Knowledge Brief Health, Nutrition and Population Global Practice CHILD MARRIAGE AND FERTILITY IN EGYPT Adenike Onagoruwa and Quentin Wodon June 2017 Child Marriage Series with Education Global Practice KEY MESSAGES: • In Egypt, women who marry as children have on average 17-37 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 0.25 births or about seven 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 Egypt, 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 1.31 Controlling for socio-economic and other characteristics, more live births than women marrying after 18. women who marry as children have on average 17-37 percent more than women marrying after the age of 18. The analysis is based on data from the 2014 Egypt Demographic and Health Survey (2014 EDHS). The focus With the baseline specification, table 2 suggests that is on the number of births that women have over their marrying at age 17 increases the number of births by 17.1 lifetime. For sample size reasons, we focus on women percent in comparison to marrying at age 18 or later. between 35 and 49 years of age. Some women continue Marrying earlier often has a larger impact. Overall, the to have children after age 35, so that the total number of births considered here may be slightly underestimated, impacts vary from 36.6 percent for girls marrying at age but this should not affect too much the estimate of the 13 to 17.1 percent for girls marrying at age 17. The marginal effects of early marriage do not change much difference in the total number of births for women when additional controls are added to the regressions. 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 3.29 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 4.61 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 3.29 births by that age. For Children Ever Born by Age of Marriage, 2014 EDHS women who married before 18, the average is 4.61 births. Age at first Baseline Extended The difference (1.31 births) is statistically significant. marriage model model Except for girls marrying at 12 or earlier (these are Married <= 12 1.298*** 1.269*** extreme cases that may have specific circumstances), the Married at 13 1.366*** 1.357*** number increases when girls marry earlier, as expected. Married at 14 1.294*** 1.270*** Married at 15 1.252*** 1.263*** Married at 16 1.188*** 1.185*** Table 1: Mean Number of Children Ever Born by Age Married at 17 1.171*** 1.167*** of First Marriage, 2014 EDHS Source: Authors. Age 35-49 Levels of statistical significance: *** 1%, ** 5%, * 10%. Sample as a whole 3.67 (0.028) Married after 18 years of age 3.29 (0.026) Box 2: Risk of Omitted Variable Bias Married before 18 years of age 4.61 (0.049) Married at 17 4.18 (0.078) Child marriage appears to be positively correlated with fertility Married at 16 4.42 (0.076) after controlling for other factors that may also contribute to Married at 15 4.76 (0.106) fertility. This could indicate a causal effect. However, other Married at 14 5.01 (0.136) variables correlated with both child marriage and fertility not Married at 13 5.23 (0.179) included in the analysis could be at the source of the correlation Married at 12 /below 5.02 (0.164) observed between child marriage and fertility. Because of the Source: Authors. Standard error in parentheses. risk of omitted variable bias, the results cannot be considered as Controlling for other factors, child marriage still fully conclusive regarding a causal impact of child marriage on fertility, even though in this specific case causality is very likely. increases the number of live births substantially. In order to measure the impact of child marriage at the Because early marriage also has an impact on other margin on the number of births, regression analysis is variables used as controls in the regression, the overall needed. Details of the methodology is provided in the effect of child marriage on the number of births including annex. Table 2 shows the results for the variables of through indirect effects could be larger than the direct interest with two models: a baseline specification and the estimates observed from the regression coefficients. For specification with the largest number of added variables example, for some girls marrying early, child marriage has as controls. The interpretation of the coefficients is in a negative effect on education attainment, and it may also terms of incident rate ratios. A coefficient of 1.15 for girls contribute to lower household wealth. Still, in terms of marrying at the age of 17 suggests that if a girl marries at magnitude, those indirect effects are likely to be small in that age, the number of children she will have over her comparison to direct effects. Only a relatively small share lifetime will be 15 percent higher than the number of of girls marrying early would have been able to complete children she would have had if she had married at age 18 their secondary education if they had married later and or later. 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 to a lower level of education. This implies that one may Page 2 HNPGP Knowledge Brief rely on the estimated direct effects of child marriage on of children of 3.67 births per woman in the country (first the number of births that women have over their lifetime in column in table 3), this suggests that the average number order to simulate the impact of the elimination of child of births (essentially the total fertility rate) would be marriage on total fertility. Not factoring in indirect effects in reduced by about seven percent if child marriage could be the simulations does not entail large mismeasurement. eliminated. This in turn would have a substantial effect on demographic growth in the country. A number of other factors not shown in table 2 lead to differences in the number of births for women. As already Eliminating child marriage could reduce the country’s total mentioned, better educated women, especially those with fertility rate by 0.25 births or about seven percent. This a higher degree, tend to have fewer children. The would help reduce population growth substantially. differences by wealth quintiles are statistically significant, with women from wealthier households tending to have Table 3: Impact of the Elimination Child Marriage fewer children. Younger women within the sample have under the Baseline Model for the Estimations fewer births, but may still get more later on in their life. Women 35+ Observed Predicted Simulated Differences according to rural-urban residency are not (n=9,122) Mean Mean Mean statistically significant, but differences according to All 3.67 3.67 3.42 geographic areas are. Women with decision-making Age at first marriage abilities in the household have fewer children than women 30-34 1.97 3.21 3.21 with no agency. Indicating that the distance to a health 25-29 2.72 3.18 3.18 facility is a problem is associated with more births. 20-24 3.41 3.26 3.26 18 and above 3.29 3.29 3.29 Eliminating child marriage would help reduce the 18 4.05 3.49 3.49 number live births for women marrying early by 0.87. 17 4.18 4.19 3.58 16 4.42 4.42 3.72 15 4.76 4.76 3.80 The last step in the analysis consists in assessing the 14 5.01 5.01 3.87 impact of eliminating child marriage on the total fertility 13 5.23 5.23 3.83 rate. Results in table 3 are obtained by predicting the 12 or below 5.02 5.02 3.87 number of births that women who married as children 17 and below 4.61 4.61 3.74 would have had if they had married later. The first column Source: Authors’ estimations. in table 3 provides the estimates of the number of births in the sample. The second column provides the predicted Conclusion values under the baseline model (results are similar with other models). The third column provide the simulated Child marriage is linked to higher and less controlled number of births without child marriage. Note that for all fertility for girls who marry early. In Egypt, under the women who marry after the age of 18, there are no baseline specification, girls marrying before the age of 18 differences between the predicted and simulated number have about one fourth more births over their lifetime than of births marriage since these women did not marry early. women who marry after the age of 18. This translates on average for all girls who marry early in an increase in the For women who did marry early, the simulated number of number of children ever born of 0.87 children versus the births are substantially lower than the predicted values number of children born for girls who marry at 18 or later. taking into account the fact that they married early. With For the country as a whole, the average number of births the baseline model, women who married early have on (essentially the total fertility rate) would be reduced by average 0.87 more children than if they had married later. about 0.25 births or about seven percent if child marriage The difference between predicted and simulated numbers were to be eliminated. of children for women who married early or not with the expanded model is the same, at 0.87 fewer children. References The top row in table 3 provides the difference that child Godha, D., Hotchkiss, D. R., & Gage, A. J. (2013). Association marriage makes for the average number of births between child marriage and reproductive health outcomes and nationally (this is similar to the total fertility rate), thereby service utilization: a multi-country study from South Asia. Journal factoring the share of women who marry early at different of Adolescent Health, 52(5), 552-558. ages. With the baseline model, the average number of Kamal, S. M. (2012). Decline in child marriage and changes in births that women have over their lifetime is reduced for its effect on reproductive outcomes in Bangladesh. Journal of the country as a whole by 0.25 births without child health, population, and nutrition, 30(3), 317. marriage. The effect is again very similar when considering the expanded model (not shown), with a Kamal, S. M., & Hassan, C. H. (2015). Child marriage and its reduction of 0.24 in the average number of births that association with adverse reproductive outcomes for women in women would have. Given the observed average number Page 3 HNPGP Knowledge Brief • Bangladesh. Asia-Pacific Journal of Public Health, 27(2), NP1492-NP1506. A few additional explanations on definitions may be useful. In this brief, the focus is on the impact of child marriage on the Ministry of Health and Population [Egypt], El-Zanaty and number of children ever born to women towards the end of their Associates [Egypt], and ICF International (2015). Egypt fertile life. This is a useful statistic that summarizes the fertility Demographic and Health Survey 2014. Cairo, Egypt and behavior of women who are nearing the end of their reproductive Rockville, Maryland, USA: Ministry of Health and Population and period. If fertility is stable over time, the mean number of ICF International. children ever born is similar to the total fertility rate (TFR) which refers to the average number of live births a woman would have Nasrullah, M., Muazzam, S., Bhutta, Z. A., & Raj, A. (2014). Girl if she were subject to current age-specific fertility rates child marriage and its effect on fertility in Pakistan: findings from throughout her reproductive years. In other words, under stable Pakistan Demographic and Health Survey, 2006–2007. Maternal conditions, the number of children ever born is a good proxy for and child health journal, 18(3), 534-543. the TFR. If fertility levels have been falling, the TFR will however be (slightly) lower than the mean number of children ever born. Raj, A., Saggurti, N., Balaiah, D., & Silverman, J. G. (2009). For sample size reasons, we consider women ages 35 to 49 to Prevalence of child marriage and its effect on fertility and fertility- estimate the number of children ever born, rather than women control outcomes of young women in India: a cross-sectional, ages 40-49. This does not affect our results substantially given observational study. The Lancet, 373(9678), 1883-1889. the focus on the differential impact of child marriage Santhya, K. G. (2011). Early marriage and sexual and As for the regression analysis, given that the variable of interest reproductive health vulnerabilities of young women: a synthesis is a count variable (taking values such as 1, 2, 3…), Poisson of recent evidence from developing countries. Current opinion in regressions are estimated. Different models are estimated to obstetrics and gynecology, 23(5), 334-339. test for the robustness of findings to the specification used. Apart from the age at first marriage or union, the baseline model Santhya, K. G., Ram, U., Acharya, R., Jejeebhoy, S. J., Ram, F., controls for: (1) location (urban versus rural); (2) education level & Singh, A. (2010). Associations between early marriage and of the girl/woman; (3) wealth quintile (from the poorest to the young women's marital and reproductive health outcomes: richest); (4) religion; (5) geographic area; and (6) age group (35- evidence from India. International perspectives on sexual and 39, 40-44, and 45-49). In other models variables capturing reproductive health, 132-139. agency for girls/women in the household and additional community-level controls are added. The community variables Annex: Methodological Note are the leave-out-means of contraceptive use and whether women experienced a child death before the age of five (leave- Previous research has been conducted on child marriage and out-means are estimated at the level of the primary sampling fertility (e.g., Santhya, 2011; Kamal, 2012; Godha et al., 2013; units in the survey). Overall, the estimated impacts of early Nasrullah et al., 2013; Kamal et al. 2015). This brief has three marriage on the number of births for women over their lifetime features that differentiate it from previous work. First, the impact are fairly robust to the choice of 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