In India, teenage pregnancy and stunted children strongly linked
Study highlights the generational challenges of poor nutrition and early marriage. Biplab Das reports.
Children born to teenage mothers are more likely to be undernourished than those born to adults, an Indian study has revealed.
India is home to more stunted children than anywhere else in the world and is one of the 10 countries with the largest burden of teenage pregnancy. Globally, every year around 16 million adolescent girls give birth, and 95% of these are in low- and middle-income countries.
Pregnancy in adolescence sometimes has fatal consequences. It also often results in school dropout, adversely affecting young women’s education, income, and health. It also significantly correlates with poor health outcomes for the resulting children.
In a first comprehensive study, published in the journal The Lancet Child and Adolescent Health, a research team from the International Food Policy Research Institute (IFPRI) in Washington DC, US, explored links between teenage pregnancy and child undernutrition in India.
The researchers analysed data from the fourth Indian National Family Healthy Survey. They specifically studied nearly 60,000 mother-child pairs, including adolescent mothers who were aged between 10 and 19 when they gave birth, and adult mothers aged 20 and above. The research probed potential social, biological, and other factors that possibly contribute to early pregnancy and child stunting.
“This study showed that adolescent pregnancy is linked to childhood stunting through a set of factors,” says lead author Phuong Hong Nguyen, a research fellow from IFPRI.
Compared to adult mothers, teenage mothers had poorer nutritional status, lower education, a lower likelihood of accessing prenatal health services, and poorer living conditions. The study, Nguyen notes, shows that all of these factors are associated with child stunting.
Prevalence of stunting and underweight were found to be 10% higher in children born to adolescent mothers than in children born to adults. Stunting is defined as a height that is more than two standard deviations below the World Health Organisation (WHO) Child Growth Standards median.
First-time adolescent mothers were on average shorter and thinner than the first-time adult mothers. They also had lower haemoglobin levels. Anaemia among them was associated with reduced child growth.
Low-haemoglobin levels stem from iron deficiency. According to a recent study published in journal Proceedings of the Nutrition Society, foetal and postnatal iron deficiency results in a range of adverse consequences for mother and infant, including low birth-weight, impaired cognitive development and poor immune function.
The adolescent mothers had poorer access to and use of prenatal care services than adult ones, missing out, for instance, on advice to eat iron-rich food. Many pregnant teenagers also faced poorer sanitation and living conditions, thus exposing their babies to infections that aggravate stunting.
If current trends of teenage pregnancy continue, projections indicate that 127 million Indian children under five years will be stunted by 2025. Besides predisposing the children to increased risk of degenerative diseases such as diabetes, stunting greatly affects their future livelihood and a country’s economic progress.
According to a World Bank estimate, stunting can reduce a country’s gross domestic product by up to 3%.
Ending early marriage is the only solution that can banish teenage pregnancy and child stunting, the researchers say. A Teenage Girls Survey (TAG) conducted by non-profit research organisation the Naandi Foundation in 2018 found that girls are willing to break free from the cycle of early marriage.
The survey, a direct conversation with girls across India, revealed that more than 70% of them want to marry only after the age of 21.
Policies and programs designed to delay marriage can cash in on this mindset. A review published in 2016 in the Journal of Adolescent Health showed that it is possible to prevent marriage of teenage girls in low and middle-income countries through interventions such as unconditional cash transfers, cash transfers conditional on school enrolment, and livelihood training. All these had a positive impact on increasing age at marriage.
India is making small steps in that direction. With a strong law that prohibits early marriage, states are already testing the efficacy of different cash transfer programs conditional on education, with complementary programming meant to encourage investment in girls' human capital.
The Indian government’s Poshan Abhiyaan, launched in 2018 to deal with child undernutrition, Nguyen says, must also align strongly with the policy communities working on reducing early marriage and early childbearing, and accelerate actions in areas where these are most prevalent.