Should India re-think the age of marriage, in a bid to lower our alarming maternal mortality rate (MMR)? Can the state decide the appropriate age for women to become mothers? And there’s the larger question: will this move actually save Indian mothers?
On Saturday, 1 February, Finance Minister Nirmala Sitharaman unveiled the 2020 Budget and announced that a task force would be assembled to recommend the right age for women to become mothers.
In her speech, Sitharaman noted that the age of marriage had been amended from 15 to 18 for women in 1978. She linked the lowering of MMR and improving nutrition levels to the progress of our country, and urged that the “issue about the age of a girl entering motherhood needs to be seen in this light.”
Sitharaman said India is a "caring society" and reaffirmed the government’s commitment to women’s health. But is increasing the age of marriage the best way forward?
FIT spoke to industry experts.
Where Does India Stand on MMR?
Before we begin dissecting this development, we need to ask: what contributes to our high MMR? And what progress has been made so far?
Sustainable Development Goal 3 of Good Health For All has targets for reducing MMR to less than 70 women per 1,00,000 live births. Closer to home, our National Health Policy of 2017 aimed at 100 per 1,00,000 births by 2020.
In a press release from the GOI in November 2019, Minister of Health and Family Welfare, Dr Harsh Vardhan congratulated 11 states that have achieved this goal and added that,
The Effect of Increasing the Marriage Age for Women
Poonam Muttreja, Executive Director, Population Foundation of India (PFI) tells FIT that evidence shows a clear link between early marriage and increased levels of anaemia and nutritional deficiencies amongst girls and women.
MMR is intrinsically linked with gender equality: the lack of agency women, especially young women, have in society and within their marriages coupled with low levels of education and access to family planning or affordable healthcare services result in many preventable deaths.
The lower the age, the more the risks and Muttreja adds that, “ Teenage pregnancy is relatively high in rural areas. Nearly 1 in every 10 women in rural areas in the age group (15-19) have begun childbearing. Furthermore, 27.3 percent of married teenage girls have given birth to one child while 4.2 percent of married girls have two or more children. Also, more than 50 per cent women in the reproductive age (15-49) were found to be anaemic.”
Most of this data suggests that the threat to mortality increases manifold when the mother is below 18.
This begs the question: will raising the age of marriage make a difference if even the limit of 18 is not met?
An industry expert who wished to stay anonymous said, “Any task force recommendation is welcome, but the focus should be on improving the current systems like enforcing the marriage limit rather than raising it further.”
For this, Muttreja offers up solutions for government strategies:
- Strengthen on-ground vigilance systems and child protection schemes implemented by the government.
- Ensure the registration of births as well as marriages.
- Invest in social behavioural communication interventions to address regressive socio-cultural barriers that have an impact on decisions related to marriage and childbirth.
The industry expert, however, argues that first “ There needs to be a specific age-based survey to determine the most vulnerable ages and how to target those. Most MM occurs at the age of 20-25 when most women have children. Yes, the risk of dying is higher in those below 18, but the number of births is less, so increasing the marriage age will only have a marginal impact on the overall MMR.”
What About Pre-Marital and Teen Pregnancies?
Another important point is that marriage and pregnancy are not always linked, and premarital pregnancies, especially among younger women results in a high MMR.
Imagine a young girl, in rural India who finds herself pregnant through consensual, premarital sex. Who does she turn to for help to understand her situation, options and way forward?
Again, a lack of sexual and reproductive rights (including abortion rights) awareness, access to contraceptives and family planning resources and sensitive, accessible healthcare systems means that she could be left with little options. Now imagine the millions of women who are in this unfriendly environment different - different age groups with different situations and problems like abusive relationships, lack of proper nutrition, personal choice - what happens to their reproductive and personal health?
Experts say we need to improve services in hospitals, increase the number of staff and facilities. Our priority should be to improve healthcare policies, to expand public hospitals or make arrangements for free services at private hospitals to reach the most vulnerable.
What Should The Task Force Keep in Mind?
We’ve explored the problem points in addressing MMR, what should be the priorities for the task force at a national level?
“The Maternal Mortality Rate in India has declined consistently due to efforts of successive government on pre-natal and maternal care, increase in the enrolment ratio of girls in education at all levels and the increase in the average of marriage. To ensure this continues, the task force should focus on bringing in policy interventions that allow girls to complete their schooling years, develop adequate life skills and secure jobs for themselves,” says Muttreja.
The industry expert says that its important to first rigorously determine the leading cause of MM and then focus on targeted-solutions in different demographics and states.