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Effect of Child Marriage on Use of Maternal Health Care Services in Pakistan

Nasrullah, Muazzam MD, MPH; Zakar, Rubeena MD, PhD; Krämer, Alexander MD, PhD

doi: 10.1097/AOG.0b013e31829b5294
Global Women's Health: Original Research

OBJECTIVE: To assess the association between child marriage (before 18 years of age) and maternal health care services use in Pakistan.

METHODS: We limited the data from Pakistan Demographic and Health Survey, 2006–2007, to ever-married females aged 15–24 years with at least one childbirth (n=1,404) to identify differences in prenatal care provision (skilled or unskilled medical care provider), antenatal care (antenatal visits; care at home or a hospital), care at delivery (assistance by unskilled medical care provider), and place of birth by early (younger than 18 years) compared with adult (18 years or older) age at marriage. Associations between child marriage and health care services use were assessed by calculating adjusted odds ratios (OR) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), employment status, and partners' education.

RESULTS: Overall, 66.1% of ever-married respondents aged 15–24 years in Pakistan with at least one childbirth were married before the age of 18 years. More than half (61.9%) of females married as children had no formal education, and the majority (71.0%) resided in rural areas. Child marriage was significantly associated with decreased likelihood of any prenatal care (adjusted OR 0.73, 95% confidence interval [CI] 0.534–0.993) and prenatal care by skilled medical care providers (adjusted OR 0.64, 95% CI 0.476–0.871) and increased likelihood of delivery assistance by unskilled medical providers (adjusted OR 1.90, 95% CI 1.435–2.518) and delivery at home (adjusted OR 2.17, 95% CI 1.617–2.915).

CONCLUSIONS: Efforts to increase the age of marriage and delay childbearing may have population-level effects on reducing disparities between females married as children and adults and improving maternal and child health in Pakistan.


Efforts to increase the age of marriage and delay childbearing may have population-level effects on maternal and child health in Pakistan.

Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany; Rollins School of Public Health, Emory University, Atlanta, Georgia; the Injury Control Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia; and the Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.

Corresponding author: Muazzam Nasrullah, MD, MPH, 2924 Clairmont Road, Atlanta, GA 30329; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.