title: Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study.
abstract: BACKGROUND
  Child marriage is a substantial barrier to social and economic development in India, and a primary concern for women's health. We assessed the prevalence of child marriage-ie, before 18 years of age-in young adult women in India, and the associations between child marriage and women's fertility and fertility-control outcomes.
  
  
  METHODS
  Data from the National Family Health Survey-3 (2005-06) were limited to a sample of Indian women aged 20-24 years (n=22 807), of whom 14 813 had been or were presently married (ever-married). Prevalence of child marriage was estimated for the whole sample. We used regression models adjusted for demographics, and models adjusted for demographics and duration of marriage to estimate odds ratios (ORs) for the associations between child marriage and both fertility and fertility-control outcomes, in the ever-married subsample.
  
  
  RESULTS
  44.5% of women aged 20-24 years were married before age 18 years, 22.6% were married before age 16 years, and 2.6% were married before age 13 years. Child marriage was significantly associated with no contraceptive use before first childbirth (adjusted OR 1.37 [95% CI 1.22-1.54]), high fertility (three or more births) (7.40 [6.45-8.50]), a repeat childbirth in less than 24 months (3.00 [2.74-3.29]), multiple unwanted pregnancies (2.36 [1.90-2.94]), pregnancy termination (1.48 [1.34-1.63]), and female sterilisation (6.68 [5.78-7.60]). The association between child marriage and high fertility, a repeat childbirth in less than 24 months, multiple unwanted pregnancies, pregnancy termination, and sterilisation all remained significant after controlling for duration of marriage.
  
  
  CONCLUSIONS
  Increased enforcement of existing policies is crucial for prevention of child marriage. Improved family-planning education, access, and support are urgently needed for women married as children, their husbands, and their families to reduce the high fertility and poor fertility-control outcomes of this practice.
  
  
  BACKGROUND
  US National Institutes of Health and Indian Council of Medical Research.
authors.affiliation: Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA 02118, USA. anitaraj@bu.edu
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
authors.forename: Donta
authors.initials: D
authors.lastname: Balaiah
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D001294:Attitude to Health / Q000208:ethnology; D002648:Child; D002669:Child Welfare / Q000208:ethnology / Q000331:legislation & jurisprudence / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D005298:Fertility; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008393:Marriage / Q000208:ethnology / Q000331:legislation & jurisprudence / Q000639:trends*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D015995:Prevalence; D012044:Regression Analysis; D012959:Socioeconomic Factors; D016387:Women's Health / Q000208:ethnology / Q000331:legislation & jurisprudence