Knowledge Brief Health, Nutrition and Population Global Practice CHILD MARRIAGE AND FERTILITY IN MALI Adenike Onagoruwa and Quentin Wodon June 2017 Child Marriage Series with Education Global Practice KEY MESSAGES: • In Mali, women who marry as children have on average 19-33 percent more births over their life time as compared to women marrying after the age of 18. • Controlling for socio-economic and other characteristics, the average number of births per woman would be reduced by 0.57 births or about ten percent if child marriage could be eliminated. This in turn would have a substantial effect on demographic growth. Box 1: Brief and Series Primer Girls marrying early tend to have children earlier than girls who marry later. They also have more children over their How is child marriage defined? Child marriage is defined as a lifetime. Given the importance of population growth, marriage or union taking place before the age of 18. assessing the impact of child marriage on fertility matters. Why a series on child marriage? Child marriage has Child marriage is associated with higher fertility. significant negative impacts – not only for girls, but also for a range of development outcomes. Demonstrating these impacts will assist governments and others to make the case for The relationship between child marriage and fertility could intervening to reduce the practice. be due in part to the socio-economic and cultural context in which girls who marry early tend to live. But child What are the topics discussed in the series? The series marriage may also have a direct impact on fertility after looks at the impacts of child marriage on health, population, controlling for socio-economic and cultural context. education, employment, agency, and violence, among other Marrying early is often associated with a lack of agency outcomes. The welfare, budget, and non-monetary costs of child for girls, including in terms of access to family planning marriage are estimated. Legal/institutional aspects and options that could help delay or reduce births if women so desire. to reduce the practice are also discussed. For societies, higher total fertility rates lead to higher What is the question asked in this brief? The question is: To population growth, lower growth in GDP per capita, slower what extent would the number of live births that women have poverty reduction, and difficulties for governments to over their lifetime decrease if child marriage were eliminated? provide basic services to a growing population. This brief estimates the impact of child marriage on the number of How is the question answered? Econometric analysis of children that women have over their lifetime in Mali, as Demographic and Health Survey data is used to estimate the part of a series of standardized briefs on this topic for impact of child marriage on the number of births women have. multiple countries. Page 1 HNPGP Knowledge Brief • Statistically, women marrying as children have 1.33 Controlling for socio-economic and other characteristics, more live births than women marrying after 18. women who marry as children have on average 19-33 percent more than women marrying after the age of 18. The analysis is based on data from the fifth Demographic and Health Survey for Mali implemented in 2012/13. The With the baseline specification, table 2 suggests that focus is on the number of births that women have over marrying at age 17 increases the number of births by 26.1 their lifetime. For sample size reasons, we focus on percent in comparison to marrying at age 18 or later. women between 35 and 49 years of age. Some women Marrying earlier has a similar impact. Overall, the impacts continue to have children after age 35, so that the total number of births considered here may be slightly vary from 32.7 percent for girls marrying at age 12 or underestimated, but this should not affect too much the younger to 19.2 percent for girls marrying at age 15. The marginal effects of early marriage do not change much estimate of the difference in the total number of births for when additional controls are added to the regressions. women marrying as children (before age 18) or not. There is thus clear evidence that after controlling for a wide range of other variables, child marriage may Women ages 35-49 who married after 18 have on contribute to higher fertility, but prudence remains needed average 5.03 live births by that age. For women who when interpreting these results given the risk of omitted married before 18, the average is higher at 6.36 births. variable bias (see box 2). As shown in table 1, women ages 35-49 who married Table 2: Impact of Child Marriage on Number of after 18 have on average 5.03 births by that age. For Children Ever Born by Age of Marriage, 2012/13 DHS women who married before 18, the average is 6.36 births. Age at first Baseline Extended The difference (1.33 births) is statistically significant. The marriage model model mean number of children born increases when girls marry Married <= 12 1.327*** 1.306*** earlier, as expected. Married at 13 1.195*** 1.151*** Married at 14 1.263*** 1.255*** Table 1: Mean Number of Children Ever Born by Age Married at 15 1.192*** 1.159*** of First Marriage, 2012/13 DHS Married at 16 1.273*** 1.240*** Age 35-49 Married at 17 1.261*** 1.243*** Sample as a whole 5.60 (0.077) Source: Authors. Married after 18 years of age 5.03 (0.081) Levels of statistical significance: *** 1%, ** 5%, * 10%. Married before 18 years of age 6.36 (0.101) Married at 17 6.40 (0.203) Box 2: Risk of Omitted Variable Bias Married at 16 6.41 (0.190) Married at 15 6.10 (0.182) Child marriage appears to be positively correlated with fertility Married at 14 6.38 (0.215) after controlling for other factors that may also contribute to Married at 13 6.13 (0.258) fertility. This could indicate a causal effect. However, other Married at 12 /below 6.81 (0.299) variables correlated with both child marriage and fertility not Source: Authors. Standard error in parentheses. included in the analysis could be at the source of the correlation Controlling for other factors, child marriage still observed between child marriage and fertility. Because of the risk of omitted variable bias, the results cannot be considered as increases the number of live births substantially. fully conclusive regarding a causal impact of child marriage on fertility, even though in this specific case causality is very likely. In order to measure the impact of child marriage at the margin on the number of births, regression analysis is Because early marriage also has an impact on other needed. Details of the methodology is provided in the variables used as controls in the regression, the overall annex. Table 2 shows the results for the variables of effect of child marriage on the number of births including interest with two models: a baseline specification and the through indirect effects could be larger than the direct specification with the largest number of added variables estimates observed from the regression coefficients. For as controls. The interpretation of the coefficients is in example, for some girls marrying early, child marriage has terms of incident rate ratios. A coefficient of 1.15 for girls a negative effect on education attainment, and it may also marrying at the age of 17 suggests that if a girl marries at contribute to lower household wealth. Still, in terms of that age, the number of children she will have over her magnitude, those indirect effects are likely to be small in lifetime will be 15 percent higher than the number of comparison to direct effects. Only a relatively small share children she would have had if she had married at age 18 of girls marrying early would have been able to complete or later. their secondary education if they had married later and the coefficient of secondary education on the number of births in the regression is close to one, suggesting limited impact of a secondary education on fertility in comparison Page 2 HNPGP Knowledge Brief to a lower level of education. This implies that one may number of births (essentially the total fertility rate) would rely on the estimated direct effects of child marriage on be reduced by about ten percent if child marriage could the number of births that women have over their lifetime in be eliminated. This in turn would have a substantial effect order to simulate the impact of the elimination of child on demographic growth in the country. marriage on total fertility. Not factoring in indirect effects in the simulations does not entail large mismeasurement. Eliminating child marriage could reduce the country’s total fertility rate by 0.57 births or about ten percent. This would A number of other factors not shown in table 2 lead to help reduce population growth substantially. differences in the number of births for women. As already mentioned, better educated women, especially those with Table 3: Impact of the Elimination Child Marriage a higher degree, tend to have fewer children. The impact under the Baseline Model for the Estimations of wealth on fertility is statistically significant in the third Women 35+ Observed Predicted Simulated and fifth quintiles. Younger women within the sample (n=2,894) Mean Mean Mean have fewer births, but may still get more later on in their All 5.60 5.62 5.05 life. Differences according to religion are statistically Age at first marriage significant. Most of the additional control are not 30-34 3.92 5.11 5.11 associated with statistically significant effects on fertility, 25-29 4.19 5.05 5.05 especially in the last model. 20-24 5.00 4.98 4.98 18 and above 5.03 5.03 5.03 Eliminating child marriage would help reduce the 18 6.14 5.04 5.04 number live births for women marrying early by 1.27. 17 6.40 6.40 5.08 16 6.41 6.41 5.03 15 6.10 6.10 5.12 The last step in the analysis consists in assessing the 14 6.38 6.38 5.05 impact of eliminating child marriage on the total fertility 13 6.13 6.13 5.13 rate. Results in table 3 are obtained by predicting the 12 or below 6.81 6.81 5.13 number of births that women who married as children Never married 1.91 - - would have had if they had married later. The first column 17 and below 6.36 6.36 5.09 in table 3 provides the estimates of the number of births in Source: Authors’ estimations. the sample. The second column provides the predicted values under the baseline model (results are similar with Conclusion other models). The third column provide the simulated number of births without child marriage. Note that for all Child marriage is linked to higher and less controlled women who marry after the age of 18, there are no fertility for girls who marry early. In Mali, under the differences between the predicted and simulated number baseline specification, girls marrying before the age of 18 of births marriage since these women did not marry early. have one fourth more births over their lifetime than women who marry after the age of 18. This translates on For women who did marry early, the simulated number of average for all girls who marry early in an increase in the births are substantially lower than the predicted values number of children ever born of 1.27 children versus the taking into account the fact that they married early. With number of children born for girls who marry at 18 or later. the baseline model, women who married early have on For the country as a whole, the average number of births average 1.27 more children than if they had married later. (essentially the total fertility rate) would be reduced by The difference between predicted and simulated numbers about 0.57 births or about ten percent if child marriage of children for women who married early or not with the were to be eliminated. expanded model is similar, at 1.15 fewer children. References The top row in table 3 provides the difference that child marriage makes for the average number of births Cellule de Planification et de Statistique (CPS/SSDSPF), Institut nationally (this is similar to the total fertility rate), thereby National de la Statistique (INSTAT/MPATP), INFO-STAT et ICF factoring the share of women who marry early at different International, 2014. Enquête Démographique et de Santé au Mali 2012-2013. Rockville, Maryland, USA : CPS, INSTAT, ages. With the baseline model, the average number of INFO-STAT et ICF International. births that women have over their lifetime is reduced for the country as a whole by 0.57 births without child Godha, D., Hotchkiss, D. R., & Gage, A. J. (2013). Association marriage. The effect is again very similar when between child marriage and reproductive health outcomes and considering the expanded model (not shown), with a service utilization: a multi-country study from South Asia. Journal reduction of 0.52 in the average number of births that of Adolescent Health, 52(5), 552-558. women would have. Given the observed average number of children of over five births per woman in the country Kamal, S. M. (2012). Decline in child marriage and changes in (first column in table 3), this suggests that the average its effect on reproductive outcomes in Bangladesh. Journal of health, population, and nutrition, 30(3), 317. Page 3 HNPGP Knowledge Brief • Kamal, S. M., & Hassan, C. H. (2015). Child marriage and its A few additional explanations on definitions may be useful. In association with adverse reproductive outcomes for women in this brief, the focus is on the impact of child marriage on the Bangladesh. Asia-Pacific Journal of Public Health, 27(2), number of children ever born to women towards the end of their NP1492-NP1506. fertile life. This is a useful statistic that summarizes the fertility behavior of women who are nearing the end of their reproductive Nasrullah, M., Muazzam, S., Bhutta, Z. A., & Raj, A. (2014). Girl period. If fertility is stable over time, the mean number of child marriage and its effect on fertility in Pakistan: findings from children ever born is similar to the total fertility rate (TFR) which Pakistan Demographic and Health Survey, 2006–2007. Maternal refers to the average number of live births a woman would have and child health journal, 18(3), 534-543. if she were subject to current age-specific fertility rates throughout her reproductive years. In other words, under stable Raj, A., Saggurti, N., Balaiah, D., & Silverman, J. G. (2009). conditions, the number of children ever born is a good proxy for Prevalence of child marriage and its effect on fertility and fertility- the TFR. If fertility levels have been falling, the TFR will however control outcomes of young women in India: a cross-sectional, be (slightly) lower than the mean number of children ever born. observational study. The Lancet, 373(9678), 1883-1889. For sample size reasons, we consider women ages 35 to 49 to estimate the number of children ever born, rather than women Santhya, K. G. (2011). Early marriage and sexual and ages 40-49. This does not affect our results substantially given reproductive health vulnerabilities of young women: a synthesis the focus on the differential impact of child marriage of recent evidence from developing countries. Current opinion in obstetrics and gynecology, 23(5), 334-339. As for the regression analysis, given that the variable of interest is a count variable (taking values such as 1, 2, 3…), Poisson Santhya, K. G., Ram, U., Acharya, R., Jejeebhoy, S. J., Ram, F., regressions are estimated. Different models are estimated to & Singh, A. (2010). Associations between early marriage and test for the robustness of findings to the specification used. young women's marital and reproductive health outcomes: Apart from the age at first marriage or union, the baseline model evidence from India. International perspectives on sexual and controls for: (1) location (urban versus rural); (2) education level reproductive health, 132-139. of the girl/woman; (3) wealth quintile (from the poorest to the richest); (4) religion; (5) geographic area; (6) ethnicity and (7) Annex: Methodological Note age group (35-39, 40-44, and 45-49). In other models variables capturing agency for girls/women in the household and Previous research has been conducted on child marriage and additional community-level controls are added. The community fertility (e.g., Santhya, 2011; Kamal, 2012; Godha et al., 2013; variables are the leave-out-means of contraceptive use and Nasrullah et al., 2013; Kamal et al. 2015). This brief has three whether women experienced a child death before the age of five features that differentiate it from previous work. First, the impact (leave-out-means are estimated at the level of the primary of each additional year of early marriage on the number of births sampling units in the survey). Overall, the estimated impacts of a woman has over her lifetime is estimated. Previous studies early marriage on the number of births for women over their typically looked only at the impact of marrying early or not. lifetime are fairly robust to the choice of specification. Here, we look at the impact of each single additional year of early marriage. Second, we estimate the impact of child marriage on a woman’s number of child births over her lifetime. Previous studies focused mostly on young women (ages 18 to This brief was produced by a World Bank team as part of the Economic 24). The reason for considering older women is to account for Impacts of Child Marriage study. The synthesis report under the study potential substitution effects whereby if a woman does not have was produced jointly with the International Center for Research on children early in life, she may want more children later on. Women. The study benefitted from support from the Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation, and the Global Partnership for Education. Comments from colleagues and peer In order to look at the impact of child marriage on total fertility, reviewers are gratefully acknowledged. The opinions expressed in this we need to consider women towards the end of their fertile age. brief are those of the authors only and need not reflect the views of the Third, we use the estimations from the regression analysis to World Bank, its Executive Directors, of the countries they represent. conduct simulations about the magnitude of the reduction in the average number of children that women are expected to have that could be achieved through the elimination of child marriage. The Health, Nutrition and Population Knowledge Briefs of the World Bank are a quick reference on the essentials of specific HNP-related topics summarizing new findings and information. These may highlight an issue and key interventions proven to be effective in improving health, or disseminate new findings and lessons learned from the regions. For more information on this topic, go to: www.worldbank.org/health. Page 4