The role of empowerment in maternal and neonatal outcomes among young brides and mothers in South Asia

Aside from being a fundamental violation of human rights, child marriage and subsequent early pregnancy have been associated with adverse maternal and neonatal outcomes. There is conflicting evidence around what drives these associations, with authors citing physiological immaturity, nutritional insufficiency, socioeconomic confounding, inadequate access to healthcare and psychological stress as potential drivers. It is important to elucidate the cause of these associations to improve outcomes, particularly in South Asia where rates of child marriage and early pregnancy are high.

Preliminary analysis during my rotation project found that early marriage,
rather than early pregnancy, is associated with preterm birth in Nepal. In South Asia, female empowerment is central to associations between age at marriage and maternal/neonatal outcomes, as the personal freedoms of girls are restricted considerably after marriage, with consequences for their physical and mental health.

My PhD project will address the associations of early marriage and subsequent early pregnancy with maternal and neonatal outcomes, with a focus on empowerment. I will utilize two rich data sets of pregnant girls and women in Nepal to examine how measures of empowerment differ between girls according to their age at marriage and pregnancy. I will also investigate which additional factors, such as diet, anthropometry and healthcare access, are associated with empowerment, and determine whether these associations differ according to age at marriage and pregnancy.

Through this analysis I will generate hypotheses for what is driving associations between early marriage and pregnancy and adverse maternal and neonatal outcomes. I will develop research questions to address these hypotheses using primary data collection as part of an intervention of remote antenatal counselling during the COVID pandemic in Nepal. The specifics of the primary data collection are dependent on various approval, timeline, and logistical considerations at this stage.

As there is heterogeneity in associations between early marriage/pregnancy and maternal/neonatal outcomes between regions, I will try to understand these differences either by systematic review or additional data collection.