India has an enormous problem of malnourishment, being home to almost 25% of the world’s malnourished children. A new study shows that child marriages and underage pregnancies are making a sizeable contribution to this problem, drawing a clear correlation to undernutrition of children born to adolescent mothers.

Researchers from the International Food Policy Research Institute analysed data relating to more than 60,000 first time mothers across the country from the National Family Health Survey. The study, published in The Lancet Child & Adolescent Health, found that 25% of the respondents first gave birth during adolescence. The children born to adolescent mothers were shorter for their age and had lower weights for height than children born to adult mothers.

The findings show that India needs to look beyond the challenge of providing food to tackle the challenge of malnutrition, said Purnima Menon, senior research fellow at IFPRI and one of the authors of the paper.

“Some things create bigger risks,” she said. “Babies that are born to teenage mothers are at a much greater risk of being malnourished.”

Adolescent mothers also tended to be shorter, were more likely to be underweight and were more likely to be anaemic than adult mothers.

Menon said that these adolescents may well have been undernourished as children and carried forward that state of malnourishment. “But you do have a growth spurt during adolescence and if you are pregnant at this time, there is competition in the body for resources, which is not good,” she said.

They were also less likely to access health services and were less likely to provide their children proper complementary food along with breastfeeding.

India has a number of programmes aimed at bringing down malnutrition – the Integrated Child Development Scheme, the system of anganwadi creches to look after and feed toddlers and the mid-day meal scheme at schools to ensure that children get at least one full nutritious meal. These programmes have been successful to a large extent.

The Global Childhood Report 2019 shows that stunting (low height for age) due to malnutrition has fallen by 30% since 2000, that is, there are 23 million fewer stunted children in the country than 19 years ago. However, more than 38% of children below the age of five are stunted.

In this scenario, the IFPRI study suggests that in addition to the nutrition and maternal health programmes that need to be strengthened, preventing early marriage and underage pregnancies could bring malnutrition down significantly.

“The policy link to the paper is that it is fine what the government is doing with ICDS and health services but in fact ending early child bearing is in itself an important policy lever for ending malnutrition,” said Menon.

Early marriage

Menon suggested two policy imperatives that can be taken to eliminate the risk of early pregnancies. One is to prevent early marriage itself and the second is to provide better access to family planning and contraception to women who have already married early.

Despite the Prohibition of Child Marriage Act, 2006, making the marriage of a girl below the age of 18 illegal, child marriages remain fairly common in India even if on the decline. According to National Family Health Survey data, the prevalence of child marriage amongst girls between the ages of 15 and 19 is almost 12% and for girls between the ages of 20 and 24 is almost 27%.

Several states and union territories offer incentives to families to delay the marriage of their girls until they are at least 18. As a result, families get the girls married as soon as they turn 18, pointed out Nandita Bhan, research scientist with the Centre for Gender Equity and Health at the University of California San Diego.

“We have some good laws and policies, but design innovations are needed and their effectiveness and implementation needs testing and strengthening respectively,” said Bhan, who was not part of the study but has written a comment on it for The Lancet.

The IFPRI study shows that adolescent mothers had less education, less bargaining power and lived in poorer households with poorer sanitation than adult mothers. This overall lack of agency, Bhan said, is probably the major factor keeping them from accessing health services.

But another possible complication is simply the fact that underage marriages are illegal and approaching the health system can get the adolescent girls and their families into trouble.

Unintended consequences

Kannan Gopinathan, district collector of Dadra and Nagar Haveli, illustrated this problem in a recent Twitter thread. Dadra and Nagar Haveli has a high rate of teenage pregnancies among its tribal population. has earlier reported how this has been a major factor contributing to infant deaths.

In the Twitter thread, Gopinath pointed out that it is culturally accepted for a boy and girl in tribal communities to live together at around when they are about 16 or 17 and marry only later. Accordingly, the district administration has tailored its awareness programme around delaying pregnancy rather than discouraging live-in relationships. However, Protection of Children from Sexual Offences criminalises intercourse with a minor without leaving any scope for consent for a boy or girl under 18 years of age.

The Act also makes not reporting a sexually exploitative act an offence punishable with six months imprisonment. As a result, government doctors started reporting every teenage pregnancy to the police. The union territory has achieved almost 100% institutional delivery, but now, Gopinath worries, Adivasi families will not come into hospitals for childbirth for fear of having a police case registered against them – an unintended consequence of the POSCO Act.

Bhan said that the IFPRI study is an indicator public policy system must think beyond the usual silos within public health to solve the malnutrition problem. “We think of malnutrition as a nutrition problem,” she said. “What this piece makes a case of is thinking about multi-sectoral linkages, that it is really gender empowerment that is going to affect nutrition in the long run.”