Exclusion of married adolescents in a study of gestational diabetes mellitus: a case study

A study on gestational diabetes mellitus (GDM) among 200 married women in Malappruam, Kerala, India, chose to exclude married women below the age of 18 from participation. Marriages before age 18 are not considered legally valid and persons below age 18 do not have the status of an adult. Parents are considered the legal guardians of married women under age 18, but because marriages are patrilocal, obtaining consent from parents would have time costs. Further, obtaining parental consent may also be considered disrespectful of the in-laws. The inclusion of married adolescents in this study was considered difficult for these reasons. This exclusion can also result in wrongly estimating the levels of GDM among all women at risk. We argue that such exclusion is also unethical; it unfair to exclude women who stand to benefit from participation by enabling them to identify the enhanced life time risk for diabetes mellitus and monitor their future health status better. Recognizing married adolescents as emancipated minors would enable their participating without violating confidentiality regarding their GDM status to parents and in-laws.