Child marriage and adverse reproductive outcomes among young Afghan women: implication for policy and practice in Afghanistan

Background Child marriage is defined as marriage before the age of 18 years and it has been linked to several adverse health and social outcomes. This study aimed to explore the prevalence and determinants of child marriage and its association with adverse reproductive outcomes among a nationally representative sample of young Afghan women. Methods This was a secondary analysis of the 2015 Afghanistan Demographic and Health Survey (DHS) data. Based on the UN recommendation on child marriage study, only women aged 20-24 years old were included. Descriptive statistics and binary logistic regression were employed to determine the distribution of respondents’ characteristics and prevalence and determinants of child marriage. Multivariate logistic models examined the association between child marriage and adverse reproductive outcomes accounting for the sociodemographic factors. Results An estimated 52% of the Afghan women aged 20-24 married at ages less than 18 years. Poor illiterate women were more likely to marry at early ages (<18). There was a significant negative relationship between child marriage and history of rapid repeat childbirth, delivery by skilled personnel, and institutional delivery. In both adjusted and unadjusted models, women married at age ≤14 were more likely to experience terminated or unintended pregnancy (AOR = 1.89, 95% CI: 1.31-2.75 and AOR = 2.20. 95% CI: 1.24-3.91, respectively), inadequate ANC (AOR = 1.71, 95% CI: 1.01-2.90), unmet need for family planning (AOR = 1.44, 95% CI: 1.05-1.98), fistula (AOR = 2.36, 95% CI: 1.22-4.57); While, for those married at age 15-17 years, only terminated or unintended pregnancy remained significant. Conclusion The younger age of marriage was associated with a higher prevalence of adverse reproductive outcomes among Afghan women. Moreover, poverty and illiteracy proved to be important predictors of child marriage in Afghan women. Strict international law enforcement and advocacy are a need in the current situation of Afghanistan to increase young women’s education, promote their civil rights, and improve their autonomy and role in decision-making concerning their health.