Exploring the Socio-Cultural Factors Behind the Early Marriage and Pregnancy Cases in Eastern India: A Qualitative Study

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Early pregnancies are associated with various complications, including preterm labor and perinatal deaths. In India, despite a decline in the percentage of teenage pregnancies, absolute figures remain high, impacting a substantial portion of the population. Our study aims to explore the sociocultural factors among others which led to teenage pregnancies. Methods This qualitative study, conducted in the OBG and Pediatrics departments of ESIC Medical College & Hospital, Joka, aimed to explore socio-cultural factors contributing to early and teenage pregnancies. One-to-one in-depth interviews were conducted with 27 teenage and early-aged pregnant women, focusing on demographic, socio-cultural, and awareness factors. Thematic analysis was employed for qualitative data. Results The study identified three major themes: Demographic factors, Socio-cultural factors, and Awareness of Reproductive & Child Health. Lack of education, financial constraints, and familial expectations emerged as primary drivers. Family pressure and cultural norms promoted early conception after marriage. Despite awareness, contraception use was low, and pregnancies were often unplanned. Conclusion Addressing early pregnancies requires a multifaceted approach involving basic education, awareness campaigns, and economic empowerment. Prioritizing higher education for girls, dispelling cultural norms, and promoting contraceptive use are essential. Government schemes supporting women's empowerment and discouraging teenage pregnancies play a crucial role. Comprehensive measures, including sex education, and stringent laws against early marriages, are vital for reducing the societal burden of early and teenage pregnancies. Adolescent health Early marriage Family planning Lack of education Teenage pregnancy Figures Figure 1 Introduction World Health Organisation (WHO) defines adolescent pregnancy as a pregnancy between 10–19 years. [1] It can be further divided into early teenage pregnancy (Between 10–15 years) and late teenage pregnancy (Between 16–19 years). [2] Early pregnancy is the leading cause of death in girls aged 15–19 years in Lower Middle-Income Countries (LMIC) where almost all of the estimated three million unsafe abortions occur. Girls under the age of 15 are less likely to be physically developed enough to sustain a healthy pregnancy or to give birth to a healthy child. Such pregnancies are associated with various complications like preterm labor, pregnancy-induced hypertension, and anemia in pregnancy. Complications are also common in young-aged pregnancies of age 16–20 years. There are also several complications associated with the child born to teenage mothers. Perinatal deaths arising from low birth weight babies are significantly higher in babies born to teenage mothers than in those born to mothers aged 20–29 years [3, 4] If we look at the global scenario, teenage pregnancy is a worldwide problem, having its roots in almost every country. The global teenage birth rate was 47 births per 1000 women in 2015 Approximately 16 million girls aged 15–19 years and 2.5 million girls under 16 years give birth in developing countries. The Alan Guttmacher Institute (AGI) conducted a study of teenage pregnancy and childbearing in 37 developed countries to unveil the factors responsible for teenage pregnancy cases and found that the lowest teenage birthrates were found in those countries with the most liberal attitudes toward sex as demonstrated through media representation of female nudity, extent of nudity on public beaches, sales of sexually explicit literature, and media advertising of condoms. The older teenage birthrate was found to be lower for countries with higher minimum ages for marriage. A subtler factor was found that although contraception was available, it was not that accessible to young women and men because of the cost. [5, 6] WHO conducted studies across various developing countries related to the occurrence of teenage pregnancies and found that complications during pregnancy and childbirth were the leading cause of death for 15 to 19-year-old girls globally. Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions and every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions. Teenage mothers were also found to face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years. [1, 7] India is home to one of the world’s largest youth populations, where 358 million young people (10–24 years) represent 20% of India’s population. Though the percentage of teenage pregnancies has gone down as per the data in NFHS-4 compared to that in NFHS-3, the absolute figures are colossal due to the increasing population in India. One-third of married rural girls are between 10–19 years with a prevailing teenage pregnancy rate of 9.2% Numerical estimates suggest that every year around 4 million teenage girls in India get pregnant and give birth. For every 1000 girls aged 15–19 years, there were 76 births from teenage pregnancies in India in 2010 as compared to 49 worldwide and 53 in less developed countries. Actually, by the age of 15 years, 26% of girls in India get married, and by the age of 18 years, this figure rises to 54%. So, the early age of marriage automatically links to the early onset of sexual activity and thereby fertility. The condition in Eastern India is even worse. The state of West Bengal ranks second among women who have started childbearing between the age of 15 and 19 years with a teenage pregnancy rate of 18% well above the national average of 7.9%. The conditions in the rural areas are worse with 1 in every 10 women between the age of 15 & 19 years having at least 1 child. According to NFHS-4, 41.6% of women were married in the state before the age of 18. Moreover, the use of contraceptives was also very limited. Pills were used by only 20% of the couples while the use of condoms was seen to be as low as 5.9%. [8, 9] It has been seen that very few significant studies have been conducted on the social causes leading to such early pregnancies in our society. Most of the studies done in this field are of quantitative type, with limited results and outcomes Our study is a comprehensive one that tries to focus on the various socio-cultural and other factors like family pressure regarding conception of child after marriage which led to young aged and teenage pregnancies. Thus, our study aims to understand the various socio-cultural factors leading to young age and teenage pregnancy cases and explore the reasons behind them in eastern India. Materials & Methods Study Type & Design Setting-based Qualitative study Study Setting The study was conducted in the OPD and In-Patient Department of OBG (Obstetrics & Gynecology) and Pediatrics department and Labor room of Employee State Insurance Corporation (ESIC) Medical College & Hospital, Joka. Study Period The study was conducted over a period of one month from September to October 2017. Study Population The study was conducted among teenage pregnant ladies (up to 19 years old) or early-aged pregnant ladies up to 21 years old, who were attending the OPD or were admitted to the labor room or in-patient department of the OBG Department; and postnatal women below the age of 22 years who were attending OPD or in-patient ward of Pediatrics department. Those who were in labor or suffering from discomfort and pain were excluded. Sampling Technique Convenience sampling was used Study Technique One-to-one In-depth interviews (IDI) Data Collection Study participants were approached and they were explained the purpose of the study. Upon ensuring full comprehension their written informed consent was obtained. They were ensured of privacy and following which an IDI was conducted using a pre-designed pre-tested semi-structured questionnaire asking primary socio-demographics information such as age, religion, socio-economic status, educational status, age of marriage, etc., and an IDI guide focusing on the various socio-cultural factors behind the young age and teenage pregnancy. A total of 27 IDIs were conducted. One IDI lasted for 15 to 20 minutes. All IDIs were written & and audio-recorded simultaneously with permission from the participants. Data Analysis Socio-demographic data was analyzed using MS Excel 2021 and presented as numbers (%) whereas for qualitative data manual thematic analysis was performed. The IDI audio recordings were heard meticulously and then carefully transcribed into English notes and cross-checked with the written notes. These notes were read several times to gain an understanding of the text and to capture the essential meaning. Responses were then classified sequentially as code → Sub-themes→ Themes. Results The mean age of the study population is 19.5 ± 4.2 years, where 19 (70.4%) of them are 20 to 21 years old. Eight (29.7%) participants were graduates and five (18.5%) participants were illiterate. Most of them (96.2%) belong to middle and lower socio-economic strata. 12 (44.4%) of the study participants had underage marriages. (Table 1 ) Table 1 shows the characteristics of the study population (n = 27) Characteristics Number (Frequency) Age (Mean ± SD) 19.5 ± 4.2 • Less than 18 1 (3.7%) • 18 to 19 7 (25.9%) • 20 to 21 19 (70.4%) Religion • Hindu 24 (88.8%) • Muslim 3 (11.2%) Education • illiterate 5 (18.5%) • Secondary 10 (37%) • Higher Secondary 4 (14.8%) • Graduate 8 (29.7%) Socio-economic Status (As per Modified B.G. Prasad Scale 2015) • Upper Class 0 (0%) • Upper- Middle class 1 (3.7%) • Middle Class 9 (33.3%) • Lowe-Middle Class 8 (29.7%) • Lower Class 9 (33.3%) Occupation • Homemaker 25 (92.5%) • Working 2 (7.5%) Age of Marriage • Below 18 years 12 (44.4%) • Above 18 years 15 (55.6%) On qualitative exploration, we arrived at three major themes behind teenage marriage & and pregnancy a) Demographic factors, b) Socio-cultural factors, and c) Awareness of Reproductive and Child Health (Table 2 ) Table 2 describes the various themes with their sub-themes Themes Sub-themes Quotes Demographic Factors • Education : The perceived notion of the need for education in girl children is that higher studies delay their marriages but sometimes it is not viewed as necessary due to their predominant role in household work rather than intellectual proceedings , “ I think a girl should at least graduate before getting married.” “ Educational qualification is not a major criterion for a girl as it is not necessary for looking after or financially supporting her family ." • Financial Status : Poor socioeconomic status compelled family members to get their girl married early “ I wanted to continue my studies but we were very weak financially so my father forcefully fixed my marriage to reduce the burden on the family. ” • Working Status : If a girl is working their marriage is usually delayed otherwise without any financial contribution they were married quickly “ Girls are not allowed to work in our family. How would she take care of her family if she spends most of the day away from home? ” Socio-cultural factors • Age of Marriage : Awareness regarding the legal age of marriage is that most of them know about it but its effects were equivocal to containing marriage beyond 18 years “ Marriage at an early age would put an end to any academic aspiration of the girl .” • Age of Pregnancy : The ideal age to bear a child is known to some but again its effect is equivocal “ If a girl has married in her teenage then she should wait for a few years before planning a child because the mother needs to have a certain level of maturity to raise a child .” • Familial Expectations : The perceived notion of the need for a child soon after marriage makes young girls vulnerable to early pregnancy “ My mother-in-law coaxed me to take a child right after marriage .” Awareness of RCH care • Effect of Maternal and Child Health : Knowledge that Pregnancy at a young age is harmful to the health of both mother and child, somehow helps to delay the pregnancy. “ Yes, a girl in our village died during childbirth and she was only fourteen years old. So, I feel that taking a child at a very young age like within her teenage is harmful to the mother .” • Contraception : Availability & and accessibility to contraception help them delay their pregnancy but at the same time fear of adverse effects discourages them from using any contraceptives. “ We did not use any type of contraceptive though we were aware of various types of contraceptive methods .” • Planned Pregnancy : Pre-planned pregnancy helps to delay the pregnancy but if accidental they are often forced to bear it. “ We did not particularly plan on taking the child, but once I came to know that I was pregnant, my mother-in-law asked me to take the baby .” Under the theme of demography, we found that the educational& and working status of the girl as well as the financial status of their birth family plays a principal role in influencing their early marriage. Education Participant’s opinions varied widely when they were asked about the minimum desirable educational level for a girl. Most (37%) of them said till graduation, 29.6% said as long her father can afford, 14.8% said till higher secondary (12th standards), 11.2% said till 10th standards and surprisingly 7.4% participants said a girl should continue her studies as long as she wants to. R7, who had herself completed her course in B. A clearly stated, “ I think a girl should at least graduate before getting married.” However, a few participants like R4 said, “ Educational qualification is not a major criterion for a girl as it is not necessary for looking after or financially supporting her family ." Like R-25 stated, “ I wanted to pursue my studies till my graduation. ” Financial Status 66.7% of the respondents claimed that they belonged to a very poor strata of society, and thus poverty was the main cause why they couldn’t study further and were thus married early and had early pregnancy. R-10 told us, “ I wanted to continue my studies but we were very weak financially so my father forcefully fixed my marriage to reduce the burden on the family. ” Working Status The majority of the participants were homemakers and only two participants were working. We found that a few of the respondent’s family members were against letting them work outside. As R4 stated, “ Girls are not allowed to work in our family. How would she take care of her family if she spends most of the day away from home? ” As per R8 if the girl is working somewhere, marriage should be delayed. Untangling the complex spider-web of sociocultural factors we found that the cultural notion of marital age and pregnancy with unnerving familial expectations cast its large shadow behind teenage marriage and pregnancy. Age of Marriage When asked about the ideal age of marriage majority of the respondents (15 i.e. 56% of the total) stated that 18 years was the ideal age of marriage amongst which 11, i.e.41%, said that it was because of legal issues and 4 i.e.15% of them felt it was because of the social structure in our society. Very few (3, i.e.11% of the total) felt 23 + was the ideal age for marriage. Some of the respondents like R7 were strongly against early-age marriage and said, “ Marriage at an early age would put an end to any academic aspiration of the girl .” Age of Pregnancy 44.4% of the respondents said that pregnancy depended on social customs and that it is necessary to have a child after getting married Having a child is like an unsaid norm any time after marriage . Another 22.2% of participants said that the maturity of the woman was an important factor for pregnancy as it is imperative for raising the child. If a girl has married in her teenage then she should wait for a few years before planning a child because the mother needs to have a certain level of maturity to raise a child . Seven respondents said 20–22 years or above is the ideal age for pregnancy due to medical reasons and most of them said, “ A pregnancy in the teenage leads to various medical issues ” and one of them even added that,“… of my relatives had to undergo abortion .” Only R4 was found to be unaware of the various facts of young-aged pregnancy and when asked, she replied, “ I don't know if the age of the girl has anything to do with her becoming pregnant .” Familial expectations 14.8% of participants stated family pressure to conceive the child. They said that after marriage it becomes almost imperative to conceive a child and due to the pressure by their families they were forced to take the child early. R20 stated, “ My mother-in-law coaxed me to take a child right after marriage .” Knowledge of mothers on Reproductive & and child health care services came out as one of the most influential factors in determining their pregnancy. Effect on Maternal Health 16 participants (59.25%) said that early pregnancy adversely affects the woman’s health whereas nine (33.33%) participants said that there was no effect of early pregnancy. “ Yes, a girl in our village died during childbirth and she was only fourteen years old. So, I feel that taking a child at a very young age like within her teenage is harmful to the mother .”, these were exact words told by R23. However, most of them kept saying ‘ No, it doesn’t cause any harm .” The remaining two respondents could not tell about this. Effect on Child Health The respondents had a belief that conceiving a child at a higher age could lead to complications, so they preferred to conceive right after marriage. In our neighborhood, a lady in her thirties gave birth to a handicapped child…….I don’t want such things to happen to me Contraception 20 (74%) of the participants were not practicing any contraceptive methods though all of them were aware of the methods as they thought it could have complications when they would like to conceive. We did not use any type of contraceptive though we were aware of various types of contraceptive methods . The rest of them used some kind of contraceptive method sometimes. Planned Pregnancy Out of 27 as many as 22 cases were planned pregnancies. Rest five which were accidental. We did not particularly plan on taking the child, but once I came to know that I was pregnant, my mother-in-law asked me to take the baby . Discussion In our study, we found a complex inter-relationship between social, cultural, and demographic factors along with the awareness regarding reproductive and child health determines the age of marriage of a girl child as well as their age of pregnancy respectively. In our study lack of education was a predominant cause of teenage pregnancy. Similar findings were observed in the study by Dutta et. al. [10] who reported a higher proportion of primigravida teenage mothers (53.5%) had not even gone to school compared to adult primigravida (8.1%) Study by Yasmin G et. al . [11] and Gyesaw NYK et. al. [12] also reported similar findings. In India, one attains 18 years of age by the time they complete their 12th standard and their age becomes at least 21 years when they graduate. So, when a girl marries after her graduation her age of pregnancy along with her age of marriage is increased and the incidence of teenage pregnancy is reduced. India is a country where a substantial proportion of the population is still living below the poverty line (9) In our study Poverty evolved as an important factor responsible for teenage pregnancy. Poverty has a direct influence on education, awareness, health-seeking behavior, etc. A socioeconomically poor father accounts for a girl child as a burden. He tries to get her daughter married as soon as he gets a plausible chance which is echoed in the study conducted by Pati RN et. al. [13] After marriage, it has been found that sometimes there is pressure on teenage girls to conceive a child. In most cases, it was almost a norm to conceive a child right after marriage irrespective of her age. Hence, early marriage potentially increases the chances of a young age and teenage pregnancy and robs a girl’s opportunity for education or making her own choices. The findings of our study were in concordance with Paul M. et. al. [14] and Dubey R et. al. [15] The general lack of awareness regarding the importance of family planning services and the ill effects of teenage pregnancy was found to be a predominant cause of young teenage pregnancy. In all of the cases, there was awareness about the methods of contraception, but there was a general unwillingness towards using any of these methods. This is concurrent to the findings got by Boustani MM et. al . [16] People reported that they were careful and they were unwilling to use family planning methods. There is a myth that by using traditional contraceptive methods like “coitus interruptus”, ”periodic abstinence” etc. one is safe from getting pregnant but the truth is even with correct use, periodic abstinence has three times higher odds of resulting in unintended pregnancies compared with modern contraception which indirectly adds on to the burden of teenage pregnancy. [17] As seen in our study, most couples did not plan to conceive the child but decided to take the child when they got to know about the pregnancy. Similar reasons like lack of education, lack of awareness about ill effects of teenage pregnancy, lack of women empowerment, early marriage, poor knowledge of family planning services, etc. were found shown by Bhattacharyya et. al. in December 2017 on Perceptions of Accredited Social Health Activists (ASHAs) Regarding Teen Age Pregnancy was reported by ASHA workers. [18] Previous literature such as Suthapom S et. al . [19] showed that exposure to many physical, mental, and social sufferings resulting in pregnancy is more common in teenagers compared to adults according to the study conducted by but in our study, we found no such cases where the subject was confronted with such a scenario. Other studies like Dubey R et. al [15] and Sah RB et. al. [20] found that SC and STs marry early and are reluctant to use family planning services, but again in our study, we found no such cause. In this study, IDIs were conducted confidentially so that the subjects could open up about sensitive topics. Secondly, written data and voice record was maintained simultaneously so that the data could be properly analyzed. Despite this our study had a few limitations like only a few study subjects were taken from the patients coming to E.S.I.C. Medical College and Hospital otherwise a larger study population may help us to capture a holistic picture. Secondly, although a female attendant is present during IDIs the fact that researchers were male might have inhibited some of the women. Most importantly, we could not question them directly if they were facing any domestic violence if they were not interested in becoming pregnant at such an early age. Last but not least in India marriage & and pregnancy are a social phenomenon the involvement of family members most importantly husband and in-laws could give a comprehensive picture. Conclusion The primary drivers of early marriage and pregnancies include a lack of basic education, financial instability leading to school dropout, and limited awareness among parents about the importance of education and livelihood for girls. Early pregnancy is often perpetuated by the tradition of immediate childbearing after marriage. Reluctance to use contraceptives, despite awareness, and occasional family pressure to conceive also contributes to early pregnancies. Thus addressing early pregnancies requires prioritizing basic education and guidance while spreading awareness about the pivotal role of higher education in deterring young marriages. Economic struggles often drive parents from poor families to marry off their daughters early, and dismantling this social norm necessitates widespread awareness initiatives. Accidental pregnancies can be curbed by promoting increased use of contraceptives, emphasizing the importance of family planning. Parental awareness programs should discourage early marriages, even in financially strained conditions, with the support of government schemes like "Beti Bachao Beti Padhao," "SABALA," and "Kanyashree Prakalpa," aiming to empower women and discourage teenage pregnancies. Comprehensive measures, including personal counseling, women empowerment initiatives, sex education in schools, and stringent laws against early marriages, are essential for reducing this societal challenge. Declarations Informed written consent was taken from the study participants along with informed written consent from their parent/legal guardians. Authors Contribution: MS: Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor RD: Concept, Design, Definition of intellectual content, Literature search, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor SR: Definition of intellectual content, Literature search, Data analysis, Statistical analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor RoD: Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor AP: Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor Authors Statement: The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work. Corresponding Author: Dr. Shuvajit Roy Address: Majherhati, Ashrom Road, PO + PS – Nimta, Kolkata - 49 Email ID: [email protected] Acknowledgement: We would like to thank Dr. Smarak Das, Dr. Sourav Kangsha Banik, Dr. Abhishek Baidya, and Dr. Santu Biswas and others who participated in this study and helped in making it possible. Conflict of Interest: Authors declares no conflicts Funding Statement: Authors declared that this study did not receive any funding in any form. Human Ethics & Consent Statement: This study was approved by the Institutional Ethical Committee (IEC) of the ESI Medical College, Joka. All of the ethical principals were strictly followed during the study and informed written consent was obtain from every participant prior to the participation. Consent to Publish: All of the participant gave consent for the publication of this study and all of the authors were agreed to this final manuscript. 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Perceived benefits and proposed solutions for teen pregnancy: qualitative interviews with youth care workers. Am J Orthopsychiatry. 2015 Jan;85(1):80–92. Bellizzi S, Sobel HL, Obara H, Temmerman M. Underuse of modern methods of contraception: underlying causes and consequent undesired pregnancies in 35 low- and middle-income countries. Hum Reprod. 2015 Apr;30(4):973–86. Bhattacharyya A, Biswas B, Garg S, Dey A, Dasgupta PA. Perceptions of Accredited Social Health Activists Regarding Teen Age Pregnancy: A Qualitative Study in a Rural Area of West Bengal, India. Journal of Clinical and Diagnostic Research. 2017 Dec 1;11:LC09-LC14. Suthapom S, Teerapong S, Aojanepong T, Sangviroon A, Napakorn K, Bhamarapravatana K. Characteristics and health consequences of adolescent sexual assault at Police General Hospital, Thailand. J Med Assoc Thai. 2014 Dec;97(12):1221–6. Sah RB, Gaurav K, Baral DD, Jha N, Pokharel PK. Burden of Teenage Pregnancies in Hilly Area of Eastern Region of Nepal. J Nobel Med Coll. 2015 Mar 1;3(1):13–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6431804","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448931750,"identity":"3de497a9-5f49-4e9c-8db2-504135b2a54d","order_by":0,"name":"Monalisha Sahu","email":"","orcid":"","institution":"All India Institute of Hygiene and Public Health","correspondingAuthor":false,"prefix":"","firstName":"Monalisha","middleName":"","lastName":"Sahu","suffix":""},{"id":448931751,"identity":"5937e712-b311-4388-8705-7ebc1ab0f791","order_by":1,"name":"Rekha Dutt","email":"","orcid":"","institution":"ESI Medical College, Joka","correspondingAuthor":false,"prefix":"","firstName":"Rekha","middleName":"","lastName":"Dutt","suffix":""},{"id":448931752,"identity":"35d67385-b778-45f7-8838-c98759a3bd7c","order_by":2,"name":"Shuvajit Roy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACCRBRYVPPxt4AZBhYEKvlTFoCP88BkBYJIrUwthxOkJyRADcBP5Cf3WMm8bMhLc/g5vOrG34USDDwt3cn4NVicOeMmWTvDptig9s5ZTd7gA6TOHN2A34tEjnGBrxn0hg33M5Ju8ED1GIgkYtfi/yMHGPDv22HGTfcPJN28w8xWhhu5Bg+5m07nDhzBvux20TZYnAjrfCxzJk0Y36eHLbbMgYSPAT9Ij8jecPBNxU2cmzsx5/dfPPHRo6/vZeAwxCAxwBMEqscBNgfkKJ6FIyCUTAKRhAAAA5JSvGdyEtcAAAAAElFTkSuQmCC","orcid":"","institution":"All India Institute of Hygiene and Public Health","correspondingAuthor":true,"prefix":"","firstName":"Shuvajit","middleName":"","lastName":"Roy","suffix":""},{"id":448931753,"identity":"41bfcb7a-2151-44b4-a230-64c3796e1729","order_by":3,"name":"Rohan Das","email":"","orcid":"","institution":"ESI Medical College, Joka","correspondingAuthor":false,"prefix":"","firstName":"Rohan","middleName":"","lastName":"Das","suffix":""},{"id":448931755,"identity":"ff35bd36-4a3a-4373-95e9-d8b138ac9939","order_by":4,"name":"Aritra Paul","email":"","orcid":"","institution":"ESI Medical College, Joka","correspondingAuthor":false,"prefix":"","firstName":"Aritra","middleName":"","lastName":"Paul","suffix":""}],"badges":[],"createdAt":"2025-04-12 03:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6431804/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6431804/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81966385,"identity":"8161e280-1a78-4716-a720-6ce71e67fa88","added_by":"auto","created_at":"2025-05-05 11:35:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64434,"visible":true,"origin":"","legend":"\u003cp\u003eshow Circular Dendogram of various themes with their sub-themes\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6431804/v1/aea3cd4ea74fb5cacf0e1005.png"},{"id":83575271,"identity":"97d29c28-2616-4eec-88c8-9c0dd57aa0d8","added_by":"auto","created_at":"2025-05-28 19:16:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":786182,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6431804/v1/8dcf19f6-5988-4c7f-9e40-47280132cd7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Socio-Cultural Factors Behind the Early Marriage and Pregnancy Cases in Eastern India: A Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWorld Health Organisation (WHO) defines adolescent pregnancy as a pregnancy between 10\u0026ndash;19 years. \u003csup\u003e[1]\u003c/sup\u003e It can be further divided into early teenage pregnancy (Between 10\u0026ndash;15 years) and late teenage pregnancy (Between 16\u0026ndash;19 years). \u003csup\u003e[2]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarly pregnancy is the leading cause of death in girls aged 15\u0026ndash;19 years in Lower Middle-Income Countries (LMIC) where almost all of the estimated three million unsafe abortions occur. Girls under the age of 15 are less likely to be physically developed enough to sustain a healthy pregnancy or to give birth to a healthy child. Such pregnancies are associated with various complications like preterm labor, pregnancy-induced hypertension, and anemia in pregnancy. Complications are also common in young-aged pregnancies of age 16\u0026ndash;20 years. There are also several complications associated with the child born to teenage mothers. Perinatal deaths arising from low birth weight babies are significantly higher in babies born to teenage mothers than in those born to mothers aged 20\u0026ndash;29 years \u003csup\u003e[3, 4]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIf we look at the global scenario, teenage pregnancy is a worldwide problem, having its roots in almost every country. The global teenage birth rate was 47 births per 1000 women in 2015 Approximately 16\u0026nbsp;million girls aged 15\u0026ndash;19 years and 2.5\u0026nbsp;million girls under 16 years give birth in developing countries. The Alan Guttmacher Institute (AGI) conducted a study of teenage pregnancy and childbearing in 37 developed countries to unveil the factors responsible for teenage pregnancy cases and found that the lowest teenage birthrates were found in those countries with the most liberal attitudes toward sex as demonstrated through media representation of female nudity, extent of nudity on public beaches, sales of sexually explicit literature, and media advertising of condoms. The older teenage birthrate was found to be lower for countries with higher minimum ages for marriage. A subtler factor was found that although contraception was available, it was not that accessible to young women and men because of the cost. \u003csup\u003e[5, 6]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWHO conducted studies across various developing countries related to the occurrence of teenage pregnancies and found that complications during pregnancy and childbirth were the leading cause of death for 15 to 19-year-old girls globally. Approximately 16\u0026nbsp;million girls aged 15 to 19 years and 2.5\u0026nbsp;million girls under 16 years give birth each year in developing regions and every year, some 3.9\u0026nbsp;million girls aged 15 to 19 years undergo unsafe abortions. Teenage mothers were also found to face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years. \u003csup\u003e[1, 7]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndia is home to one of the world\u0026rsquo;s largest youth populations, where 358\u0026nbsp;million young people (10\u0026ndash;24 years) represent 20% of India\u0026rsquo;s population. Though the percentage of teenage pregnancies has gone down as per the data in NFHS-4 compared to that in NFHS-3, the absolute figures are colossal due to the increasing population in India. One-third of married rural girls are between 10\u0026ndash;19 years with a prevailing teenage pregnancy rate of 9.2% Numerical estimates suggest that every year around 4\u0026nbsp;million teenage girls in India get pregnant and give birth. For every 1000 girls aged 15\u0026ndash;19 years, there were 76 births from teenage pregnancies in India in 2010 as compared to 49 worldwide and 53 in less developed countries. Actually, by the age of 15 years, 26% of girls in India get married, and by the age of 18 years, this figure rises to 54%. So, the early age of marriage automatically links to the early onset of sexual activity and thereby fertility. The condition in Eastern India is even worse. The state of West Bengal ranks second among women who have started childbearing between the age of 15 and 19 years with a teenage pregnancy rate of 18% well above the national average of 7.9%. The conditions in the rural areas are worse with 1 in every 10 women between the age of 15 \u0026amp; 19 years having at least 1 child. According to NFHS-4, 41.6% of women were married in the state before the age of 18. Moreover, the use of contraceptives was also very limited. Pills were used by only 20% of the couples while the use of condoms was seen to be as low as 5.9%. \u003csup\u003e[8, 9]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIt has been seen that very few significant studies have been conducted on the social causes leading to such early pregnancies in our society. Most of the studies done in this field are of quantitative type, with limited results and outcomes Our study is a comprehensive one that tries to focus on the various socio-cultural and other factors like family pressure regarding conception of child after marriage which led to young aged and teenage pregnancies. Thus, our study aims to understand the various socio-cultural factors leading to young age and teenage pregnancy cases and explore the reasons behind them in eastern India.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy Type \u0026amp; Design\u003c/strong\u003e \u003cp\u003eSetting-based Qualitative study\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Setting\u003c/strong\u003e \u003cp\u003eThe study was conducted in the OPD and In-Patient Department of OBG (Obstetrics \u0026amp; Gynecology) and Pediatrics department and Labor room of Employee State Insurance Corporation (ESIC) Medical College \u0026amp; Hospital, Joka.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Period\u003c/strong\u003e \u003cp\u003eThe study was conducted over a period of one month from September to October 2017.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Population\u003c/strong\u003e \u003cp\u003eThe study was conducted among teenage pregnant ladies (up to 19 years old) or early-aged pregnant ladies up to 21 years old, who were attending the OPD or were admitted to the labor room or in-patient department of the OBG Department; and postnatal women below the age of 22 years who were attending OPD or in-patient ward of Pediatrics department. Those who were in labor or suffering from discomfort and pain were excluded.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSampling Technique\u003c/strong\u003e \u003cp\u003eConvenience sampling was used\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Technique\u003c/strong\u003e \u003cp\u003eOne-to-one In-depth interviews (IDI)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003cp\u003eStudy participants were approached and they were explained the purpose of the study. Upon ensuring full comprehension their written informed consent was obtained. They were ensured of privacy and following which an IDI was conducted using a pre-designed pre-tested semi-structured questionnaire asking primary socio-demographics information such as age, religion, socio-economic status, educational status, age of marriage, etc., and an IDI guide focusing on the various socio-cultural factors behind the young age and teenage pregnancy. A total of 27 IDIs were conducted. One IDI lasted for 15 to 20 minutes. All IDIs were written \u0026amp; and audio-recorded simultaneously with permission from the participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis\u003c/strong\u003e \u003cp\u003eSocio-demographic data was analyzed using MS Excel 2021 and presented as numbers (%) whereas for qualitative data manual thematic analysis was performed. The IDI audio recordings were heard meticulously and then carefully transcribed into English notes and cross-checked with the written notes. These notes were read several times to gain an understanding of the text and to capture the essential meaning. Responses were then classified sequentially as code \u0026rarr; Sub-themes\u0026rarr; Themes.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the study population is 19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 years, where 19 (70.4%) of them are 20 to 21 years old. Eight (29.7%) participants were graduates and five (18.5%) participants were illiterate. Most of them (96.2%) belong to middle and lower socio-economic strata. 12 (44.4%) of the study participants had underage marriages. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshows the characteristics of the study population (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (Frequency)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) 19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Less than 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 18 to 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; 20 to 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (70.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Hindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Muslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; illiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (37%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Higher Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-economic Status (As per Modified B.G. Prasad Scale 2015)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Upper Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Upper- Middle class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Middle Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Lowe-Middle Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Lower Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Homemaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of Marriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Below 18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Above 18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn qualitative exploration, we arrived at three major themes behind teenage marriage \u0026amp; and pregnancy a) Demographic factors, b) Socio-cultural factors, and c) Awareness of Reproductive and Child Health (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edescribes the various themes with their sub-themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDemographic Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eEducation\u003c/b\u003e: The perceived notion of the need for education in girl children is that higher studies delay their marriages but sometimes it is not viewed as necessary due to their predominant role in household work rather than intellectual proceedings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e, \u0026ldquo;\u003cem\u003eI think a girl should at least graduate before getting married.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eEducational qualification is not a major criterion for a girl as it is not necessary for looking after or financially supporting her family\u003c/em\u003e.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eFinancial Status\u003c/b\u003e: Poor socioeconomic status compelled family members to get their girl married early\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI wanted to continue my studies but we were very weak financially so my father forcefully fixed my marriage to reduce the burden on the family.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eWorking Status\u003c/b\u003e: If a girl is working their marriage is usually delayed otherwise without any financial contribution they were married quickly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eGirls are not allowed to work in our family. How would she take care of her family if she spends most of the day away from home?\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSocio-cultural factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eAge of Marriage\u003c/b\u003e: Awareness regarding the legal age of marriage is that most of them know about it but its effects were equivocal to containing marriage beyond 18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMarriage at an early age would put an end to any academic aspiration of the girl\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eAge of Pregnancy\u003c/b\u003e: The ideal age to bear a child is known to some but again its effect is equivocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIf a girl has married in her teenage then she should wait for a few years before planning a child because the mother needs to have a certain level of maturity to raise a child\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eFamilial Expectations\u003c/b\u003e: The perceived notion of the need for a child soon after marriage makes young girls vulnerable to early pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMy mother-in-law coaxed me to take a child right after marriage\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAwareness of RCH care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eEffect of Maternal and Child Health\u003c/b\u003e: Knowledge that Pregnancy at a young age is harmful to the health of both mother and child, somehow helps to delay the pregnancy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eYes, a girl in our village died during childbirth and she was only fourteen years old. So, I feel that taking a child at a very young age like within her teenage is harmful to the mother\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003eContraception\u003c/b\u003e: Availability \u0026amp; and accessibility to contraception help them delay their pregnancy but at the same time fear of adverse effects discourages them from using any contraceptives.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe did not use any type of contraceptive though we were aware of various types of contraceptive methods\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; \u003cb\u003ePlanned Pregnancy\u003c/b\u003e: Pre-planned pregnancy helps to delay the pregnancy but if accidental they are often forced to bear it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe did not particularly plan on taking the child, but once I came to know that I was pregnant, my mother-in-law asked me to take the baby\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnder the theme of demography, we found that the educational\u0026amp; and working status of the girl as well as the financial status of their birth family plays a principal role in influencing their early marriage.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEducation\u003c/strong\u003e \u003cp\u003eParticipant\u0026rsquo;s opinions varied widely when they were asked about the minimum desirable educational level for a girl. Most (37%) of them said till graduation, 29.6% said as long her father can afford, 14.8% said till higher secondary (12th standards), 11.2% said till 10th standards and surprisingly 7.4% participants said a girl should continue her studies as long as she wants to.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eR7, who had herself completed her course in B. A clearly stated, \u0026ldquo;\u003cem\u003eI think a girl should at least graduate before getting married.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHowever, a few participants like R4 said, \u0026ldquo;\u003cem\u003eEducational qualification is not a major criterion for a girl as it is not necessary for looking after or financially supporting her family\u003c/em\u003e.\"\u003c/p\u003e \u003cp\u003eLike R-25 stated, \u0026ldquo;\u003cem\u003eI wanted to pursue my studies till my graduation.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFinancial Status\u003c/strong\u003e \u003cp\u003e66.7% of the respondents claimed that they belonged to a very poor strata of society, and thus poverty was the main cause why they couldn\u0026rsquo;t study further and were thus married early and had early pregnancy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eR-10 told us, \u0026ldquo;\u003cem\u003eI wanted to continue my studies but we were very weak financially so my father forcefully fixed my marriage to reduce the burden on the family.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWorking Status\u003c/strong\u003e \u003cp\u003eThe majority of the participants were homemakers and only two participants were working. We found that a few of the respondent\u0026rsquo;s family members were against letting them work outside.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAs R4 stated, \u0026ldquo;\u003cem\u003eGirls are not allowed to work in our family. How would she take care of her family if she spends most of the day away from home?\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003cp\u003eAs per R8 if the girl is working somewhere, marriage should be delayed.\u003c/p\u003e \u003cp\u003eUntangling the complex spider-web of sociocultural factors we found that the cultural notion of marital age and pregnancy with unnerving familial expectations cast its large shadow behind teenage marriage and pregnancy.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAge of Marriage\u003c/strong\u003e \u003cp\u003eWhen asked about the ideal age of marriage majority of the respondents (15 i.e. 56% of the total) stated that 18 years was the ideal age of marriage amongst which 11, i.e.41%, said that it was because of legal issues and 4 i.e.15% of them felt it was because of the social structure in our society. Very few (3, i.e.11% of the total) felt 23\u0026thinsp;+\u0026thinsp;was the ideal age for marriage.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eSome of the respondents like R7 were strongly against early-age marriage and said, \u0026ldquo;\u003cem\u003eMarriage at an early age would put an end to any academic aspiration of the girl\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAge of Pregnancy\u003c/strong\u003e \u003cp\u003e44.4% of the respondents said that pregnancy depended on social customs and that it is necessary to have a child after getting married\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eHaving a child is like an unsaid norm any time after marriage\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eAnother 22.2% of participants said that the maturity of the woman was an important factor for pregnancy as it is imperative for raising the child.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIf a girl has married in her teenage then she should wait for a few years before planning a child because the mother needs to have a certain level of maturity to raise a child\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeven respondents said 20\u0026ndash;22 years or above is the ideal age for pregnancy due to medical reasons and most of them said, \u0026ldquo;\u003cem\u003eA pregnancy in the teenage leads to various medical issues\u003c/em\u003e\u0026rdquo; and one of them even added that,\u0026ldquo;\u0026hellip;\u003cem\u003eof my relatives had to undergo abortion\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003cp\u003eOnly R4 was found to be unaware of the various facts of young-aged pregnancy and when asked, she replied, \u0026ldquo;\u003cem\u003eI don't know if the age of the girl has anything to do with her becoming pregnant\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFamilial expectations\u003c/strong\u003e \u003cp\u003e14.8% of participants stated family pressure to conceive the child. They said that after marriage it becomes almost imperative to conceive a child and due to the pressure by their families they were forced to take the child early.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eR20 stated, \u0026ldquo;\u003cem\u003eMy mother-in-law coaxed me to take a child right after marriage\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003cp\u003eKnowledge of mothers on Reproductive \u0026amp; and child health care services came out as one of the most influential factors in determining their pregnancy.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEffect on Maternal Health\u003c/strong\u003e \u003cp\u003e16 participants (59.25%) said that early pregnancy adversely affects the woman\u0026rsquo;s health whereas nine (33.33%) participants said that there was no effect of early pregnancy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eYes, a girl in our village died during childbirth and she was only fourteen years old. So, I feel that taking a child at a very young age like within her teenage is harmful to the mother\u003c/em\u003e.\u0026rdquo;, these were exact words told by R23.\u003c/p\u003e \u003cp\u003eHowever, most of them kept saying \u0026lsquo;\u003cem\u003eNo, it doesn\u0026rsquo;t cause any harm\u003c/em\u003e.\u0026rdquo; The remaining two respondents could not tell about this.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEffect on Child Health\u003c/strong\u003e \u003cp\u003eThe respondents had a belief that conceiving a child at a higher age could lead to complications, so they preferred to conceive right after marriage.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eIn our neighborhood, a lady in her thirties gave birth to a handicapped child\u0026hellip;\u0026hellip;.I don\u0026rsquo;t want such things to happen to me\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContraception\u003c/strong\u003e \u003cp\u003e20 (74%) of the participants were not practicing any contraceptive methods though all of them were aware of the methods as they thought it could have complications when they would like to conceive.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eWe did not use any type of contraceptive though we were aware of various types of contraceptive methods\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe rest of them used some kind of contraceptive method sometimes.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePlanned Pregnancy\u003c/strong\u003e \u003cp\u003eOut of 27 as many as 22 cases were planned pregnancies. Rest five which were accidental.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eWe did not particularly plan on taking the child, but once I came to know that I was pregnant, my mother-in-law asked me to take the baby\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we found a complex inter-relationship between social, cultural, and demographic factors along with the awareness regarding reproductive and child health determines the age of marriage of a girl child as well as their age of pregnancy respectively.\u003c/p\u003e \u003cp\u003eIn our study lack of education was a predominant cause of teenage pregnancy. Similar findings were observed in the study by \u003cem\u003eDutta et. al.\u003c/em\u003e \u003csup\u003e[10]\u003c/sup\u003e who reported a higher proportion of primigravida teenage mothers (53.5%) had not even gone to school compared to adult primigravida (8.1%) Study by \u003cem\u003eYasmin G et. al\u003c/em\u003e. \u003csup\u003e[11]\u003c/sup\u003e and \u003cem\u003eGyesaw NYK et. al.\u003c/em\u003e \u003csup\u003e[12]\u003c/sup\u003e also reported similar findings. In India, one attains 18 years of age by the time they complete their 12th standard and their age becomes at least 21 years when they graduate. So, when a girl marries after her graduation her age of pregnancy along with her age of marriage is increased and the incidence of teenage pregnancy is reduced. India is a country where a substantial proportion of the population is still living below the poverty line (9) In our study Poverty evolved as an important factor responsible for teenage pregnancy. Poverty has a direct influence on education, awareness, health-seeking behavior, etc. A socioeconomically poor father accounts for a girl child as a burden. He tries to get her daughter married as soon as he gets a plausible chance which is echoed in the study conducted by \u003cem\u003ePati RN et. al.\u003c/em\u003e\u003csup\u003e[13]\u003c/sup\u003e After marriage, it has been found that sometimes there is pressure on teenage girls to conceive a child. In most cases, it was almost a norm to conceive a child right after marriage irrespective of her age. Hence, early marriage potentially increases the chances of a young age and teenage pregnancy and robs a girl\u0026rsquo;s opportunity for education or making her own choices. The findings of our study were in concordance with \u003cem\u003ePaul M. et. al.\u003c/em\u003e \u003csup\u003e[14]\u003c/sup\u003e and \u003cem\u003eDubey R et. al.\u003c/em\u003e \u003csup\u003e[15]\u003c/sup\u003e The general lack of awareness regarding the importance of family planning services and the ill effects of teenage pregnancy was found to be a predominant cause of young teenage pregnancy. In all of the cases, there was awareness about the methods of contraception, but there was a general unwillingness towards using any of these methods. This is concurrent to the findings got by \u003cem\u003eBoustani MM et. al\u003c/em\u003e. \u003csup\u003e[16]\u003c/sup\u003e People reported that they were careful and they were unwilling to use family planning methods. There is a myth that by using traditional contraceptive methods like \u0026ldquo;coitus interruptus\u0026rdquo;, \u0026rdquo;periodic abstinence\u0026rdquo; etc. one is safe from getting pregnant but the truth is even with correct use, periodic abstinence has three times higher odds of resulting in unintended pregnancies compared with modern contraception which indirectly adds on to the burden of teenage pregnancy. \u003csup\u003e[17]\u003c/sup\u003e As seen in our study, most couples did not plan to conceive the child but decided to take the child when they got to know about the pregnancy. Similar reasons like lack of education, lack of awareness about ill effects of teenage pregnancy, lack of women empowerment, early marriage, poor knowledge of family planning services, etc. were found shown by \u003cem\u003eBhattacharyya et. al.\u003c/em\u003e in December 2017 on Perceptions of Accredited Social Health Activists (ASHAs) Regarding Teen Age Pregnancy was reported by ASHA workers. \u003csup\u003e[18]\u003c/sup\u003e Previous literature such as \u003cem\u003eSuthapom S et. al\u003c/em\u003e.\u003csup\u003e[19]\u003c/sup\u003e showed that exposure to many physical, mental, and social sufferings resulting in pregnancy is more common in teenagers compared to adults according to the study conducted by but in our study, we found no such cases where the subject was confronted with such a scenario. Other studies like \u003cem\u003eDubey R et. al\u003c/em\u003e \u003csup\u003e[15]\u003c/sup\u003e and \u003cem\u003eSah RB et. al.\u003c/em\u003e \u003csup\u003e[20]\u003c/sup\u003e found that SC and STs marry early and are reluctant to use family planning services, but again in our study, we found no such cause.\u003c/p\u003e \u003cp\u003eIn this study, IDIs were conducted confidentially so that the subjects could open up about sensitive topics. Secondly, written data and voice record was maintained simultaneously so that the data could be properly analyzed.\u003c/p\u003e \u003cp\u003eDespite this our study had a few limitations like only a few study subjects were taken from the patients coming to E.S.I.C. Medical College and Hospital otherwise a larger study population may help us to capture a holistic picture. Secondly, although a female attendant is present during IDIs the fact that researchers were male might have inhibited some of the women. Most importantly, we could not question them directly if they were facing any domestic violence if they were not interested in becoming pregnant at such an early age. Last but not least in India marriage \u0026amp; and pregnancy are a social phenomenon the involvement of family members most importantly husband and in-laws could give a comprehensive picture.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe primary drivers of early marriage and pregnancies include a lack of basic education, financial instability leading to school dropout, and limited awareness among parents about the importance of education and livelihood for girls. Early pregnancy is often perpetuated by the tradition of immediate childbearing after marriage. Reluctance to use contraceptives, despite awareness, and occasional family pressure to conceive also contributes to early pregnancies.\u003c/p\u003e \u003cp\u003eThus addressing early pregnancies requires prioritizing basic education and guidance while spreading awareness about the pivotal role of higher education in deterring young marriages. Economic struggles often drive parents from poor families to marry off their daughters early, and dismantling this social norm necessitates widespread awareness initiatives. Accidental pregnancies can be curbed by promoting increased use of contraceptives, emphasizing the importance of family planning. Parental awareness programs should discourage early marriages, even in financially strained conditions, with the support of government schemes like \"Beti Bachao Beti Padhao,\" \"SABALA,\" and \"Kanyashree Prakalpa,\" aiming to empower women and discourage teenage pregnancies. Comprehensive measures, including personal counseling, women empowerment initiatives, sex education in schools, and stringent laws against early marriages, are essential for reducing this societal challenge.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eInformed written consent was taken from the study participants along with informed written consent from their parent/legal guardians.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMS:\u0026nbsp;Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor\u003c/p\u003e\n\u003cp\u003eRD: Concept, Design, Definition of intellectual content, Literature search, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor\u003c/p\u003e\n\u003cp\u003eSR: Definition of intellectual content, Literature search, Data analysis, Statistical analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor\u003c/p\u003e\n\u003cp\u003eRoD: Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;AP: Concept, Design, Definition of intellectual content, Literature search, Data acquisition, Data analysis, Manuscript preparation, Manuscript edit, Manuscript review, Guarantor\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors Statement:\u003c/strong\u003e The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author:\u003c/strong\u003e Dr. Shuvajit Roy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddress:\u003c/strong\u003e Majherhati, Ashrom Road, PO + PS \u0026ndash; Nimta, Kolkata - 49\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmail ID:\u003c/strong\u003e [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe would like to thank Dr. Smarak Das, Dr. Sourav Kangsha Banik, Dr. Abhishek Baidya, and Dr. Santu Biswas and others who participated in this study and helped in making it possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eAuthors declares no conflicts\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eAuthors declared that this study did not receive any funding in any form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics \u0026amp; Consent Statement:\u003c/strong\u003e This study was approved by the Institutional Ethical Committee (IEC) of the ESI Medical College, Joka. All of the ethical principals were strictly followed during the study and informed written consent was obtain from every participant prior to the participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u003c/strong\u003e All of the participant gave consent for the publication of this study and all of the authors were agreed to this final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e All of the participants were participated voluntarily, after giving informed written consent to do.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e It is not applicable since this is not a clinical trial\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organisation. Adolescent pregnancy [Internet]. [cited 2023 Nov 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy\u003c/li\u003e\n\u003cli\u003ePark K. Park\u0026rsquo;s Textbook of Preventive and Social Medicine. 26th ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 2021. 683\u0026ndash;85 p. (Preventive Medicine in Obstetrics, Pediateics and Geriatrics). \u003c/li\u003e\n\u003cli\u003eChung HW, Kim EM, Lee JE. Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review. J Adolesc. 2018 Dec;69:180\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eUNICEF. The State of the World\u0026rsquo;s Children 2009 | UNICEF [Internet]. 2009 [cited 2023 Nov 12]. Available from: https://www.unicef.org/reports/state-worlds-children-2009\u003c/li\u003e\n\u003cli\u003eSully EA, Biddlecom A, Darroch JE, Riley T, Ashford LS, Lince-Deroche N, et al. Adding It Up: Investing in Sexual and Reproductive Health 2019. 2020 Jul 28 [cited 2023 Nov 12]; Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019\u003c/li\u003e\n\u003cli\u003eDarroch JE, Woog V, Bankole A, Ashford LS. Adding it up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents. 2016 May 5 [cited 2023 Nov 12]; Available from: https://www.guttmacher.org/report/adding-it-meeting-contraceptive-needs-of-adolescents\u003c/li\u003e\n\u003cli\u003eJoshi P, Dutta DK. Outcome of Teenage Pregnancy in Rural India with Particular Reference to Obstetrical Risk Factors and Perinatal Outcome. Journal of South Asian Federation of Obstetrics and Gynaecology. 2013 Dec;5(3):102\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eInternational Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005\u0026ndash;06: India: Volume I. [Internet]. Mumbai, India: International Institute for Population Sciences (IIPS); 2007 Sep [cited 2023 Dec 11]. Available from: https://dhsprogram.com/pubs/pdf/frind3/frind3-vol1andvol2.pdf\u003c/li\u003e\n\u003cli\u003eInternational Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019-21: India: Volume I. [Internet]. Mumbai: International Institute for Population Sciences (IIPS); 2022 Mar [cited 2022 Aug 11]. Available from: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf\u003c/li\u003e\n\u003cli\u003eDutta I, Jha N, Dutta DK. Teenage pregnancy \u0026ndash; A Socio-demographic study at a Rural Medical College Hospital in Southern India. Asian Journal of Medical Sciences. 2014 May 15;5(4):29\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eYasmin G, Kumar A, Parihar B. A Study of Socio-demographic Factors of Teenage Pregnancy at a Tertiary Care Centre. Journal of Evolution of Medical and Dental Sciences. 2014 Jan 1;3(4):1020\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eGyesaw NYK, Ankomah A. Experiences of pregnancy and motherhood among teenage mothers in a suburb of Accra, Ghana: a qualitative study. Int J Womens Health. 2013;5:773\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003ePati RN, Tekie S. Biocultural Dynamics of Teenage Pregnancies in Ethiopia: Medico Anthropological Appraisal. International Journal of Social Sciences and Management. 2016 Jan 21;3(1):68\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003ePaul M, Ess\u0026eacute;n B, Sariola S, Iyengar S, Soni S, Allvin K. Negotiating Collective and Individual Agency. Qual Health Res. 2017;3(27):311\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eDubey R, Dixit S. A Cross Sectional Study to Assess Socio Economic Complications of Adolescent Pregnancy in a Metropolitan City of Central India. National journal of community medicine [Internet]. 2014 [cited 2023 Nov 12]; Available from: https://www.semanticscholar.org/paper/A-CROSS-SECTIONAL-STUDY-TO-ASSESS-SOCIO-ECONOMIC-OF-Dubey-Dixit/0191bb76d9df0146132429f6a5d551da4b30c379\u003c/li\u003e\n\u003cli\u003eBoustani MM, Frazier SL, Hartley C, Meinzer M, Hedemann E. Perceived benefits and proposed solutions for teen pregnancy: qualitative interviews with youth care workers. Am J Orthopsychiatry. 2015 Jan;85(1):80\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eBellizzi S, Sobel HL, Obara H, Temmerman M. Underuse of modern methods of contraception: underlying causes and consequent undesired pregnancies in 35 low- and middle-income countries. Hum Reprod. 2015 Apr;30(4):973\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eBhattacharyya A, Biswas B, Garg S, Dey A, Dasgupta PA. Perceptions of Accredited Social Health Activists Regarding Teen Age Pregnancy: A Qualitative Study in a Rural Area of West Bengal, India. Journal of Clinical and Diagnostic Research. 2017 Dec 1;11:LC09-LC14. \u003c/li\u003e\n\u003cli\u003eSuthapom S, Teerapong S, Aojanepong T, Sangviroon A, Napakorn K, Bhamarapravatana K. Characteristics and health consequences of adolescent sexual assault at Police General Hospital, Thailand. J Med Assoc Thai. 2014 Dec;97(12):1221\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eSah RB, Gaurav K, Baral DD, Jha N, Pokharel PK. Burden of Teenage Pregnancies in Hilly Area of Eastern Region of Nepal. J Nobel Med Coll. 2015 Mar 1;3(1):13\u0026ndash;9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescent health, Early marriage, Family planning, Lack of education, Teenage pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-6431804/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6431804/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eAdolescent pregnancy, defined by the World Health Organization (WHO) as pregnancies between 10\u0026ndash;19 years, poses significant health risks, particularly in Lower Middle-Income Countries (LMIC). Early pregnancies are associated with various complications, including preterm labor and perinatal deaths. In India, despite a decline in the percentage of teenage pregnancies, absolute figures remain high, impacting a substantial portion of the population. Our study aims to explore the sociocultural factors among others which led to teenage pregnancies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative study, conducted in the OBG and Pediatrics departments of ESIC Medical College \u0026amp; Hospital, Joka, aimed to explore socio-cultural factors contributing to early and teenage pregnancies. One-to-one in-depth interviews were conducted with 27 teenage and early-aged pregnant women, focusing on demographic, socio-cultural, and awareness factors. Thematic analysis was employed for qualitative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study identified three major themes: Demographic factors, Socio-cultural factors, and Awareness of Reproductive \u0026amp; Child Health. Lack of education, financial constraints, and familial expectations emerged as primary drivers. Family pressure and cultural norms promoted early conception after marriage. Despite awareness, contraception use was low, and pregnancies were often unplanned.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAddressing early pregnancies requires a multifaceted approach involving basic education, awareness campaigns, and economic empowerment. Prioritizing higher education for girls, dispelling cultural norms, and promoting contraceptive use are essential. Government schemes supporting women's empowerment and discouraging teenage pregnancies play a crucial role. Comprehensive measures, including sex education, and stringent laws against early marriages, are vital for reducing the societal burden of early and teenage pregnancies.\u003c/p\u003e","manuscriptTitle":"Exploring the Socio-Cultural Factors Behind the Early Marriage and Pregnancy Cases in Eastern India: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 11:35:48","doi":"10.21203/rs.3.rs-6431804/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2a7039a-cb3a-496b-99d6-9e39d03a07e2","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-28T19:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 11:35:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6431804","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6431804","identity":"rs-6431804","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}