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