Quantifying the association of natal household wealth with women's early marriage in Nepal

Abstract

Background: Women's early marriage (<18 years) is a critical global health issue affecting 650 million women worldwide. It is associated with a range of adverse maternal physical and mental health outcomes, including early childbearing, child undernutrition and morbidity. Poverty is widely asserted to be the key risk factor driving early marriage. However, most studies do not measure wealth in the natal household, but instead, use marital household wealth as a proxy for natal wealth. Further research is required to understand the key drivers of early marriage.

Methods: We investigated whether natal household poverty was associated with marrying early, independently of women's lower educational attainment and broader markers of household disadvantage. Data on natal household wealth (material asset score) for 2,432 women aged 18-39 years was used from the cluster-randomized Low Birth Weight South Asia Trial in lowland rural Nepal. Different early marriage definitions (<15, <16, <17 and <18 years) were used because most of our population marries below the conventional 18-year cut-off. Logistic mixed-effects models were fitted to estimate the probabilities, derived from adjusted Odds Ratios, of (a) marrying at different early ages for the full sample and for the uneducated women, and (b) being uneducated in the first place.

Results: Women married at median age 15 years (interquartile range 3), and only 18% married ≥18 years. Two-thirds of the women were entirely uneducated. We found that, rather than poverty, women's lower education was the primary factor associated with early marriage, regardless of how 'early' is defined. Neither poverty nor other markers of household disadvantage were associated with early marriage at any age in the uneducated women. However, poverty was associated with women being uneducated.

Conclusion: When assets are measured in the natal household in this population, there is no support for the conventional hypothesis that household poverty is associated with daughters' early marriage, but it is associated with not going to school. We propose that improving access to free education would both reduce early marriage and have broader benefits for maternal and child health and gender equality.

Keywords: Adolescence; Child marriage; Education; Natal household poverty; Nepal; Reproductive health; South Asia; Women’s early marriage.

Figure 1. Early marriage groups used in analysis.

Our first outcome variable, women’s ‘early marriage,’ uses four different age groupings, described as Scenarios A, B, C and D. To ensure comparability across these results, the same reference group, marrying at the minimum age cut-off of ≥18 years, is used irrespective of the age used to define early marriage. Each of the scenarios above the <15 years has the lower group nested within it, but excludes the higher group up to 18 years.

Figure 2. Heat map of women’s educational attainment by natal household wealth.

Green shaded areas indicate low numbers and red shaded numbers the highest numbers.

Figure 3. Association of women’s marriage age and their education level stratified by natal household asset score.

This figure uses the raw data to stratify the association of women’s marriage age with women’s education by natal household asset quintiles.