Knowledge Brief Health, Nutrition and Population Global Practice CHILD MARRIAGE AND FERTILITY IN NEPAL Adenike Onagoruwa and Quentin Wodon June 2017 Child Marriage Series with Education Global Practice KEY MESSAGES: • In Nepal, women who marry as children have on average 15-26 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 0.45 births or about eleven percent if child marriage could be eliminated. This in turn would have a substantial effect on demographic growth. Girls marrying early tend to have children earlier than girls Box 1: Brief and Series Primer 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 Nepal, 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 1.04 Controlling for socio-economic and other characteristics, more live births than women marrying after 18. women who marry as children have on average 15-26 percent more than women marrying after the age of 18. The analysis is based on data from the fourth Demographic and Health Survey for Nepal implemented With the baseline specification, table 2 suggests that in 2011. The focus is on the number of births that women marrying at age 17 increases the number of births by 14.8 have over their lifetime. For sample size reasons, we percent in comparison to marrying at age 18 or later. focus on women between 35 and 49 years of age. Some Marrying earlier often has a larger impact. Overall, the women continue to have children after age 35, so that the total number of births considered here may be slightly impacts vary from 26.4 percent for girls marrying at age underestimated, but this should not affect too much the 14 to 14.8 percent for girls marrying at age 17. 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 some 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 3.39 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 4.43 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 3.39 births by that age. For Children Ever Born by Age of Marriage, 2011 DHS women who married before 18, the average is 4.43 births. Age at first Baseline Extended The difference (1.04 births) is statistically significant. marriage model model Except for girls marrying very young, the number mostly Married <= 12 1.204*** 1.218*** increases when girls marry earlier, as expected. Married at 13 1.249*** 1.217*** Married at 14 1.264*** 1.244*** Table 1: Mean Number of Children Ever Born by Age Married at 15 1.199*** 1.194*** of First Marriage, 2011 DHS Married at 16 1.204*** 1.202*** Age 35-49 Married at 17 1.148*** 1.146*** Sample as a whole 3.95 (0.073) Source: Authors. Married after 18 years of age 3.39 (0.071) Levels of statistical significance: *** 1%, ** 5%, * 10%. Married before 18 years of age 4.43 (0.084) Married at 17 4.04 (0.122) Box 2: Risk of Omitted Variable Bias Married at 16 4.32 (0.146) Married at 15 4.45 (0.111) Child marriage appears to be positively correlated with fertility Married at 14 4.78 (0.128) after controlling for other factors that may also contribute to Married at 13 4.69 (0.207) fertility. This could indicate a causal effect. However, other Married at 12 /below 4.54 (0.153) 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 reduction of 0.44 in the average number of births that rely on the estimated direct effects of child marriage on women would have. Given the observed average number the number of births that women have over their lifetime in of children of about four births per woman in the country order to simulate the impact of the elimination of child (first column in table 3), this suggests that the average marriage on total fertility. Not factoring in indirect effects in number of births (essentially the total fertility rate) would the simulations does not entail large mismeasurement. be reduced by about eleven percent if child marriage could be eliminated. This in turn would have a substantial A number of other factors not shown in table 2 lead to effect on demographic growth in the country. differences in the number of births for women. As already mentioned, better educated women, especially those with Eliminating child marriage could reduce the country’s total a higher degree, tend to have fewer children. The impact fertility rate by 0.45 births or about eleven percent. This of wealth on fertility is statistically significant in all would help reduce population growth substantially. quintiles: women in the highest wealth quintile (the richest 20% of households) have 34.1 percent fewer children Table 3: Impact of the Elimination Child Marriage than women in the poorest 20% of households. Younger under the Baseline Model for the Estimations women within the sample have fewer births, but may still Women 35+ Observed Predicted Simulated get more later on in their life. Differences according to (n=3,777) Mean Mean Mean religion and ecological zone are not statistically All 3.95 4.00 3.55 significant, but differences according to development Age at first marriage regions are. Most of the additional control are not 30-34 1.33 2.93 2.93 associated with statistically significant effects on fertility, 25-29 2.24 3.28 3.28 especially in the last model. 20-24 3.15 3.24 3.24 18 and above 3.39 3.39 3.39 Eliminating child marriage would help reduce the 18 3.98 3.61 3.61 number live births for women marrying early by 0.76. 17 4.04 4.04 3.52 16 4.32 4.32 3.59 15 4.45 4.45 3.71 The last step in the analysis consists in assessing the 14 4.78 4.78 3.78 impact of eliminating child marriage on the total fertility 13 4.69 4.69 3.76 rate. Results in table 3 are obtained by predicting the 12 or below 4.54 4.54 3.77 number of births that women who married as children Never married 0.01 - - would have had if they had married later. The first column 17 and below 4.43 4.43 3.67 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 Nepal, 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 fifth more births over their lifetime than women who marry after the age of 18. This translates on average For women who did marry early, the simulated number of for all girls who marry early in an increase in the number births are substantially lower than the predicted values of children ever born of 0.76 children versus the number taking into account the fact that they married early. With of children born for girls who marry at 18 or later. For the the baseline model, women who married early have on country as a whole, the average number of births average 0.76 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 0.45 births or about eleven percent if child marriage of children for women who married early or not with the were to be eliminated. expanded model is similar, at 0.74 fewer children. References The top row in table 3 provides the difference that child marriage makes for the average number of births Godha, D., Hotchkiss, D. R., & Gage, A. J. (2013). Association nationally (this is similar to the total fertility rate), thereby between child marriage and reproductive health outcomes and factoring the share of women who marry early at different service utilization: a multi-country study from South Asia. Journal of Adolescent Health, 52(5), 552-558. ages. With the baseline model, the average number of births that women have over their lifetime is reduced for Kamal, S. M. (2012). Decline in child marriage and changes in the country as a whole by 0.45 births without child its effect on reproductive outcomes in Bangladesh. Journal of marriage. The effect is again very similar when health, population, and nutrition, 30(3), 317. considering the expanded model (not shown), with a Page 3 HNPGP Knowledge Brief • Kamal, S. M., & Hassan, C. H. (2015). Child marriage and its association with adverse reproductive outcomes for women in Bangladesh. Asia-Pacific Journal of Public Health, 27(2), A few additional explanations on definitions may be useful. In NP1492-NP1506. this brief, the focus is on the impact of child marriage on the number of children ever born to women towards the end of their Ministry of Health and Population (MOHP) [Nepal], New ERA, fertile life. This is a useful statistic that summarizes the fertility and ICF International Inc. 2012. Nepal Demographic and Health behavior of women who are nearing the end of their reproductive Survey 2011. Kathmandu, Nepal: Ministry of Health and period. If fertility is stable over time, the mean number of Population, New ERA, and ICF International, Calverton, children ever born is similar to the total fertility rate (TFR) which Maryland. refers to the average number of live births a woman would have if she were subject to current age-specific fertility rates Nasrullah, M., Muazzam, S., Bhutta, Z. A., & Raj, A. (2014). Girl throughout her reproductive years. In other words, under stable child marriage and its effect on fertility in Pakistan: findings from conditions, the number of children ever born is a good proxy for Pakistan Demographic and Health Survey, 2006–2007. Maternal the TFR. If fertility levels have been falling, the TFR will however and child health journal, 18(3), 534-543. be (slightly) lower than the mean number of children ever born. For sample size reasons, we consider women ages 35 to 49 to Raj, A., Saggurti, N., Balaiah, D., & Silverman, J. G. (2009). estimate the number of children ever born, rather than women Prevalence of child marriage and its effect on fertility and fertility- ages 40-49. This does not affect our results substantially given control outcomes of young women in India: a cross-sectional, the focus on the differential impact of child marriage observational study. The Lancet, 373(9678), 1883-1889. As for the regression analysis, given that the variable of interest Santhya, K. G. (2011). Early marriage and sexual and is a count variable (taking values such as 1, 2, 3…), Poisson reproductive health vulnerabilities of young women: a synthesis regressions are estimated. Different models are estimated to of recent evidence from developing countries. Current opinion in test for the robustness of findings to the specification used. obstetrics and gynecology, 23(5), 334-339. Apart from the age at first marriage or union, the baseline model controls for: (1) location (urban versus rural); (2) education level Santhya, K. G., Ram, U., Acharya, R., Jejeebhoy, S. J., Ram, F., of the girl/woman; (3) wealth quintile (from the poorest to the & Singh, A. (2010). Associations between early marriage and richest); (4) religion; (5) ecological zone (6) development region; young women's marital and reproductive health outcomes: (7) ethnicity and (8) age group (35-39, 40-44, and 45-49). In evidence from India. International perspectives on sexual and other models variables capturing agency for girls/women in the reproductive health, 132-139. household and additional community-level controls are added. The community variables are the leave-out-means of Annex: Methodological Note contraceptive use and whether women experienced a child death before the age of five (leave-out-means are estimated at Previous research has been conducted on child marriage and the level of the primary sampling units in the survey). Overall, fertility (e.g., Santhya, 2011; Kamal, 2012; Godha et al., 2013; the estimated impacts of early marriage on the number of births Nasrullah et al., 2013; Kamal et al. 2015). This brief has three for women over their lifetime are fairly robust to the choice of features that differentiate it from previous work. First, the impact specification. of each additional year of early marriage on the number of births a woman has over her lifetime is estimated. Previous studies typically looked only at the impact of marrying early or not. Here, we look at the impact of each single additional year of This brief was produced by a World Bank team as part of the Economic early marriage. Second, we estimate the impact of child Impacts of Child Marriage study. The synthesis report under the study marriage on a woman’s number of child births over her lifetime. was produced jointly with the International Center for Research on Women. The study benefitted from support from the Bill & Melinda Gates Previous studies focused mostly on young women (ages 18 to Foundation, the Children’s Investment Fund Foundation, and the Global 24). The reason for considering older women is to account for Partnership for Education. Comments from colleagues and peer potential substitution effects whereby if a woman does not have reviewers are gratefully acknowledged. The opinions expressed in this children early in life, she may want more children later on. brief are those of the authors only and need not reflect the views of the World Bank, its Executive Directors, of the countries they represent. In order to look at the impact of child marriage on total fertility, we need to consider women towards the end of their fertile age. Third, we use the estimations from the regression analysis to 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