Knowledge on Health Consequences of Early and Late Marriage among Students at Selected College, East Sikkim

Introduction

Marriage is defined as “the blending together of two lives, two personalities of the opposite sex for as long as two shall live in this world. It is the building law of God and protects the mankind. Health consequences are defined as a health which has the opposite effect causing or contributing to ill health.¹Early marriage by UNICEF is defined by “a formal marriage or union before 18 years of age”. The effect of early marriage may lead to the occurrences of physiological and psychological stress, denial of freedom and personal development, denial of education.²Late pregnancy is defined as pregnancy above 35 years of age. Late marriage naturally results late pregnancy. It results in complications which affectthe health of mother as well as babies; such as difficulty in conceiving, pre-eclampsia, risk for miscarriages, the chances of fetus having genetic defect and still births. So women should be aware about ideal time of marriage and pregnancy.³

A study at Ludhania shows the effectiveness of health education in improving knowledge of urban mothers about relationship between early and late marriage and pregnancy with increased risk. The researcher concluded that further study needed to be done among large sample.⁴ A hospital baased cohort study was undertaken on rural hospital in west Bengal by Bharati Banerjee, G.K Pandey, Debashis Dutt, Bhaswati Sengupta, Maitraeyi Mandal, Sila Deb to assess the magnitude of the problem ofteenage pregnancy and its complication among teenage mothers between 15-19 years old and control cohort of mother between 20-24 years old. Teenage pregnancy compromised 24.17% of total pregnancies. Study shows that anemia, preterm delivery and low birth weight were more prevalence among teenager than among women who were 20-24 years old.⁵

The practice of marrying girls at young age is quite common in many part of the world. In developing countries like India, adolescent motherhood is associated with early marriage as a consequence of early initiation of sexual activity. Early marriage often takes place even before the girl has attained puberty.Pregnancy before 18 years leads to many health risks. Teenagers have high rate of mortality in pregnancy or child birth than women aged 20-24 years.Globally, it shows that about 50% of miscarriage occurs for mothers who are over 45 years and rate of caesareans are about 40% high in older mothers compared to younger. Late marriage and low infertility rates tend to be closely linked. World report shows in Myanmar and South Korea having lowest rate of fertility in world because of delayed marriage.⁶

The prevalence rate estimated that, about 67 million women around the world had been married before the age of 18 in 2010.⁷International agreements affirm that students have a right to know about information regarding reproductive health, accurate timing of marriage, and child bearing. Students receive most of this information from peers which often leads to misinformation. So they need structured formal and informal learning packages for better future.⁷From the reviews and present statistics, it has been found that early and late marriage leads to many complications. Therefore the investigators felt that there is a need to conduct a study in order to develop appropriate knowledge on health consequences of early and late marriage among the college students with a view to develop an informational leaflet.

Methods

A descriptive survey study design was conducted among 100 management students at ICFAI College, Gangtok; East Sikkim.The investigators adopted a convenient sampling technique. After thorough review of literatures and discussion with experts, toolwhich consists of Section 1: Demographic variables and Section 1A: Structured knowledge questionnaires on health consequences of early marriage and Section 1B: Structured knowledge questionnaires on health consequences of late marriagewere developed and sent for validation to experts. Pretesting and reliability of the tool was done and found to be reliable i.e; r = 0.8. The data was collected after taking prior administrative permission and consent from the participants. A pilot study was conducted in order to determine the feasibility and practicability of the final study and it was found to be feasible. The data collection for the final study was done during the December “13-January”14. The analysis of the data was done according to the objectives of the study using the descriptive and inferential statistics.

Findings

The study findings in table 1, shows that majority 81% belonged to age group of 19-23 years, 46% were male and 54% were female, majority 93% of student were unmarried, majority 48%of the participant were Buddhist, majority 73% were 3^rd year management students, majority 49% of participants belonged to joint family, majority 47% of participants parents had skilled occupation, 34% of participant's parents had monthly income between Rs.15001-25000, 84% of the participant did not have family history of early marriage, 90% of participants did not have family history of late marriage. Majority 50% of participants had knowledge related to early marriage through family members and relatives, 40% had knowledge related to late marriage through family members and relatives.

Table 1 Frequency and Percentage distribution of demographic characteristics (Ν=100)

SL	Demographic variables	Frequency	Percentage (%)
1	Age (in years)
	19-23	81	81
	24-28	14	14
	29-33	5	5
2	Gender
	Female	46	54
	Male	46	54
3	Religion
	Buddhist	48	48
	Christian	11	11
	Hindu	39	39
	Muslim	2	2
4	Marital status
	Married	7	93
	Unmarried	7	93
5	Education
	2ndYear BBA	27	73
	3rdYear BBA	27	73
6	Type of family
	Extended	26	26
	Joint	49	49
	Nuclear	25	25
7	Parent's occupation
	Governmentjob	33	33
	Private job	10	10
	Skilled	47	47
	Professional	10	10
8	Monthly income of family (in Rs)
	≤5001	9	9
	5001-15000	26	26
	15001-25000	34	34
	◊ 25001	31	31
9	Family history of early m arriage
	No	84	84
	Yes	16	16
10	Source of information related to early marriage and its
	health consequences (mostly heard)
	Family members and relative	50	50
	Friends	11	11
	Health workers	12	12
	Newspaper	07	07
	Television	03	03
	Radio	17	17
11	Family history of late marriage
	No	90	90
	Yes	10	10
12	Source of information related to early marriage and its health consequences (mostly heard)
	Family members and relative	40	40
	Friends	23	23
	Health workers	17	17
	Newspaper	13	13
	Televesion	01	01
	Radio	06	06

Figure 1 shows that majority 84% of students has moderate knowledge, 12% has good knowledge and 4% has poor knowledge on health consequences of early marriage.

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Figure 1

Cone diagram of knowledge score on health consequences of early marriage

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Figure 2 shows that majority 49% of students has moderate knowledge, 47% has good knowledge and 4% has poor knowledge on health consequences of late marriage.

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Figure 2

Pie diagram of knowledge score on health consequences of late marriage

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The data in the table 2 shows that there is no association between knowledge on health consequences of early marriage with selected demographic variables.

Table 2 Association between knowledge on health consequences of early marriage with the selected demographic variables.(N=100)

Demographic Variables	Knowledge score		Chisquare	df	Table value	Remarks
	<Median	◊Median
Age (in years)
19-23	36	45	0.51	2	5.99	NS
24-28	2	2
29-33	2	3
Gender
Male	19	27	0.01	1	3.89	NS
Female	21	33
Religion
Buddhist	20	25	0.07	3	4.82	NS
Christian	5	5
Hinduism	14	20
Muslim	1	10
Marital status
Married	4	3	0.05	1	3.84	NS
Unmarried	36	57
Education
2nd Year ΒΒA	11	16	0.006	1	3.84	NS
3rd Year ΒΒA	29	44
Type of family
Extended	11	15	0.03	2	5.99	NS
Joint	20	29
Nuclear	9	16
Parent's occupation
Government job 12	21	0.09	3	7.82	NS
Private job	3	7
Skilled	20	27
Professional	5	5
Monthly income of family (in Rs)
≤5000	2	7	0.51	3	7.82	NS
5001- 15000 9	17
15001-25000 18	16
◊ 25001	11	20
Family history of early marriage
No	29	55	0.86	1	3.84	NS
Yes	11	05
Source of information related to early marriage and its health consequences (mostly heard)
Family members/Friends
	25	36	0.02	2	5.99	NS
Health workers 4	8
Media	11	16

p<0.05 (level of significant)

The data in the table 3 shows that there is no association between knowledge on health consequences of early marriage with selected demographic variables.

Table 3 Association between knowledge on health consequences of late marriage with the selected demographic variables.(Ν=100)

Demographic Variables	Knowledge score		Chisquare	df	Table value	Remarks
	<Median	◊Median
Age (in years)
19-23	37	44	0.06	2	5.99	NS
24-28	8	6
29-33	2	3
Gender
Male	21	25	0.015	1	3.84	NS
Female	26	28
Religion
Buddhist	22	26	0.015	3	7.82	NS
Christian	5	6
Hinduism	19	20
Muslim	1	1
Marital status
Married	3	7	0.003	1	3.84	NS
Unmarried	44	49
Education
2nd Year ΒΒA	12	15	0.019	1	3.84	NS
3rd Year ΒΒA	35	38
Type of family
Extended	13	13	0.24	2	5.99	NS
Joint	25	24
Nuclear	9	16
Parent's occupation
Government jobl4		19	0.75	3	7.82	NS
Private job	5	5
Skilled	20	27
Professional	5	5
Monthly income of family (in Rs)
‹5000	3	6	0.17	3	7.82	NS
5001- 15000 13	13
15001-25000 3	6
0 25001	13	18
Family history of late marriage
No	39	51	0.84	1	3.84	NS
Yes	08	02
Source of information related to late marriage and its health consequencesfmostly heard)
Family members/Friends
	35	28	1.16	2	5.99	NS
Health workers 8	9
Media	416

p<0.05 (level of significant)

Discussion

The present study shows that majority 47% has poor knowledge on health consequences of late marriage, which was supported by a study conducted on delayed child bearing and its complication in United Kingdom where majority 40% has poor knowledge.

Conclusion

The present study reveals, majority 84% and 49% of the college students have moderate knowledge on health consequences of early and late marriage respectively. Adolescents and college students are the future of the society and it is important for them to be aware about the health consequences of early and late marriage. So, as health care professional we play an important role in disseminating information on health consequences of early and late marriage so as to improve the health and decrease the morbidity and mortality rate.