Knowledge Brief Health, Nutrition and Population Global Practice CHILD MARRIAGE AND FERTILITY IN THE DEMOCRATIC REPUBLIC OF CONGO Adenike Onagoruwa and Quentin Wodon June 2017 Child Marriage Series with Education Global Practice KEY MESSAGES: • In the Democratic Republic of Congo, women who marry as children have on average 14-33 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 0.63 births or slightly more than one tenth 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 lifetime. Given the importance of population growth, How is child marriage defined? Child marriage is defined as a assessing the impact of child marriage on fertility matters. marriage or union taking place before the age of 18. 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 The relationship between child marriage and fertility could will assist governments and others to make the case for be due in part to the socio-economic and cultural context intervening to reduce the practice. in which girls who marry early tend to live. But child marriage may also have a direct impact on fertility after What are the topics discussed in the series? The series controlling for socio-economic and cultural context. looks at the impacts of child marriage on health, population, Marrying early is often associated with a lack of agency education, employment, agency, and violence, among other 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 population growth, lower growth in GDP per capita, slower What is the question asked in this brief? The question is: To poverty reduction, and difficulties for governments to what extent would the number of live births that women have provide basic services to a growing population. This brief over their lifetime decrease if child marriage were eliminated? estimates the impact of child marriage on the number of children that women have over their lifetime in the How is the question answered? Econometric analysis of Demographic and Health Survey data is used to estimate the Democratic Republic of Congo, as part of a series of impact of child marriage on the number of births women have. standardized briefs on this topic for multiple countries. Page 1 HNPGP Knowledge Brief • Statistically, women marrying as children have 1.64 Controlling for socio-economic and other characteristics, more live births than women marrying after 18. women who marry as children have on average 14-33 percent more than women marrying after the age of 18. The analysis is based on data from the Demographic and Health Survey for the Demographic Republic of Congo With the baseline specification, table 2 suggests that implemented in 2013-14. The focus is on the number of marrying at age 17 increases the number of births by 24.9 births that women have over their lifetime. For sample percent in comparison to marrying at age 18 or later. size reasons, we focus on women between 35 and 49 Marrying earlier often has a larger impact. Overall, the years of age. Some women continue to have children after age 35, so that the total number of births considered impacts vary from 14.4 percent to 32.6 percent. In most here may be slightly underestimated, but this should not cases, the marginal effects of early marriage do not change much when additional controls are added to the affect too much the estimate of the difference in the total regressions. There is thus some evidence that after number of births for women marrying as children (before controlling for a wide range of other variables, child age 18) or not. marriage may contribute to higher fertility, but prudence remains needed when interpreting these results given the Women ages 35-49 who married after 18 have on risk of omitted variable bias (see box 2). average 5.39 live births by that age. For women who married before 18, the average is higher at 7.03 births. Table 2: Impact of Child Marriage on Number of Children Ever Born by Age of Marriage, 2013-14 DHS As shown in table 1, women ages 35-49 who married Age at first Baseline Extended after 18 have on average 5.39 births by that age. For marriage model model women who married before 18, the average is 7.03 births. Married <= 12 1.144* 1.222*** The difference (1.64 births) is statistically significant. Married at 13 1.326*** 1.312*** Except for girls marrying at 12 or earlier (these are Married at 14 1.255*** 1.245*** extreme cases that may have specific circumstances), the Married at 15 1.237*** 1.235*** number increases when girls marry earlier, as expected. Married at 16 1.225*** 1.227*** Married at 17 1.249*** 1.238*** Table 1: Mean Number of Children Ever Born by Age Source: Onagoruwa and Wodon (2015). Levels of statistical of First Marriage, 2013-14 DHS significance: *** 1%, ** 5%, * 10%. Age 35-49 Box 2: Risk of Omitted Variable Bias Sample as a whole 6.03 (0.069) Married after 18 years of age 5.39 (0.079) Child marriage appears to be positively correlated with fertility Married before 18 years of age 7.03 (0.084) after controlling for other factors that may also contribute to Married at 17 6.99 (0.172) fertility. This could indicate a causal effect. However, other Married at 16 6.90 (0.182) variables correlated with both child marriage and fertility not Married at 15 6.95 (0.140) included in the analysis could be at the source of the correlation Married at 14 7.21 (0.199) observed between child marriage and fertility. Because of the Married at 13 7.55 (0.246) risk of omitted variable bias, the results cannot be considered as Married at 12 /below 6.58 (0.474) fully conclusive regarding a causal impact of child marriage on Source: Authors. Standard error in parentheses. fertility, even though in this specific case causality is very likely. Controlling for other factors, child marriage still increases the number of live births substantially. Because early marriage also has an impact on other variables used as controls in the regression, the overall In order to measure the impact of child marriage at the effect of child marriage on the number of births including margin on the number of births, regression analysis is through indirect effects could be larger than the direct needed. Details of the methodology is provided in the estimates observed from the regression coefficients. For annex. Table 2 shows the results for the variables of example, for some girls marrying early, child marriage has interest with two models: a baseline specification and the a negative effect on education attainment, and it may also specification with the largest number of added variables contribute to lower household wealth. Still, in terms of as controls. The interpretation of the coefficients is in magnitude, those indirect effects are likely to be small in terms of incident rate ratios. A coefficient of 1.15 for girls comparison to direct effects. Only a relatively small share marrying at the age of 17 suggests that if a girl marries at of girls marrying early would have been able to complete that age, the number of children she will have over her their secondary education if they had married later and lifetime will be 15 percent higher than the number of the coefficient of secondary education on the number of children she would have had if she had married at age 18 births in the regression is close to one, suggesting limited or later. impact of a secondary education on fertility in comparison to a lower level of education. This implies that one may rely on the estimated direct effects of child marriage on Page 2 HNPGP Knowledge Brief the number of births that women have over their lifetime in reduction of 0.65 in the average number of births that order to simulate the impact of the elimination of child women would have. Given the observed average number marriage on total fertility. Not factoring in indirect effects in of children of just above six births per woman in the the simulations does not entail large mismeasurement. country (first column in table 3), this suggests that the average number of births (essentially the total fertility rate) A number of other factors not shown in table 2 lead to would be reduced by slightly more than 10 percent if child differences in the number of births for women. As already marriage could be eliminated. This in turn would have a mentioned, better educated women, especially those with substantial effect on demographic growth in the country. a higher degree, tend to have fewer children. The differences by wealth quintiles tend to be small by Eliminating child marriage could reduce the country’s total contrast, and often not statistically significant. Younger fertility rate by 0.63 births or slightly more than 10 percent. women within the sample have fewer births, but may still This would help reduce population growth substantially. get more later on in their life (22 percent of women ages 35-39 have a birth in the year preceding the survey). Table 3: Impact of the Elimination Child Marriage Differences according to religion are not statistically under the Baseline Model for the Estimations significant, but differences according to geographic areas Women 35+ Observed Predicted Simulated (provinces) are. A few of the differences according to (n=4,991) Mean Mean Mean ethnic groups are also statistically significant. Most of the All 6.03 6.14 5.51 additional control are not associated with statistically Age at first marriage significant effects on fertility, especially in the last model, 30-34 3.12 4.99 4.99 but proximity to health facilities is associated with a 25-29 4.15 5.17 5.17 slightly lower number of births over a woman’s lifetime. 20-24 5.57 5.41 5.41 18 and above 5.39 5.39 5.39 Eliminating child marriage would help reduce the 18 6.29 5.57 5.57 number live births for women marrying early by 1.37. 17 6.99 6.99 5.60 16 6.90 6.90 5.63 15 6.95 6.95 5.62 The last step in the analysis consists in assessing the 14 7.21 7.16 5.71 impact of eliminating child marriage on the total fertility 13 7.55 7.55 5.69 rate. Results in table 3 are obtained by predicting the 12 or below 6.58 6.55 5.73 number of births that women who married as children Never married 1.62 - - would have had if they had married later. The first column 17 and below 7.03 7.02 5.65 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 the Democratic differences between the predicted and simulated number Republic of Congo, under the baseline specification, girls of births marriage since these women did not marry early. marrying before the age of 18 have more births over their lifetime than women who marry after the age of 18. This For women who did marry early, the simulated number of translates on average for all girls who marry early in an births are substantially lower than the predicted values increase in the number of children ever born of 1.37 taking into account the fact that they married early. With children versus the number of children born for girls who the baseline model, women who married early have on marry at 18 or later. For the country as a whole, the average 1.37 more children than if they had married later. average number of births (essentially the total fertility rate) The difference between predicted and simulated numbers would be reduced by about 0.63 births or slightly more of children for women who married early or not with the than one tenth if child marriage were to be eliminated. expanded model is similar. 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 0.63 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 Third, we use the estimations from the regression analysis to association with adverse reproductive outcomes for women in conduct simulations about the magnitude of the reduction in the Bangladesh. Asia-Pacific Journal of Public Health, 27(2), average number of children that women are expected to have NP1492-NP1506. that could be achieved through the elimination of child marriage. Nasrullah, M., Muazzam, S., Bhutta, Z. A., & Raj, A. (2014). Girl A few additional explanations on definitions may be useful. In child marriage and its effect on fertility in Pakistan: findings from this brief, the focus is on the impact of child marriage on the Pakistan Demographic and Health Survey, 2006–2007. Maternal number of children ever born to women towards the end of their and child health journal, 18(3), 534-543. fertile life. This is a useful statistics that summarizes the fertility behavior of women who are nearing the end of their reproductive Onagoruwa. A. O. and Q. Wodon, 2015, Impact of Child period. If fertility is stable over time, the mean number of Marriage on Fertility in the Democratic Republic of Congo, children ever born is similar to the total fertility rate (TFR) which Mimeo, ICRW-World Bank Economic Impacts of Child Marriage refers to the average number of live births a woman would have Project. Washington, DC: ICRW and the World Bank. 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 République Démocratique du Congo, 2014, Deuxième enquête ages 40-49. This does not affect our results substantially given démographique et de santé (EDS-RDC II 2013-2014), Ministère the focus on the differential impact of child marriage du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité, Ministère de la Santé Publique, et MEASURE DHS, As for the regression analysis, given that the variable of interest Rockville, MD: ICF International. is a count variable (taking values such as 1, 2, 3…), Poisson regressions are estimated. Different models are estimated to Santhya, K. G. (2011). Early marriage and sexual and test for the robustness of findings to the specification used. reproductive health vulnerabilities of young women: a synthesis Apart from the age at first marriage or union, the baseline model of recent evidence from developing countries. Current opinion in controls for: (1) location (urban versus rural); (2) education level obstetrics and gynecology, 23(5), 334-339. of the girl/woman; (3) wealth quintile (from the poorest to the richest); (4) religion; (5) geographic area (provinces); and (6) Santhya, K. G., Ram, U., Acharya, R., Jejeebhoy, S. J., Ram, F., age group (35-39, 40-44, and 45-49). In other models ethnicity, & Singh, A. (2010). Associations between early marriage and variables capturing agency for girls/women in the household, young women's marital and reproductive health outcomes: and additional community-level controls are added. The evidence from India. International perspectives on sexual and community variables are the leave-out-means of contraceptive reproductive health, 132-139. use and whether women experienced a child death before the age of five (leave-out-means are estimated at the level of the Annex: Methodological Note primary sampling units in the survey). Overall, the estimated impacts of early marriage on the number of births for women Previous research has been conducted on child marriage and over their lifetime are fairly robust to the choice of specification. fertility (e.g., Santhya, 2011; Kamal, 2012; Godha et al., 2013; Nasrullah et al., 2013; Kamal et al. 2015). This brief has three This brief was produced by a World Bank team as part of the Economic features that differentiate it from previous work. First, the impact Impacts of Child Marriage study. The synthesis report under the study of each additional year of early marriage on the number of births was produced jointly with the International Center for Research on a women has over her lifetime is estimated. Previous studies Women. The study benefitted from support from the Bill & Melinda Gates typically looked only at the impact of marrying early or not. Foundation, the Children’s Investment Fund Foundation, and the Global Here, we look at the impact of each single additional year of Partnership for Education. Comments from colleagues and peer early marriage. Second, we estimate the impact of child reviewers are gratefully acknowledged. The opinions expressed in this marriage on a woman’s number of child births over her lifetime. brief are those of the authors only and need not reflect the views of the Previous studies focused mostly on young women (ages 18 to World Bank, its Executive Directors, of the countries they represent. 24). The reason for considering older women is to account for potential substitution effects whereby if a woman does not have children early in life, she may want more children later on. 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. 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