Health, psychology, economic resilience and wellbeing: Long-term effects on family welfare of early marriage

Introduction

Early married is a global problem.^1–3 Globally, early marriage rates reach 12 million per 4 years.⁴ In Indonesia, data shows that over the last decade, the number of early marriages in Indonesia has fallen by 3.5%. However, this reduction will require systemic and integrated efforts to reach the target of 8.74% in 2024 and 6.94 percent in 2030.⁵ East Java is one of the regions with the highest early marriage rate. Early marriages in Ponorogo increased by 100% in 2020.⁶ Based on the area of residence, the rural area (16.87%) has a higher early marriage rate than urban areas (7.15%).⁷ The occurrence of early marriage in rural areas is a common practice. This is the the result of poor parenting environments, lack of maternal and paternal education, and lack of communication between parents and adolescents regarding reproductive and social issues.⁸ Rural communities assume that remarriage will not significantly affect their lives. Research has shown that the effect of early marriage includes maternal health, early school dropout, infantfeeding, early pregnancy, and economic well-being.^9–11

Research is needed to determine the long-term effect of simultaneous early marriage on aspects of health, psychology, wellbeing and economic resilience. It can be used by advocacy groups as policy material to develop programs to reduce the impact of early marriage.

Methods

Results

This research was conducted in a rural area in Ponorogo Regency, namely Ngrayun, Sawoo and Pulung sub-districts, with a total of 104 respondents of which 63.5% of respondents married in their teens (<19 years) and 37.5% of adults (≥19 years). The following is the frequency distribution of the respondents' characteristics (Table 1).

In this study, the table above shows that the wives when getting married were still adolescent, the husbands when getting married had been an adult, the wives' and husbands' last education was junior high school, the wives was unemployed after the marriage, the mothers' health was poor, the children's health was good, the psychological state of the wives and husbands was good, the level of family welfare of the early-married couple was in the prosperous category, and family economic resilience was in the non-survival category. The constituent variables are listed in Table 2.

The results of polychoric PCA analysis for each composite variable are shown in Table 3. In the Maternal Health variable, 35% of the variation can be explained by the variables Mother's age during childbirth, Antenatal care Checker, Place of antenatal care, Danger signs of pregnancy, Iron Tablet consumption, Birth attendant, Place of delivery and Type of delivery. In the infant health variable, 44% of the variation can be explained by the variables of low birth weight, breast milk, immunization, vitamin A, and worming. The wife's psychological variables 56% can be explained by the variables Satisfaction, Disappointment, Cries, Anxiety, Associations, Decision, Effort, Sleep quality, Feelings of offense, Concentration, Fatigue, and Interest in sex. On the husband's psychological variables, 56% can be explained by the variables Satisfaction, Disappointment, Anxiety, Associations, Decision, Effort, Sleep quality, Feelings of offense, Concentration, Fatigue, and Interest in sex. The 30% wellbeing variable can be explained by place of residence, clean water sources, toilet facilities, vehicle ownership, agricultural land, livestock, livestock ownership and bank account ownership. The 40% economic resilience variable, can be explained by the variables of financial manager, business ownership, ownership of health insurance and recipients of social programs.

Based on Figure 1, it can be seen that there is a comparison of variables in the early marriage group with adult marriage. The variables include maternal health, infant health, wife's psychology, husband's psychology, welfare and economic resilience. The group of individuals who had early marriages (adolescents) had worse maternal health conditions, poorer infant health, poorer welfare, poorer economic resilience compared to the adult marriage group. This can be seen from the higher percentage of adolescents from each variable. However, the psychological condition variable of the wife and husband is better at the age of adolescence.

Figure 1. Comparison of the effect of adolescent and adult marriages on maternal health, infant health, wife’s psychology, husband’s psychology, wellbeing and economic resilience.

Discussion

Early marriage has a tremendous impact, not only on couples but also on children born to teenage mothers, and causes changes in the welfare and economic resilience of the family.

Married couples and their families often want to get pregnant soon after marriage, without acknowledging the dangers for young women who get pregnant under the age of 19 years. Adolescent pregnancy can also make the mother's health worse than adult pregnancy. Adolescent pregnancies come with a 2-4 times higher likelihood of causing death than adult pregnancies,¹² can cause incidences of anemia and chronic energy deficiency caused by the growth period of adolescents who still require sufficient energy and high use of iron in the body.^13,14 The impact of anemia causes bleeding and the condition of fetal development is hampered. Adolescents aged 15-19 years are 1.234 times more likely to experience pregnancy complications than women aged 20-24 years, such as hypertension and gestational diabetes, anemia.^15,16 Adolescent pregnancy will also increase fertility rates. Women who had a delivery were 8.00 times more likely to have 3 children (lifelong fertility), compared with adult pregnancy (OR = 8.00; 95% CI: 7.52, 8, 46).^17,18 Adolescents married before the legal age were 1.27 times as likely to have a terminated pregnancy, compared to women married at 18 years (OR = 1.27; 95%CI: 1.20, 1.34).¹⁷

Adolescent pregnancy can cause the health of babies born to be worse than pregnancy in adulthood. Adolescent pregnancies are at risk of causing babies to be born with low birth weight (LBW), premature, and have abnormalities in the respiratory tract.¹² Infants born to young mothers with repeated pregnancies had at least 0.15 (95% CI - 0.23, 0.08) lower LAZ and had a higher chance of stunting at least 40% (95% CI 1.19, 1,67) at the age of 12 and 24 months.¹⁹ Likewise, another study stated that the stunting prevalence was also higher in children under five years from adolescent pregnant women (44.4%) compared to mothers who were of sufficient age (35.6%). Adolescent pregnancy is associated with the incidence of stunting. A married teenage woman is 1.2 times at risk, and a pregnant woman who is less than 20 years old is 1.3 times at risk of having a stunting toddler.²⁰

Adolescent pregnancy also contributes to the wife's poor economic, emotional, social and health conditions, which are exacerbated by inadequate nutritional intake.¹⁶ In rural areas, the risk of age-related pregnancy is often compounded by malnutrition, poor socioeconomic conditions, low literacy rates and limited access to maternal health care.¹² In this study, the psychological sub-variable of the wife in early marriage is better than in adult marriage. This contrasts with previous research which states the impact of early marriage on adolescents from a psychological aspect is anxiety and stress.²¹ Anxiety experienced by an adolescent wife who makes early marriages will feel afraid and anxious in dealing with problems that arise in the family.²² Most women who marry early do not have the power to make decisions. We found that the psychological condition of husbands in early marriage couples is better than that of adult marriages. This study's results differ from previous studies, which state that adolescents must have a higher commitment, so psychological conditions may be worse than in adult marriages.²³

The welfare of the families of early married couples is worse than that of families of adult married couples. Low economic income had no effect on marital satisfaction.²⁴ This shows that physical well-being is not always the main benchmark in a family. Efforts to strengthen the welfare of families with low economic income are expected to improve the ability to adjust to new roles with partners, with extended families, manage family stress and minimize vulnerable conditions.²⁵ The risk of unemployment and poverty increases in couples who marry early²¹ and they often live in poverty and under pressure.²⁶ In accordance with the results of previous studies that found women who marry young have a higher percentage of living in poverty when they are older, the results of this study imply that decisions women make early in life can have long-term consequences.²⁷

Conclusion

The long-term impact of early marriage compared to adult marriage is on the poorer aspects of maternal health, poorer baby health, poorer wellbeing and worse economic resilience There needs to be special monitoring of cases of early marriage, so that it will suppress the negative impact.