Desire to delay the first childbirth among young, married women in India: a cross-sectional study based on national survey data

Ibarra-Nava et al. BMC Public Health (2020) 20:350 https://doi.org/10.1186/s12889-020-8402-9 RESEARCH ARTICLE Open Access Desire to delay the first childbirth among young, married women in India: a crosssectional study based on national survey data Ismael Ibarra-Nava1, Vikas Choudhry2 and Anette Agardh1* Abstract Background: Young women in India continue to face diverse challenges that threaten their health and wellbeing. The reproductive health and rights of newly married women, who are often expected to begin childbearing soon after marriage, are often neglected. The present study aims to understand some of the factors associated with the desire to delay the first childbirth in young, married women in India. Methods: The study utilised the data from the most recent National Family Health Survey 2015–16 in India. Our study sample was restricted to married women who were 15–24 years of age and who had never been pregnant at the time of the survey. Chi-squared tests, independent t-tests and multivariable logistic regression analyses were performed to measure associations between multiple independent factors and the reported preferred waiting time for the first childbirth. Results: Among never pregnant, married women aged 15–24, 21.49% reported a preferred waiting time for their first childbirth of 2 years or more. Belonging to an other backward class, or OBC, (ORadjusted 1.55, 95%CI 1.14–2.10), having completed higher education (ORadjusted 2.04, 95%CI 1.11–3.76), marrying after the age of 18 (ORadjusted 1.57, 95%CI 1.10–2.24), a husband’s higher education level (ORadjusted 2.42, 95%CI 1.27–4.64), a younger husband (ORadjusted 0.75, 95%CI 0.66–0.84) and non-exposure to physical violence (ORadjusted 1.84, 95%CI 1.09–3.11) were significantly associated with a longer preferred waiting time for the first childbirth. Conclusion: Intimate partner violence and partner characteristics play a role in the childbearing intentions of young women after marriage. Delaying the first childbirth could improve women’s educational and economic opportunities, their health, and the health of their future and properly planned children. To achieve this, it is crucial to promote and respect women’s right to decide who and when to marry, when to have children, and to promote relationships free of gender-based violence. Keywords: Young women, India, Intimate partner violence, First childbirth * Correspondence: 1 Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Ibarra-Nava et al. BMC Public Health (2020) 20:350 Background As of 2015, young people aged 15–24 years made up around 17% of the world’s population, and this number is expected to increase by 2030 [1, 2]. They comprise a large proportion of the population in many low- to middle-income countries (LMICs). Young people could greatly contribute to the development of LMICs over the next few decades, but this will remain a challenge unless young people gain access to high quality education and better employment opportunities [3]. An integral part of this challenge for young people involves realising their sexual and reproductive health and rights (SRHR). Improving young people’saccess to sexual and reproductive health care services and age appropriate sexuality education can help them avoid early and unintended pregnancies and sexually transmitted infections [3]. SRHR issues unequally affect women due to gender inequities around the globe, which leaves women, particularly young women, in a disadvantaged social position [3]. Their lower social status within their families and communities often undermines young women’s decisions about whether, when, and number of children to have, resulting in unwanted and early pregnancies and restricted educational and economic opportunities [3]. It is estimated that 5 to 33% of women between 15 to 24 years of age have to drop out of school in LMIC countries because of early pregnancy or marriage [4]. Consequently, many young women remain economically dependent on their spouses or their families and confined to their homes to take care of the household and their children. In India, childbirth most often occurs within marriage. Young married women are expected to begin childbearing and its associated responsibilities soon after co-habitation has begun. In fact, current patterns and trends in early childbearing after marriage continue to encourage rapid population growth in India [5]. This is particularly worrisome in a country of 1.25 billion people, where young people constitute almost one third of the population, and where the proportion of married young people is very high. As per the latest national family health survey (NFHS-4), around 1.6 and 24.4% of men aged 15–19 and 20–24, respectively, are currently married [6]. However, the proportion of currently married women in the same age groups is much higher, with 15.2% of women aged 15–19 and 65.3% of women aged 20–24 being currently married [6]. Furthermore, the proportion of women having unmet need for family planning is highest among women aged 15–19 and 20–24 years, with 22.2, and 22.3%, respectively, compared to the national average of 13% [6]. Marrying young, however, should not mean young couples should have children as soon as possible. Page 2 of 10 During the past decades, India has focused enormous efforts to prevent early marriage and early childbearing among young women. Despite some improvements in increasing the average age of marriage, early marriage and early childbearing practices are still prevalent and place a burden on young women’s lives. According to the NFHS-4, 27% of women aged 20–24 married before the age of 18 [6]. Marriage before the legal age of 18 is more prevalent amongst poor, less educated women living (...truncated)