High infant mortality rates across South Asia can be directly linked to girls getting married young and having early and frequent pregnancies, according to researchers at the University of California, San Diego, School of Medicine.
One in 14 births to youthful mothers (defined as being under 18) lead to the death of the child within the first year of life in Bangladesh, India, Nepal and Pakistan, the group said.
In the current issue of International Journal of Gynecology & Obstetrics, Anita Raj, Ph.D., professor of medicine and director of the Center on Gender Equity and Health at UC San Diego, one of the researchers of the study, also noted that short intervals between pregnancies (defined as less than 24 months) account for about one-fourth of the infant mortality rate in India and Pakistan. This translated into 200,000 baby deaths last year alone.
In Nepal, only young motherhood was linked to infant deaths, while in Bangladesh, the main culprit appeared to be brief inter-pregnancy intervals.
South Asia has some of the highest infant mortality rates in the world – United Nations data reveals that Pakistan records 70.90 deaths per 1,000 live births; India 52.91, Bangladesh 48.98 and Nepal 38.71. In stark contrast, the infant mortality rate in the United States came in at 6.81 and in Singapore, the figure is only 1.92, lowest rate in the world. For the world as whole, 49.4 deaths are recorded per 1,000 live births.
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Raj conceded that the data may not be perfect since they are based on analyses of national demographic and health surveys taken in the four countries of South Asia at different times.
“The data in India and Pakistan were collected four to five years prior to the data in Bangladesh and Nepal, and therefore represent different cross-sections of time,” she said. “In addition, both India and Pakistan have higher burdens of infant mortality -- in absolute and relative terms -- than Bangladesh or Nepal.”
Still, the given data suggests that the problem in Pakistan is significantly worse that in neighboring countries.
“A major reason you see worse infant mortality rates -- and worse maternal mortality rates -- in Pakistan relative to India, Bangladesh and Nepal is lower reproductive and maternal health care coverage for women there,” Raj told International Business Times.
“Also, Pakistan has lower rates of exclusive breastfeeding, which increases risk for infant mortality. Exclusive breastfeeding refers to providing only breast milk to the baby for six months. This reduces risk for things like diarrhea from bacteria in water.”
The overriding factor to all these alarming data is the prevalence of child marriage in South Asia -- which presents a grave public health concern, for both mother and baby. Child brides are themselves highly susceptible to early deaths or serious health problems. They also tend to find themselves trapped in poverty and illiteracy.
Raj and her colleagues revealed last year in another study that more than 10 million girls under the age of 19 get married every year – nearly one-half of them in India and Pakistan.
“There is inadequate recognition that issues like early marriage of girls are primary drivers of problems like infant mortality in the region,” said Raj, adding, however, that Bangladesh and Nepal have made “measurable improvements” in some areas, including greater access to education and health care for girls.
Child-marriages have been illegal in India since the 2006 passage of the Prohibition of Child Marriage Act, but the practice persists unabated, particularly among the rural poor. (India officially raised the legal marriage age to 18 in 1978, although the law was actually enacted in 1973).
The United Nations Children's Fund (Unicef) estimates that 40 percent of all child marriages in the world take place in India.
Child marriage is also a serious problem in Bangladesh, Afghanistan, Pakistan, Nepal, Yemen and parts of sub-Saharan Africa. In fact, in some these countries, the rates of child marriage are higher than in India. But given India's huge population, in absolute terms, it accounts for the largest number of these marriages.
Early marriages can lead to numerous medical and psychological problems, particularly in relation to early childbirths where the mother is not physically mature.
Unicef said more than one-fifth (22 percent) of women in India between the ages of 20 and 24 gave birth to a child before they turned 18, and these young mothers are twice as likely to die during pregnancy or childbirth as women who have babies in their 20s.
A study published in Lancet magazine in 2009 found that almost half of adult Indian women between the ages 20 to 24 were married before the legal age of 18, and many of these unions led to unwanted and terminated pregnancies, repeat childbirths in less than 24 months, and increased sterilization rates.
These results suggest that neither recent progress in economic and womens' development, nor existing policy or programmatic efforts to prevent child marriage and promote maternal and child health, have been sufficient to bring the prevalence of child marriage in India down to the level of most other developing nations.
Despite the huge economic strides India has made in recent decades, the rural areas – where child weddings tend to dominate – remain disproportionately trapped in poverty.
Girls Not Brides, an activist organization that seeks to stamp out child marriage, believes the practice victimizes girls since they are frequently married off to much older men, sometimes twice their age.
In many communities where child marriage is practiced, girls are not valued as much as boys - they are seen as a burden, Laura Dickinson of Girls Not Brides told Al Jazeera.
It must also be pointed out that there are some misconceptions about child marriage. In such an arrangement, the parents or guardians agreed to the union when the “bridge” and “groom” are indeed very, very young. But the “husband” and “wife” do not live together until they have reached puberty (that is, little children are not living together as “husband and wife”).