Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN MAURITANIA Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in Mauritania. The share of women ages 18-22 who had a child before 18 is 19.8 percent, but it has decreased over time. The share of girls who had a child before the age of 15, at 6.3 percent, has also decreased.  Early childbirth is associated with lower wealth, lower education levels, and employment without cash earnings. These are however only correlations, not necessarily causal effects. In order to design programs and policies to reduce the Box 1: Brief and Series Primer prevalence of early childbirth, information is needed on its How is child marriage defined? Child marriage is defined as a trend over time, where it is most prevalent in a country, marriage or union taking place before the age of 18. and what the characteristics of girls giving birth early are. Why a series on child marriage? Child marriage has Measuring early childbirth is needed to inform policy. significant negative impacts – not only for girls, but also for a range of development outcomes. Demonstrating these impacts Early pregnancy and childbirth are important issues in will assist governments and others to make the case for intervening to reduce the practice. many countries. Early childbirth is associated with higher health risks for the mother and the child as well as higher What are the topics discussed in the series? The series fertility. It may lead girls to drop out of school. In most looks at the impacts of child marriage on health, population, countries, most early childbirths take place after marriage. education, employment, agency, and violence, among other But in some countries, it may also often take place without outcomes. The welfare, budget, and non-monetary costs of child a marriage or union. To reduce the prevalence of early marriage are estimated. Legal/institutional aspects and options childbirth, specific programs and policies are required, for to reduce the practice are also discussed. which basic information is needed. Using techniques inspired by the poverty literature, this brief provides a What is the question asked in this brief? The question is: How widespread is early childbirth, not only in terms of the share basic profile of early childbirth in Mauritania. The brief of girls affected by it, but also in terms of how early births occur? documents the extent of early childbirth, its trend over time, in which areas it is most prevalent, and what some How is the question answered? Measures and a profile of of the characteristics of the girls affected by early early childbirth inspired by the literature on poverty are provided. childbirth are. The brief is part of a series of standardized briefs on this topic for several countries. Page 1 HNPGP Knowledge Brief  One fifth of women have an early childbirth. The consequences of early childbirth for girls and their The analysis relies on data from the latest Demographic children are not the same whether girls have a child at 12 and Health Survey (DHS) for Mauritania for 2000-01, the or 17. Measures inspired from the poverty literature help latest DHS available. While the data are now somewhat in capturing how early girls have children (see the annex). dated, they still provide valuable insights. Table 1 The headcount (H) measures the share of girls with an provides basic statistics on the age at first birth. Two early childbirth. The early childbirth gap (ECG) measures samples are considered: women ages 18 to 22, the the “depth” of early childbirth, taking into account how youngest age group that can be used to measure early early girls have children. The squared gap (SG) puts even childbirth1 and women 18-49 (the women’s questionnaire more weight on the girls who have children very early. in the DHS collects data for women up to age 49). One in every five women has their first child before 18, and six Early childbirths have decreased over time. percent do so before 15. There is a decrease in the mean age at first birth between the 18-49 sample and the 18-22 Table 3 provides trends over time in the measures of sample. This is in large part because many women ages 18 to 22 did not yet has a birth, but it also suggests a early childbirth inspired by the poverty literature. Consider decrease in early childbirth over time. first the age group 18-22. In that age group, one fifth of women had their first child before the age of 18 (19.8 Table 1: Age at First Birth for Women (%) percent for the 18-22 age group). The early childbirth gap 18-22 years 18-49 years (CBG) is at 3.1 percent and the squared gap (SG) at 0.7 No live Birth 65.2 29.7 percent for that group. By estimating the same measures 18 or Above 15.0 42.9 on older groups, the table provides the trend in early Below 12 0.4 1.1 childbirth over time. There has been a decrease over time 12 1.1 2.9 in early childbirth. In other words, as for child marriage, 13 1.9 2.8 early childbirth has been reduced over time. The same is 14 2.9 3.6 observed when considering very early childbirth before 15 4.0 4.6 the age of 152. 16 4.3 5.8 17 5.1 6.7 Table 3: Trend in Early childbirth (%) Total 100.0 100.0 Mean age at first birth 16.9 19.2 18 years 15 years Source: Authors’ estimation. H CMG SG H CMG SG All 18-49 years 27.4 4.7 1.1 10.4 1.5 0.3 Age group Most early childbirths take place after marriage. 18-22 years 19.8 3.1 0.7 6.3 0.8 0.1 23-30 years 26.5 4.6 1.1 9.9 1.4 0.3 In Mauritania, there is a strong relationship between the 31-40 years 32.5 5.7 1.3 12.9 1.8 0.3 age at first birth and the age at first marriage as 41-49 years 33.2 6.2 1.5 13.9 2.2 0.4 communities do not look favorably at births out of Source: Authors’ estimation. wedlock. Table 2 displays the shares of girls with an early childbirth according to four categories in terms of the The incidence of early childbirth in Mauritania in 2000-01 timing (or absence) of marriage among women ages 18- was lower than that observed 25 years ago. There has 22. Most early childbirths take place after marriage, hence been a decrease over time in how early girls have delaying the age at marriage is essential to avoid early children. childbirth. Table 2: Marriage and Early Childbirth, Age 18-22 (%) Girls are more likely to have children early if they live in rural areas and are from poorer backgrounds. Share Early childbirth without marriage - Early childbirth before marriage 0.5 As expected, early childbirth is much more prevalent in Early childbirth in the same year as marriage 14.2 rural than in urban areas. There are also large differences Early childbirth at least one year after marriage 85.3 between regions, with the lowest measures observed in Total 100.0 the Center zone, and the highest measures observed Source: Authors’ estimation. Values rounding to 0.0 not shown. (according to the headcount index with the 18 years threshold) in the River zone. Early childbirth is also less 1 prevalent in the North zone. The ranking of the regions in Early childbirth measures must be estimated on the population older than 18, because some younger girls who did not yet have a child by 18 could still have a child by the time they reach 18. It 2 is best to measure early childbirth as early as possible after the Note that the various measures have standard errors (not age of 18 to provide data on conditions as current as possible, shown here to save space). While some of the differences in the which is why the age bracket 18-22 is used here. trends over time are statistically significant, some are not. Page 2 HNPGP Knowledge Brief  terms of the measures obtained with the 15 and 18 years their first child. The causality goes the other way as well, thresholds changes a bit depending on the threshold. as the ability to pursue one’s education may help delay the age at marriage and thereby the age at first birth. As Table 4: Early childbirth by Location, Age 18-22 (%) seen in table 6, early childbirth measures are strongly 18 years 15 years correlated with education levels. The same is observed H CMG SG H CMG SG when considering literacy where three categories are All 18-22 years 19.8 3.1 0.7 6.3 0.8 0.1 considered: the woman cannot read at all, can read part Region of a sentence, or can read a full sentence. Nouakchott 18.5 2.6 0.5 5.0 0.6 0.1 South zone (g1) 19.6 2.8 0.5 5.6 0.6 0.1 Table 6: Early childbirth by Education Level and River zone (g2) 23.0 3.9 0.9 7.8 1.0 0.2 North zone (g3) 16.5 2.4 0.5 4.4 0.6 0.1 Literacy Status, Age 18-22 (%) Center zone (g4) 15.9 3.1 0.8 7.7 1.1 0.2 18 years 15 years Residence H CMG SG H CMG SG Urban 19.4 2.9 0.6 5.3 0.6 0.1 All 18-22 years 19.8 3.1 0.7 6.3 0.8 0.1 Rural 20.1 3.3 0.7 7.1 1.0 0.2 Education Source: Authors’ estimation. No education 27.4 4.6 1.0 9.8 1.3 0.2 Coranic 23.9 3.9 0.8 8.9 1.0 0.1 Primary,some 21.1 3.1 0.6 5.1 0.5 0.1 Rural girls are much more likely to have children early Primary, compl. 17.9 3.3 0.8 7.2 1.1 0.2 than urban girls. Girls from the bottom four quintiles of Secondary, some 5.8 0.6 0.1 1.1 0.2 - wealth are also more likely to have children early. The Secondary,compl. 11.5 1.5 0.3 1.5 0.2 - relationship between early childbirth, literacy, and Higher 12.3 1.4 0.2 - - - education attainment is strong. Early childbirth measures Literacy are higher for women who work. Cannot read 24.9 4.1 0.9 8.6 1.1 0.2 Limited ability 24.8 4.2 0.9 9.5 1.0 0.1 Full sentence 9.4 1.2 0.2 1.8 0.2 - Household welfare is measured through a wealth index No card available 60.8 7.6 1.2 6.7 0.9 0.1 with households categorized according to five quintiles of Source: Authors’ estimation. Values rounding to 0.0 not shown. wealth. Women who had a birth tend to be married, hence the level of wealth is that of the household in which the Table 7 provides data on labor force participation. One women married, not that of the household or origin. Yet would expect early childbirth to reduce women’s labor the quintile of wealth after marriage and first birth may not force participation, for example through higher fertility. But be very different from that of the household of origin. On if early childbirth is associated with poverty, women may the other hand, since early childbirth measures are based leave little choice but to work. Other effects could also be on young women ages 18-22, their level of assets may be at work. In Mauritania, early childbirth measures are lower than would be the case later in life. In any case, the higher among women who work. measures of early childbirth differ by quintile, but it is only with the top quintile that early childbirth is much less Table 7: Early childbirth by Labor Force Participation prevalent. Status, Age 18-22 (%) 18 years 15 years Table 5: Early childbirth by Quintile, Age 18-22 (%) H CMG SG H CMG SG 18 years 15 years All 18-22 years 19.8 3.1 0.7 6.3 0.8 0.1 H CMG SG H CMG SG Working All 18-22 years 19.8 3.1 0.7 6.3 0.8 0.1 No 18.4 2.9 0.6 6.0 0.8 0.1 Wealth quintiles Yes 23.9 3.7 0.8 7.2 0.8 0.1 Poorest 22.8 4.0 0.9 8.7 1.2 0.2 Earns cash for work Poorer 26.3 4.1 0.8 8.0 0.9 0.1 No 24.3 4.4 1.0 9.2 1.1 0.2 Middle 18.3 2.8 0.6 4.5 0.6 0.1 Yes 24.0 3.5 0.7 6.5 0.7 0.1 Richer 20.0 2.9 0.6 5.9 0.7 0.1 Source: Authors’ estimation. Richest 7.3 1.1 0.2 2.5 0.3 - Source: Authors’ estimation. Values rounding to 0.0 not shown. Conclusion Early childbirth is associated with lower education This brief has provided a basic profile of early childbirth in attainment, lower likelihood of literacy, and higher Mauritania. Measures of early childbirth are high. The labor force participation. share of women ages 18-22 who had their first child before 18 is 19.8 percent and it has decreased over time. Table 6 provides data on early childbirth by level of The share of women with their first child before 15 is at education of the women, as well as literacy. Early 6.3 percent. Early childbirth is associated with lower childbirth affects education attainment negatively, wealth and lower education levels, and employment because girls often drop out of school when they have without cash earnings. These are however only Page 3 HNPGP Knowledge Brief  correlations, not necessarily causal effects. Other briefs in gap if girls who have their first child early have that child a little this series look at potential causal effects. less early. References Finally, the squared early childbirth gap measures the “severity” of early childbirth. While the early childbirth gap takes into account the average number of years of early marriage for girls Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of who have their first child early, the squared gap takes into Decomposable Poverty Measures, Econometrica 52: 761–776. account the square of that number, thereby putting more emphasis on girls who have their first child very early. Together Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, the three measures provide a better diagnostic of early childbirth Economics Bulletin 32(1): 398-411. than the headcount index alone. The measures also have attractive properties that are beyond the scope of this . Annex: Methodological Note The headcount index, early childbirth gap, and squared gap are While many studies have discussed trends in child marriage, the first three measures of the so-called FGT class (Foster et al., less work has been done on trends in early childbirth. When 2014). Denote by q the number of girls who have their first child conducted, measurement of early childbirth (or early pregnancy) early and by n the number of girls in the overall population. has focused on one simple statistic such as the share of girls Denote by yi the age at which girl i had her first child and by z who have a live birth before the age of 18 or 15. Such statistics the age threshold defining early childbirth (18 years of age, but a are useful, but they do not capture well the distribution of the lower age threshold such as 15 can also be used to measure age at first birth in the form of aggregate statistics that tell us extremely early childbirth). The general formula for the FGT about the depth and severity of the problem. Basic statistics on class of measures depends on a parameter α which takes a the share of girls having an early childbirth also do not facilitate value of zero for the headcount, one for the early childbirth gap, testing for the robustness of comparisons of trends in early and two for the squared gap in: childbirth between countries, between groups within countries,  1 q  z  yi  P    or between time periods. Following the approach used by Ngyuen and Wodon (2012) for n i1  z   child marriage, this brief and its companion paper (available on request) rely on methods from the poverty literature to measure early childbirth. Three measures are used: the incidence of early This brief was produced as part of the Economic Impacts of Child childbirth or headcount index, the early childbirth gap, and the Marriage study, a joint project of the International Center for Research squared early childbirth gap. The headcount index is simply the on Women (ICRW) and the World Bank, which is supported by the Bill & share of the girls who have their first live birth before the age of Melinda Gates Foundation and the Children’s Investment Fund 18. The headcount index can be computed for other age Foundation (CIFF). More details on the research can be found at the thresholds, such as 15 years of age. project’s website: www.costsofchildmarriage.org. Partial funding for the work related to child marriage and education, labor force participation, earnings, and program responses has been provided by the Global The early childbirth gap represents the “depth” of early childbirth. Partnership for Education. Comments from Jeff Edmeades and Michele It takes into account not only the share of girls who had their first Gragnolati are gratefully acknowledged. The opinions expressed in this child early, but also the mean number of years below 18 (or 15) brief are those of the authors only and need not reflect the views of the at which girls had their first child. This matters because even if World Bank, its Executive Directors, of the countries they represent. the share of girls who have their first child early does not change, there may still be improvements in the early childbirth 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