Having children early and in rapid succession are major factors fueling high infant mortality rates in the South Asian countries of Bangladesh, India, Nepal and Pakistan where one in 14 births to young mothers ends with the death of the child within the first year, say researchers at the University of California, San Diego School of Medicine.

Writing in the current online issue of the International Journal of Gynecology & Obstetrics, Anita Raj, PhD, professor of medicine and director of the Center on Gender Equity and Health at UC San Diego, and colleagues said younger maternal age (under 18 years old) and short intervals between pregnancies (under 24 months) accounted for roughly one-quarter of the infant mortality rate among young mothers in India and Pakistan, a percentage that represents almost 200,000 infant deaths in 2012 for those two nations alone.

In Bangladesh, only the short inter-pregnancy interval was linked to infant mortality while in Nepal, only young motherhood was associated with infant death.

Infant mortality is a significant public health issue in South Asia. According to United Nations data, the infant mortality rate worldwide is 49.4 deaths per 1,000 live births. In Pakistan, it is 70.90; India, 52.91; Bangladesh, 48.98 and Nepal, 38.71. By comparison, the infant mortality rate in the United States is 6.81 and just 1.92 in Singapore, lowest in the world.

The new infant mortality findings are based upon analyses of national demographic and health surveys taken in the four countries. Raj noted the comparisons may be somewhat skewed by imperfect comparisons.

"The data in India and Pakistan were collected four to five years prior to the data in Bangladesh and Nepal," she said, "and therefore represent different cross-sections of time. In addition, both India and Pakistan have higher burdens of infant mortality - in absolute and relative terms - than Bangladesh or Nepal."

But Raj said the findings still underscore concerns about the social consequences of child marriage and young motherhood. In a study published last year, she and colleagues reported that more than 10 million girls under the age of 19 marry each year worldwide, usually under the force of local tradition and social custom. Almost half of these compulsory marriages occur in South Asia.

Childhood marriage, which mostly involves girls, is widely condemned as a violation of individual human rights. Numerous studies have found that child brides are more likely to die young, suffer from serious health problems, live in poverty and remain illiterate.

"There is inadequate recognition that issues like early marriage of girls are primary drivers of problems like infant mortality in the region," said Raj. Bangladesh and Nepal have made measurable improvements in some areas, she said, such as greater access to education for girls and to healthcare, but other issues remain persistently problematic, such as contraception use.

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Co-authors of the study are Lotus McDougal, Division of Global Public Health, UCSD and Melanie L. Rusch, Population Health and Epidemiology, Planning and Community Engagement, Vancouver Island Health, Canada.

Funding support for this study came, in part, from the David and Lucile Packard Foundation and National Institutes of Health (grant R01HD061115).