Research into the effect of child marriage on intergenerational healthcare investments is limited. Numerous studies have identified a negative correlation between early marriage and compromised child health and educational outcomes (Bruce, 2003; Clark, 2004; Nour, 2006; Raj et al., 2009; Santhya et al., 2010). However, there is limited focus on the causal impact of child marriage on offspring health, and so it is necessary to draw inspiration from the wider child marriage literature.
The major problem with identifying a causal effect is endogeneity: there are often unobservables affecting both underage marriage, child health and healthcare utilisation. Sekhri and Debnath (2014) explain this precisely, giving the example of an altruistic father who wants to both invest in the wellbeing of his children, and who has a preference for marrying an appropriately aged female. In this example, the preferences of the altruistic father may drive increased child healthcare investment, rather than the age of the mother. Field and Ambrus (2008) provided the seminal approach in overcoming this problem, using age of menarche to provide exogenous variation in child marriage through the instrumental variable approach, subsequently demonstrating that child marriage reduces the education of the women within these unions. The reasoning behind the use of this instrument originates from the sociological observation that parents become anxious to marry their daughter once she reaches menarche (Caldwell et al., 1983; Srinivas, 1984).
Both Chari et al. (2017) and Sekhri and Debnath (2014) exploit this empirical strategy when investigating the causal effect of maternal age at marriage on child outcomes, and more specifically on child educational attainment. Using nationally representative household survey data from India, Chari et al. (2017) find that a one-year delay in marriage increases the probability of school enrolment by 3.1%. Sekhri and Debnath (2014) pay more consideration to the role of income, through its effect on improving nutrition, in early menarche. To ensure that age at menarche provides the appropriate exogenous variation in age at marriage, this instrument is conditioned upon nutritional status of the mother. Using the mother0s height as a proxy for their childhood nutrition, the authors find that a delay in the mother0s age of marriage of one year increases the probability to the child completing the most challenging reading and arithmetic tasks by 3.5 percentage points. Although this literature does not provide direct insight into the effect of child marriage on offspring health, it is a useful demonstration of exploiting age at menarche as an instrument for child marriage.
Delprato and Akyeampong (2017) provide some of the only insight into the inter-generational effects of child marriage on health. Using Demographic and Health Survey (DHS) data covering 39 countries, the authors use propensity score matching to compare health outcomes between the children of mothers married at ages 10 to 14, 15 to 17 and 18 or over. Conducting regressions on these matched sub-samples indicated that infant mortality and stunting were between 1% and 3% lower for mothers married between the ages of 15 and 17 than those married between 10 and 14. It is believed that intra-household bargaining power regarding healthcare decisions is an important mediating factor in this relationship.
Raj et al. (2010) use the Indian National Family Health Survey to assess associations between maternal child marriage and the morbidity and mortality of infants and children under 5. This analysis was conducted using logistic regressions, and considered a range of child health outcomes, such as infectious disease and diarrhoea in the past two weeks and data on nutritional health. The findings suggested that the children born to mothers married as minors are significantly more likely to experience malnutrition than those born to women married as adults. However, these results should be interpreted with caution, considering that no attempt seemed to be made to relieve the endogeneity bias inherent in the relationship between child marriage and offspring health.
One of the mediating channels between child marriage and offspring health can be explained by the quantity-versusquality trade off, under which Becker (1960) posits that families face a choice between increased fertility with reduced investment in each child, versus reduced fertility with increased investment in each child. Following this reasoning, if child marriage has an effect on total fertility, it may subsequently impact upon offspring health. Both Onagoruwa and Wodon (2012) and Nasrullah et al. (2014) use logistic regression analyses to examine the relationship between child marriage and fertility, finding that child marriage has a significant effect on increasing total fertility. This does not provide direct insight into the effect of child marriage on offspring health, but may help explain the mediating channels driving this relationship.
From this review of the literature, it becomes apparent that research into this area is scarce. Of the literature that assesses this relationship, there is no consensus on the empirical approach. Within the wider literature, age at menarche is commonly used to instrument for child marriage. The aim of this paper is to exploit this estimation strategy in an attempt to find the causal effect of child marriage on offspring health, whilst also assessing the validity of this instrument.
Becker, G.S., 1960. An economic analysis of fertility. In Demographic and economic change in developed countries (pp. 209-240). Columbia University Press. Bruce, J., 2003. Married adolescent girls: human rights, health, and developmental needs of a neglected majority. Economic and Political Weekly, pp.4378-4380
Caldwell, J.C., Reddy, P.H. and Caldwell, P., 1983. The causes of marriage change in South India. Population studies, 37(3), pp.343-361.
Chari, A.V., Heath, R., Maertens, A. and Fatima, F., 2017. The causal effect of maternal age at marriage on child wellbeing: Evidence from India. Journal of Development Economics, 127, pp.42-55.
Delprato, M. and Akyeampong, K., 2017. The effect of early marriage timing on women's and children's health in subSaharan Africa and Southwest Asia. Annals of global health, 83(3-4), pp.557-567.
Field, E. and Ambrus, A., 2008. Early marriage, age of menarche, and female schooling attainment in Bangladesh. Journal of political Economy, 116(5), pp.881-930.
Nasrullah, M., Muazzam, S., Bhutta, Z.A. and Raj, A., 2014. Girl child marriage and its effect on fertility in Pakistan: findings from Pakistan Demographic and Health Survey, 2006–2007. Maternal and child health journal, 18(3), pp.534-543.
Nour, N.M., 2006. Health consequences of child marriage in Africa. Emerging infectious diseases, 12(11), p.1644.
Onagoruwa, A. and Wodon, Q., 2017. Child Marriage and Fertility in Bangladesh.
Raj, A., Saggurti, N., Balaiah, D. and Silverman, J.G., 2009. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. The Lancet, 373(9678), pp.18831889.
Raj, A., Saggurti, N., Winter, M., Labonte, A., Decker, M.R., Balaiah, D. and Silverman, J.G., 2010. The effect of maternal child marriage on morbidity and mortality of children under 5 in India cross sectional study of a nationally representative sample. BMJ, 340, p.b4258.
Santhya, K.G., Ram, U., Acharya, R., Jejeebhoy, S.J., Ram, F. and Singh, A., 2010. Associations between early marriage and young women's marital and reproductive health outcomes: evidence from India. International perspectives on sexual and reproductive health, pp.132-139.
Sekhri, S. and Debnath, S., 2014. Intergenerational consequences of early age marriages of girls: Effect on childrenâĂŹs human capital. The Journal of Development Studies, 50(12), pp.1670-1686.
Srinivas, M.N., 1984. Some reflections on dowry (No. 1983). Centre for Women's Development Studies, New Delhi.
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