New research shows positive association between adolescent pregnancy & under-nutrition among children
Adolescence is a period when physical and neuro-maturational changes take place in the body of a young girl. Although it is illegal marrying a girl under the age of 18 years as per the Prohibition of Child Marriage Act 2006, adolescent girls in our country are compelled to marry and attain pregnancy that adversely affects well-being and outcomes of both mothers and their children.
Latest available data shows that societal norms to consummate the marriage and low level of sexual reproductive health knowledge, among other factors, compelled almost one-third of Indian women (roughly 31 percent) to give birth by the age of 18 years during 2016.
A new study, which has been published recently in the prestigious Lancet Child & Adolescent Health journal, aims to explain the negative impact of childbearing at an early age on nutritional outcomes among children. The paper, which has been co-authored by Phuong Hong Nguyen, Samuel Scott, Sumanta Neupane, Lan Mai Tran, and Purnima Menon – all from International Food Policy Research Institute (IFPRI) -- found that adolescent pregnancy is associated with child under-nutrition (unlike what happens in the case of adult pregnancy) through the interplay of various factors such as poorer maternal nutritional status, lower educational attainment, less access to health services during antenatal or post-natal care and early childhood, sub-optimal complementary feeding practices, and poorer living conditions.
Using multivariable regression and structural equation models, the study shows that stunting (height-for-age) and underweight (weight-for-age) among children below 5 years were almost 11 percentage points more prevalent in children born to adolescent mothers in comparison to children born to adult mothers. The paper uses data from the fourth round of National Family Health Survey (NFHS-4).
Discussing the factors (viz. poorer maternal nutritional status, lower educational attainment, lower likelihood of accessing antenatal health services, poorer complementary feeding practices, and poorer living conditions) that play crucial roles in determining the association between adolescent pregnancy and nutritional status among children, the study, among other things, has highlighted the following points:
* In comparison to women who first gave birth as adults, adolescent mothers were shorter and thinner. Poor maternal nutritional status caused lower length or height and weight among their children.
* Adolescent mothers were more likely to be anaemic in comparison to adult mothers, and anaemia was associated with reduced child growth.
* In comparison to adult mothers, adolescent mothers had roughly 3 lesser years of education. They were also less likely to work for pay, to have money they could spend, less say in household decisions, and less freedom of mobility. Among these factors, only education was related to child height-for-age Z score (HAZ); the path was one of the strongest observed, with the effect of adolescent pregnancy on mother’s education accounting for an 18 percent difference in child HAZ.
* Adolescent (aged 10–19 years) mothers seek antenatal care later, make fewer visits during pregnancy, and receive fewer components of care than older first-time mothers.
* Children born to adolescent mothers were less likely to achieve adequate diet and consume iron-rich foods.
Intergenerational cycle of poverty and under-nutrition could be tackled through policies and programmes that delay childbearing since such measures broadly affects multiple determinants of stunting among children below 5 years of age, says the research paper.
Since India is one of the 10 countries with the highest burden of early childbearing in terms of both relative prevalence and absolute numbers and it has most number of stunted children in the world, the authors of the study have suggested reducing adolescent pregnancy. They think that by doing so the country could achieve several of the Sustainable Development Goals (SDGs) related to poverty, health, nutrition, general well-being, equity, and education. According to the research paper, improvement in maternal and child nutrition could be achieved through interventions to increase age at first marriage, age at first birth, and girl's education.
Social, biological, and programmatic factors linking adolescent pregnancy and early childhood under-nutrition: a path analysis of India’s 2016 National Family and Health Survey -Phuong Hong Nguyen, Samuel Scott, Sumanta Neupane, Lan Mai Tran, Purnima Menon, The Lancet Child & Adolescent Health journal, Volume 3, Issue 7, July 2019, Pages 463-473, please click here to access
The Prohibition of Child Marriage Act, 2006, please click here to access
New Study Links Childhood Stunting to Teen Pregnancy, TheWire.in, 19 May, 2019, please click here to access
Image Courtesy: Himanshu Joshi