Association Between Child Marriage and Utilization of Maternal Health Care Services in India: Evidence from a Nationally Representative Cross-sectional Survey

Objective: In an effort to improve utilization of maternal health care services, age at marriage of girls has gain very little attention by the policy maker and programmer. Studies have indicated that child marriage has serious negative consequences on maternal health. Moreover, there is a paucity of research on explaining the links between child marriage and maternal health care utilization. In this study, we aimed to examine the association between child marriage and utilization of maternal health care services using nationally representative sample survey of India.

Design: Cross-sectional observational study.

Setting: India.

Participants: A total number of 190,898 ever-married women who had at least one live birth during the last five years preceding the survey from the 2015 to 2016 National Family Health Survey (NFHS) were utilized.

Measurements: Outcome measures: At least four antenatal visits (ANC), ANC visit within first trimester, institutional delivery, delivery by skilled health personnel, and postnatal care (PNC) within 42 days of delivery. Predictor variable: Child marriage. Control variables: Socio-economic and demographic characteristics of women. Bivariate and multivariate analyses were performed for the analyses of the study data.

Results: The results of our study revealed that women who married at <18 years were significantly less likely to use maternal health care services than those married at ≥18 years even after accounting for socio-economic and demographic characteristics of women. Furthermore, nuanced analysis revealed that the odds of maternity care services is much lower for those women who married at ≤14 years compared with later married groups.

Conclusions: The findings of our study suggest that efforts should be made to increase age at marriage of girls which could have positive impact on utilization of maternal health care services. Moreover, targeted intervention is needed to improve the utilization of maternity care especially among socio-economically vulnerable women.