How Much Education Is Needed to Delay Women's Age at Marriage and First Pregnancy?

Abstract

Background: Early childbirth is associated with adverse maternal and child health outcomes. In South Asia, where women generally marry before having children, public health efforts need to focus on delaying marriage. Female education is widely considered the primary means to achieve this. However, it remains unclear how much education is required to delay marriage to the universal minimum age of 18 years, or what predicts marriage age in women lacking any education. This is crucial to address in the Terai region of Nepal which has the highest proportion of children out of school and where girls marry and have their first pregnancy early. Methods: We analyzed data from 6,406 women aged 23-30 years from a cluster-randomized trial in lowland Terai Nepal. Using Kaplan-Meier survival analysis, multivariable logistic and Cox proportional hazards regression models, we investigated associations between women's education level and age at marriage and first pregnancy, and the interval between these events. Among the uneducated women, we investigated associations of husband's education level with the same outcomes. Results: Compared to uneducated women, educated women had a greater probability of delaying marriage until the age of 18 years and of pregnancy until 20 years. Women needed to complete grade 9, and ideally 11, to substantially increase their odds of marrying after 18 years. Delaying first pregnancy to 20 years was largely due to marrying later; education had little extra effect. The association of marriage with first pregnancy age worked independently of education. However, later-marrying women, who generally had completed more education, had their first pregnancy sooner after marriage than earlier marrying women. Most uneducated women, regardless of their husbands' level of education, still married under the legal age of marriage. Conclusion: Delaying marriage to majority age requires greater efforts to ensure girls get to school in the first place, and complete secondary education. Since currently only 36% of girls in the Terai attend secondary school, parallel efforts to delay marriage are crucial to prevent early childbearing. Sexual and reproductive health programmes in school and in women's groups for married and uneducated adolescents may help prepare for marriage and pregnancy.

Keywords: age at first pregnancy; education; lowland Nepal; marriage to first childbearing interval; women's marriage age.

Figure 1

Sample selection. This flowchart illustrates how our sample was selected. Boxes to the left describe the number available for analysis once the exclusions have been accounted for in the boxes to the right.

Figure 2

Proportion of women uneducated by age, LBWSAT. This figure illustrates the proportion (%) of women in LBWSAT who were uneducated by age.

Figure 3

Kaplan-Meier Survival Curves of (A) women's age at marriage and (B) first pregnancy by levels of women's education for all women. The survival curves (vertical lines) represent the probability of women delaying marriage or first pregnancy by age for all women in our sample. The curves are stratified by five (differently colored) levels of women's educational attainment. Black denotes no education, green 1–5 years of schooling, blue 6–8 years, purple 9–10 years, and red 11–13 years of schooling.

Figure 4

Mean marriage age and interval between marriage and first pregnancy for all women. This figure shows the mean interval between marriage and first pregnancy for all women in the sample. Error bars represent standard error of the mean.

Figure 5

Kaplan-Meier Survival Curves of (A) women's age at marriage and (B) first pregnancy by their husband's educational attainment for uneducated women only. The survival curves (vertical lines) represent the probability of women delaying marriage or first pregnancy by age for uneducated women only. The curves are stratified by four (differently colored) levels of husband's educational attainment. Black denotes no education, green 1–5 years of schooling, blue 6–8 years, and red ≥9 years of schooling.

Figure 6

Mean marriage age and interval between marriage and first pregnancy uneducated women only. This figure shows the mean interval between marriage and first pregnancy for uneducated women only. Error bars represent standard error of the mean.