Persistence of child marriage in rural Bangladesh and impact on maternal and perinatal health: findings from a health and demographic surveillance system

ObjectivesTo describe temporal trends in child marriage between 1990 and 2019 in a rural sub-district of Bangladesh and characterize relationships between age, time to pregnancy, complications during delivery, and perinatal mortality. DesignHealth and demographic surveillance system. SettingBaliakandi sub-district, Bangladesh. Participants56,155 female residents. Main outcome measuresAnnual proportion of marriages to female residents under 18 years of age, time between first marriage and pregnancy, proportion of births with complications during delivery, and odds of perinatal mortality. ResultsBetween 1990 and 2010, the proportion of marriages to female residents under 18 years of age decreased from 71% to 57%. Most notably, marriages to females aged 10 to 12 years dropped from 22% of all marriages to 3%. In 2019, 53% of all marriages were to females under 18 years. The estimated time between first marriage and pregnancy did not differ by female age at marriage. By 365 days after marriage, the cumulative incidence of pregnancy was approximately 50% for each age group. Adolescent girls were more likely to experience complications during delivery with at least one complication reported for 36% of mothers aged 13 to 15 years, 32% of mothers aged 16 to 17 years, and 23% of mothers aged 18 to 34 years ({chi}2 test, P<0.001). Compared to adults, births among females aged 13 to 15 years were more likely to result in stillbirths (odds ratio 2.23, 95% confidence interval 1.19 to 4.16) and births among females 16-17 years were more likely to result in early neonatal deaths (odds ratio 1.57, 95% confidence interval 1.01 to 2.42). ConclusionsChild marriage persists in Baliakandi. Over half of all marriages were to child brides and only minor reductions were seen over the past decade. Pregnancies were common among adolescent girls with no evidence of delayed pregnancy after marriage. Compared to adults, adolescents were more likely to experience complications during delivery and perinatal death. Preventing child marriage has substantial social and health benefits for girls and, by doing so, will also contribute to Bangladeshs commitment to reduce child mortality.