We found that in-laws’ pressure to have a child immediately after marriage is a common experience in our sample of married adolescent girls with almost one in five girls reporting it. This notion of in-laws’ pressure has been found in other studies among women that show mother-in-laws’ influence on family planning and fertility decisions (7, 28, 29). Besides, girls feel pressure to prove their fertility early in marriage in this context, since they also reported a fear of being called barren due to lack of a child, although with a caveat that it may be associated with time since marriage. This fear may stem from a context where girls may be stigmatized for not having a child or are worried about not being able to secure their position in the household early by having a child, and experience stress from fertility pressures despite their young age. Thus, in-laws’ pressure may need to be considered when examining girls’ family planning and fertility behaviors, and not just restricted to husbands' influences. Previous assessment of attitudes has found that women may be blamed for not having children soon after marriage, which may be considered a sign of infertility or marital happiness (30).
In-laws’ pressure to have a child immediately after marriage was associated with couple communication about number of children before first pregnancy, after adjusting for socio-demographics and time since marriage. Although, the outcome of higher communication between spouses may seem to be positive or programmatically desirable for family planning interventions, we cannot confirm that it is desired in this population. Report of communication between girls and their husbands may suggest increased
female reproductive agency, however, we do not know the nature of their reported communication and whether it is by choice. Spousal communication needs further scrutiny since couples’ decision-making concordance and quality of relationship have a direct bearing on contraceptive use (20, 31), especially for married adolescent girls with limited agency in a gender unfriendly context. These reports of communication could have been due to in-laws’ pressure, conflicts with husbands, or pressure from husbands. We also do not know about recent or ongoing pressure from in-laws’, since we only measured pressure experienced immediately after marriage.
There was an association of in-laws’ pressure with lower parity, after adjusting for socio-demographics and time since marriage. Our counter-intuitive findings may be a back effect or reverse causation of girls experiencing in-laws’ pressure in response to an absence of or lower parity which cannot be established temporally from retrospectively collected cross-sectional information. Longitudinal study could explore whether this finding is indicative of girls experiencing pressure from in-laws’ due to delay in having children. Also, the same association of in-laws’ pressure with parity did not sustain in a sensitivity analysis among girls who reported at least one birth. This suggests that in-laws’ pressure is experienced by girls with 0 or low births. Lower parity in adolescence may be attributed to a lower likelihood of pregnancy due to irregular periods especially among girls with compromised nutritional status in LMICs (32, 33)
In-laws’ pressure to have a child immediately after marriage was not associated with ever use of contraception and time until birth. We did not see an association with contraception use, perhaps due to a low prevalence of contraception use in this young sample of adolescent girls who may still be far from meeting their fertility goals. Moreover, women in India do not use contraceptives until desired parity and sex composition is achieved, after which a majority opt for permanent contraceptives (8) so adolescent girls may not be using contraception yet as seen from the 15.29% use of contraceptives reported in this sample and 15.89% use among girls not reporting in-laws’ pressure, which is low. These girls may not want to delay their first birth due to pressure felt from these pronatal social norms and fear of not meeting expectations. Family planning outcomes may not be on the radar for these young adolescents yet. Previous studies have found that mother-in-laws’ desire for number of grandchildren is associated with their daughter-in-laws’ preferred family size (35), and mother-in-laws’ influence is associated with daughter-in-laws’ reporting a low likelihood of visiting a family planning clinic and use of modern contraceptives (29). Perhaps husbands are more involved in contraception, but the extended family only exerts pressure on fertility. So these findings add complexity to the literature on other measures of in-laws’ control over family planning and fertility such as desired parity measured in comparison with mother-in-laws’ (18, 28, 35), and direct coercion or interference of in-laws’ in women’s family planning access, initiation, or continuation (23).
However, these findings do not clarify how it affects adolescent wives. Furthermore, contradictory findings to what previous national analysis reported (36), have shown that living with mother-in-laws’ can result in increased use of modern contraceptives and institutional delivery among women and girls aged 15–49 years (37), perhaps due to increased social and financial support from them but need further clarification. However, these data are also cross-sectional, thus suggesting further need for longitudinal studies to assure the direction of causality.
To minimize bias of a chronological timeline back-effect, we adjusted the multivariable models for time since marriage. Although longitudinal data on adolescents' sexual and reproductive health is warranted, recent cross-sectional data gives the most up to date picture of current dynamics to inform policy, given that the indicators and predictors are rapidly changing. Further, there may be other markers of access to family planning services beyond intra-family relationships that need distinctive examination to understand use of family planning per se, especially to understand lack of the associations that were expected in this analysis. For example, living with in-laws’ or joint family has been noted as an impactful variable in previous analyses (29, 37), but our study data was lacking such a measure on co-habitation with in-laws’. Another limitation of the outcome on parity is that it does not include miscarriages, stillbirths, and abortion. Further study is needed to explain reasons behind in-laws’ pressure since girls in the current sample also reported that they were afraid their in-laws’ would call them barren if they didn’t have a child soon after marriage. There is a need to understand girls’ and couples’ fertility goals with recognition that infertility concerns may need to be addressed beyond just family planning. Moreover, pressure from in-laws’ may be due to son-preference norms in India. Future qualitative work needs to explore son preference and whether it is changing.