New Delhi: Teenage pregnancy not only wrecks a young mother’s health but also damages her baby’s growth and development before and after birth.

Teenage mothers are more likely to have stunted and underweight children than adult mothers, according to the world’s first comprehensible study to establish the link between teenage pregnancy and child undernutrition in India, which is home to one in five of adolescents and one in three stunted children in the world.

Stunting and underweight prevalence is 11 percentage points higher in children born to teenage girls than adult mothers, according to a study published earlier this week in The Lancet Child and Adolescent Health.

“The strongest links between adolescent pregnancy and child stunting were through the mother’s education, her socio-economic status, and her weight,” said study co-author Samuel Scott, from the Washington DC-based International Food Policy Research Institute, which analysed National Family Health Survey-4 (NFHS-4) data for the study.

Implementing policies and programmes to end early marriage can help break the intergenerational cycle of undernutrition and improve child health, said the report. “Our findings suggest the strongest links between teen pregnancy and child stunting in India are women’s education, socioeconomic status, and maternal weight. Compared to women who have their first child as an adult, those who have their first child as an adolescent are less educated, poorer, and more underweight; each of these factors, in turn, is associated with more child undernutrition,” said Purnima Menon, study co-author and senior research fellow in IFPRI’s Poverty, Health and Nutrition Division.

“Other links include access to health services during antenatal, delivery, and early childhood periods; infant and young child feeding (practices); living conditions; and maternal bargaining power; all of these factors are worse for adolescent mothers compared to adult mothers,” said Menon.
In 2015-2016, around 27% of girls got married before the age of 18 years, which is the legal age of marriage in India, and around 4.5 million girls were pregnant or had become mothers in 2015-16, according NFHS-4. About 38.4% children are stunted (low height for age), 35.7% are underweight (low weight for age), and 21% are wasted, according to the NFHS-4.

“Globally, adolescent pregnancy has led to over 156 million children under the age of five years to have stunted growth due to malnutrition. Every year, millions of girls give birth too early, forcing them to assume adult responsibilities and putting their health, education and economic prospects at risk. Complications from pregnancy and childbirth are the second leading cause of death for adolescent girls between the ages of 15 and 19 globally,” said Bidisha Pillai, CEO, Save the Children.

“The girls who get married early are from poorest homes and the most disadvantaged. They are poor, undernourished, stunted and anaemic to begin with and have the triple disadvantage of early marriage, early pregnancy and high mortality at birth,” said Poonam Muttreja, executive director, Population Foundation of India.

Compared to adult mothers, teenage mothers were shorter, more underweight and anaemic, and less likely to seek health services, found the IFPRI study. They also had lower education, less bargaining power, and lived in poor households with bad sanitation.

“The findings are no surprise. India has halved maternal mortality, but it hasn’t happened among the poorest. We have to start at the last mile instead of saying we failed to reach the last mile to break the intergenerational cycle of poverty and malnutrition,” said Muttreja.

Providing girls education and livelihood can help break the trend. The Naandi Foundation’s Teen Age Girls Survey (TAG Survey) of at least 70,000 households across 600 districts in 30 states shows that 73.3% of teenage girls want to marry after the age of 21, but do not have the option of staying schooling, saying no to marriage, seeking employment or postponing pregnancy.

Among the strategies that prevent child marriage in low- and middle-income countries are unconditional cash transfers, cash transfers conditional on school enrolment or attendance, school vouchers, life skills curriculum and livelihood training had a positive impact on increasing age at marriage.

“It is essential to work with vulnerable adolescents, their parents and guardians, communities and local governance representatives, and government bodies to address issues affecting their well-being, including improving their life skills; helping them access education, health, nutrition services and government’s social-protection schemes; enhancing child sensitivity to address harmful gender and social norms; and linking adolescents with livelihood and financial inclusion alternatives. This will ensure they delay their age of marriage, but are also able to choose, when and how many children to have,” said Pillai.