India’s Maternal Mortality Ratio (MMR) stands at 122 as per the latest Sample Registration System (SRS) bulletin from last year — a significant decline from an MMR of 556 in 1990. A parallel decrease in the prevalence of child marriage is also noted — 58 per cent in 1970-80 to 21 per cent by 2015-16. There is, however, a wide variation amongst states — highest in West Bengal at 39 per cent followed by Bihar and Jharkhand. The 2015-16 national family health survey (NFHS 4) also confirms the urban-rural difference in the incidence of early marriage — 17.5 per cent in urban and 31.5 per cent in rural women.
However, despite these positive developments, intrauterine growth restriction and poor birth outcome for gestational age and low birth weight (LBW) remain a grave concern, with three out of 10 children being LBW and a neonatal mortality rate of 23/1000 live births. Early marriage and early pregnancy play a central role in this grim scenario.
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The relationship between the level of education and early marriage is well established. With no education, 44.7 per cent women are married before 18 years. This drops to 39.7 per cent with primary education, 23.2 per cent with secondary education and 2.9 per cent with higher education. With higher levels of education, women are also empowered to take decisions within the family and better equipped to inculcate safe sex, family planning and safe abortion practices.
Following infancy, adolescence (10-19 years) is the last “window of opportunity” for attaining optimum height. Entering pregnancy at this stage, often under societal pressure, hinders attaining optimum height and prevents full growth of reproductive organs resulting in higher chances of obstructed labour and mortality. Poor maternal height (<145 cms) is reported to be one of the highest risk factors associated with chronic child undernutrition. Prevalence of malnutrition among children born to adolescent mothers is 11 per cent higher than among the others.
While revisiting the legal age of marriage for girls, we cannot ignore some prevalent socio-cultural determinants of early marriage. For instance, in some tribal northern regions of the country such as Jharkhand and Chhattisgarh, a young girl is “sent off” by her parents without a formal wedding, for cohabitation through what is referred as Pethu, Udhalka vivah, etc. The marriage is formalised whenever the girl’s parents have adequate resources to hold a community feast, often after a young girl has already borne children. Similarly, in certain semi-urban and rural areas, the practice of Gauna is common. As per this custom, a girl child is married at a young age, but the girl continues to live in her natal home, only to consummate the marriage once puberty is attained. In such situations, the community will find it difficult to adhere to the legal age unless an opportunity is provided and incentives built-in for a girl to have access to completing secondary school education. Such incentives or cash transfer education schemes are in operation in various states.
Along with increasing the age of marriage, efforts need to be directed to delay the age of conception. Schemes such as universal registration of marriage could be vital in providing newly married couples with timely information on family planning and family care. Moreover, if the registration is linked with Aadhaar, it can facilitate support to women to enter pregnancy well-nourished and at the right time.
According to the 1978 amendment of the Child Marriage Restraint Act, and Prohibition of Child Marriage Act, the minimum age of marriage is 18 years for girls and 21 years for boys. The Task Force responsible for reviewing the age of marriage should recognise the diversities that may hamper its implementation. Ensuring delayed marriage and pregnancy depends not just on the legal age but requires concerted efforts to keep girls in school for longer, as well as enabling them to complete higher education or vocational training.
A well-educated woman’s chances of gainful employment, making informed decisions and exercising greater agency in the household is unparalleled and monumental in breaking the cycle of poverty, early marriage and ill health, as well as the inter-generational cycle of malnutrition.
This article first appeared in the print edition on July 28, 2020 under the title ‘When She Marries’. This article first appeared in the print edition on July 28, 2020 under the title ‘When She Marries’. The writer is director, Public Health Nutrition and Development Centre, Delhi