Role of Child Marriage and Adolescent Childbearing on Hysterectomy Among Married Women in India: A Cross-Sectional and Time-to-Event 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 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.