NEW YORK May 15 (Reuters Health) - Fewer girls under 14 are getting married in Bangladesh, India, Nepal and Pakistan, with sizable declines seen in each nation, according to a study released on Tuesday that suggests positive health gains for young women in South Asia.
In Bangladesh, for example, about 34 percent of women reported being married by age 14 in 1991 and 1994. By 2005 and 2007 that number had fallen to about 19 percent.
At the same time, marriage rates for girls aged 16 to 17 stayed about the same, except for an increase of about 36 percent in Bangladesh - a country where marriage for girls under 18 is generally more common.
"The decrease for the youngest age group is dramatic, but for the oldest, we've got nothing," said Anita Raj, the study's lead author and a professor at the University of California, San Diego School of Medicine.
Raj and her colleagues reported the findings in a letter to the editor of the Journal of the American Medical Association. See: bit.ly/JOTmp1
For their study, the researchers analyzed surveys taken from 1991 to 2007 in the four countries. For marriage rates, they looked at whether 20- to 24-year-old women reported being married before their 18th birthday.
In India, the marriage rate for girls younger than 14 dropped from about 10 percent in 1991-1994 to about 6 percent in 2005-2007. Pakistan saw the rate for girls under 14 fall from about 6 percent to a little less than 3 percent over the same period.
Raj told Reuters Health that the declines may be explained by more encouragement for girls to complete their education before marriage. Students in those countries typically graduate from high school at the age of 15 or 16.
Bangladesh, India and Nepal all ban marriage before the age of 18, while Pakistan's minimum age is 16. But Raj said those laws are largely ignored, especially in rural areas.
Marrying too young is an issue because it is associated with many health concerns, including complications from pregnancy and physical abuse.
Teen mothers are at a higher risk for pregnancy-induced high blood pressure and delivering babies before 37 weeks and with low birth weights, said Monica Johnson, a women's health nurse practitioner at the Barnes-Jewish Hospital's teen pregnancy center in St. Louis.
Teens are also at risk for postpartum depression, Johnson told Reuters Health. She added that "with adequate prenatal care and emotional support a lot of those teen moms do not experience the risks."
In a previous article, however, Raj reported that the poorest and least-educated girls are at the greatest risk for an early marriage. That may limit access to healthcare.
Raj and her colleagues focused on South Asia mostly because of the amount and quality of data available, but she said that early marriage should not be seen as a problem exclusive to that area.
A 2011 report from UNICEF reported that adolescent marriage is also common in sub-Saharan Africa. It said that the psychosocial effects girls experience are enormous, including not having friends, being powerless and doing an excessive amount of housework.
Raj told Reuters Health that one way to reduce marriage among young girls may be to increase the number of choices they have, such as providing access to schools or jobs. (Editing by Michele Gershberg and Eric Walsh)