages, with only 85.80% remaining without hysterectomy by age 49
- Women married as children but not adolescent mothers had 1.40 times higher odds of hysterectomy
- Women married as adults but with adolescent childbearing had 1.53 times higher odds of hysterectomy
- The study demonstrates long-term health consequences of child marriage into adulthood
Limitations
This is a cross-sectional study that cannot establish causality, only association. The study cannot determine the specific gynaecologic conditions leading to hysterectomy or explore underlying mechanisms of how child marriage causes these health outcomes.
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 article aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynaecologic disorders leading to hysterectomy. DESIGN: Cross-sectional and time-to-event analysis. SETTING: India. 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. Nonparametric 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 adults, not an adolescent mother, women married in childhood and gave birth in adolescence were 1.87 (95% CI: 1.78-1.96) times more likely to have a hysterectomy. The latter group also had the lowest survival probability for hysterectomy at all ages (e.g., 85.80% [95% CI: 85.41-86.18] at age 49 years as compared to 91.65% [95% CI: 91.37-91.89] for the former group). Women married as children but not adolescent mothers and married as an adult but gave birth in adolescence also had higher odds of hysterectomy-1.40 (95% CI: 1.31-1.50) and 1.53 (95% CI: 1.40-1.66) times of that of the reference group, respectively. CONCLUSIONS: Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage.