Health Survey

Adolescent pregnancy and child under-nutrition are major social and public health concerns. The researchers aimed to examine associations between adolescent pregnancy and child under-nutrition in India, where one in five adolescents live, and one in three of the world’s stunted children.

Data were from India‘s fourth National Family Health Survey, 2015-16. Primiparous women aged 15-49 years who gave birth; between 2010 and 2016 were classified on the basis of age at first birth: 10-19 years (adolescence); 20-24 years (young adulthood), and 25 years or older (adulthood). Primary outcomes were anthropometric measures of offspring under-nutrition. Multivariable regression and structural equation models; were used to understand the extent to which these measures were linked to adolescent pregnancy; and the potential social, biological, and programmatic pathways.

Of the 60 096 women in the sample, 14 107 (25%) first gave birth during adolescence. Children born to adolescent mothers had lower Z scores for length or height-for-age (mean difference -0·53 SD); weight-for-age (-0·40 SD), and weight-for-length or height (-0·16 SD) than children born to adult mothers. Compared with adult mothers, adolescent mothers were shorter (-1·21 cm, 95% CI -1·78 to -0·65), more likely to be underweight (18% points, 15-21) and anaemic (8% points, 6-11), less likely to access health services (-4 to -15% points), and had poorer complementary feeding practices (-3 to -9% points).

Child anthropometry

Adolescent mothers also had less education (-3·30 years, 95% CI -3·68 to -2·91); less bargaining power (-7 to -15 percentage points); and lived in poorer households (-0·66 SD, 96% CI -0·82 to -0·50); with poorer sanitation (-28 percentage points, -32 to -24). In the path analysis, these intermediate factors predicted child anthropometry; with the strongest links being mother’s education (18%), socioeconomic status (13%), and weight (15%).

Of 60 096 women aged 15–49 included in the final sample (appendix), 14 107 (25·1%) first gave birth during adolescence, 31 475 (52·3%) during young adulthood, and 14 514 (23·2%) during adulthood. As expected, women who first gave birth during adolescence got married earlier (mean age at marriage 16·4 years of age, SD 1·67); compared with those who first gave birth as young adults (19·7, 2·14) or adults (24·3, 3·87; appendix). A greater proportion of women who first gave birth during adolescence lived in rural areas and belonged to a disadvantaged group compared with women who first gave birth as adults (appendix). The age and sex ratio of firstborn children was similar across groups

Children born to adolescent mothers are at risk of being undernourished. Adolescent pregnancy is related to child under-nutrition through poor maternal nutritional status, lower education, less health service access, poor complementary feeding practices, and poor living conditions. Policies and programs to delay pregnancy and promote women’s rights could help break the inter-generational cycle of under-nutrition through many routes.