Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN BURKINA FASO Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in Burkina Faso. The share of women ages 18-22 who had a child before 18 is 25.2 percent and it has decreased only slightly over time. The share of girls who had a child before the age of 15, at under two percent, also decreased slightly.  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 Burkina Faso. 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  A fourth of women have an early childbirth. The consequences of early childbirth for girls and their children are not the same whether girls have a child at 12 The analysis relies on data from the latest Demographic or 17. Measures inspired from the poverty literature help and Health Survey (DHS) for Burkina Faso for 2010, the in capturing how early girls have children (see the annex). latest DHS available. Table 1 provides basic statistics on The headcount (H) measures the share of girls with an the age at first birth. Two samples are considered: women early childbirth. The early childbirth gap (ECG) measures ages 18 to 22, the youngest age group that can be used the “depth” of early childbirth, taking into account how to measure early childbirth1 and women 18-49 (the early girls have children. The squared gap (SG) puts even women’s questionnaire in the DHS collects data for more weight on the girls who have children very early. women up to age 49). A fourth of women have their first child before 18, and two percent do so before 15. There is Early childbirths have decreased over time. a decrease in the mean age at first birth between the 18- 49 sample and the 18-22 sample. This is in part because Table 3 provides trends over time in the measures of many women ages 18 to 22 did not yet has a birth. early childbirth inspired by the poverty literature. Consider Table 1: Age at First Birth for Women (%) first the age group 18-22. In that age group, one quarter 18-22 years 18-49 years of women had their first child before the age of 18 (25.2 No live birth 41.0 12.7 percent for the 18-22 age group). The early childbirth gap 18 or Above 33.9 59.0 (CBG) is at 2.6 percent and the squared gap ( SG) at 0.4 12 0.1 0.2 percent for that group. By estimating the same measures 13 0.5 0.6 on older groups, the table provides the trend in early 14 1.2 1.8 childbirth over time. There has been a reduction over time 15 3.8 4.7 in early childbirth, especially in recent years, but this 16 8.4 8.5 decrease is not large. In other words, as for child 17 11.1 12.6 marriage, the early childbirth trends have been reduced Total 100.0 100.0 only slightly over the time. There has also been a Mean age at first birth 17.7 19.1 Source: Authors’ estimation. reduction in childbirth before the age of 152. Most early childbirths take place after marriage. Table 3: Trend in Early childbirth (%) 18 years 15 years In Burkina Faso, there is a strong relationship between H CMG SG H CMG SG All 18-49 years 28.4 3.1 0.4 2.6 0.2 - the age at first birth and the age at first marriage as Age group communities do not look favorably at births out of 18-22 years 25.2 2.6 0.4 1.8 0.2 - wedlock. Table 2 displays the shares of girls with an early 23-30 years 30.1 3.2 0.4 2.8 0.2 - childbirth according to four categories in terms of the 31-40 years 29.1 3.2 0.5 3.0 0.3 - timing (or absence) of marriage among women ages 18- 41-49 years 27.7 3.0 0.4 2.6 0.3 - 22. Most early childbirths take place after marriage, hence Source: Authors’ estimation. Values rounding to 0.0 not shown. delaying the age at marriage is essential to avoid early childbirth. The incidence of early childbirth in Burkina Faso in 2010 was lower than that observed 25 years ago. There has Table 2: Marriage and Early Childbirth, Age 18-22 (%) been a slight decrease in how early girls have children. Share Early childbirth without marriage 3.0 Early childbirth before marriage 4.2 Girls are more likely to have children early if they live Early childbirth in the same year as marriage 16.1 in rural areas and are from poorer backgrounds. Early childbirth at least one year after marriage 76.8 Total 100.0 As expected, early childbirth is much more prevalent in Source: Authors’ estimation. rural than in urban areas. There are also large differences between regions, with the lowest measures observed in the Central region, and the highest measures observed (according to the headcount index with the 18 years threshold) in the Sahel, East, and North regions. Early childbirth is less prevalent in Central Plateau. The ranking 1 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  the regions in terms of the measures obtained with the of Early childbirth is associated with lower education 15 and 18 years thresholds tends to be similar. attainment, lower likelihood of literacy, and higher labor force participation. Table 4: Early childbirth by Location, Age 18-22 (%) 18 years 15 years Table 6 provides data on early childbirth by level of H CMG SG H CMG SG education of the women, as well as literacy. Early All 18-22 years 25.2 2.6 0.4 1.8 0.2 - childbirth affects education attainment negatively, Region because girls often drop out of school when they have Boucle de Mouhoun 26.3 2.7 0.4 1.0 0.2 - their first child. The causality goes the other way as well, Cascades 28.4 3.0 0.4 1.5 0.1 - as the ability to pursue one’s education may help delay Central 7.3 0.7 0.1 0.6 0.0 - the age at marriage and thereby the age at first birth. As West-Center 24.0 2.0 0.2 0.9 0.1 - North-Center 22.3 2.1 0.2 0.4 0.1 - seen in table 6, early childbirth measures are strongly West-Center 22.0 1.9 0.2 0.3 0.0 - correlated with education levels. The same is observed South-Center 24.0 2.3 0.3 1.7 0.2 - when considering literacy where three categories are East 38.2 4.7 0.7 5.9 0.6 0.1 considered: the woman cannot read at all, can read part Hauts Basins 28.7 3.1 0.4 2.6 0.2 - of a sentence, or can read a full sentence. North 29.5 2.9 0.4 1.9 0.1 - Central Plateau 20.0 2.1 0.3 1.5 0.1 - Table 6: Early childbirth by Education Level and Sahel 46.7 5.5 0.8 4.3 0.4 - Literacy Status, Age 18-22 (%) South-West 32.0 3.1 0.4 0.8 0.1 - Residence 18 years 15 years Urban 11.7 1.1 0.1 0.8 0.1 - H CMG SG H CMG SG Rural 31.5 3.3 0.5 2.3 0.2 - All 18-22 years 25.2 2.6 0.4 1.8 0.2 - Source: Authors’ estimation. Values rounding to 0.0 not shown. Education No education 32.5 3.5 0.5 2.6 0.2 - Primary, some 18.4 1.7 0.2 0.6 0.1 - Rural girls are much more likely to have children early Primary, compl. 17.2 1.5 0.1 - - - than urban girls. Girls from the bottom four quintiles of Secondary, some 5.1 0.5 0.1 0.4 - - wealth are also more likely to have children early. The Secondary, compl. - - - - - - relationship between early childbirth, literacy, and Higher - - - - - - education attainment is strong. Early childbirth measures Literacy are higher for women who work. Cannot read 31.4 3.3 0.4 2.3 0.2 - Limited ability 18.1 1.8 0.2 0.2 - - Full sentence 7.4 0.7 0.1 0.5 - - Household welfare is measured through a wealth index No card available 35.2 4.6 0.7 6.8 0.5 - 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. Early women married, not that of the household or origin. Yet childbirth could reduce women’s labor force participation, the quintile of wealth after marriage and first birth may not for example through higher fertility. But if early childbirth is be very different from that of the household of origin. On associated with poverty, women may leave little choice the other hand, since early childbirth measures are based but to work. Other effects could also be at work. In on young women ages 18-22, their level of assets may be Burkina Faso, early childbirth measures are higher among lower than would be the case later in life. In any case, the women working, but the type of work associated most measures of early childbirth differ by quintile, but it is only closely with early childbirth is work with payment in both with the top quintile that early childbirth is much less cash and kind, which may be work with low productivity. prevalent. Table 7: Early childbirth by Labor Force Participation Table 5: Early childbirth by Quintile, Age 18-22 (%) Status, Age 18-22 (%) 18 years 15 years 18 years 15 years H CMG SG H CMG SG H CMG SG H CMG SG All 18-22 years 25.2 2.6 0.4 1.8 0.2 - All 18-22 years 25.2 2.6 0.4 1.8 0.2 - Wealth quintiles Working Poorest 40.0 4.7 0.7 4.5 0.4 - No 19.7 2.3 0.3 2.0 0.2 - Poorer 32.7 3.5 0.5 1.7 0.1 - Yes 27.3 2.8 0.4 1.8 0.2 - Middle 27.4 2.8 0.4 1.6 0.2 - Type of work Richer 26.8 2.5 0.3 1.7 0.2 - Not paid 27.9 2.8 0.4 1.9 0.2 - Richest 11.3 1.1 0.1 0.8 0.1 - Cash only 24.9 2.5 0.3 1.4 0.1 - Source: Authors’ estimation. Values rounding to 0.0 not shown. Cash and in-kind 35.5 3.8 0.5 3.1 0.3 - In-kind only 23.4 2.2 0.2 0.7 - - Source: Authors’ estimation. Values rounding to 0.0 not shown. Page 3 HNPGP Knowledge Brief  Conclusion The early childbirth gap represents the “depth” of early childbirth. It takes into account not only the share of girls who had their first This brief has provided a basic profile of early childbirth in child early, but also the mean number of years below 18 (or 15) Burkina Faso. Measures of early childbirth are high. The at which girls had their first child. This matters because even if share of women ages 18-22 who had their first child the share of girls who have their first child early does not change, there may still be improvements in the early childbirth before 18 is 25.2 percent and it has decreased slightly gap if girls who have their first child early have that child a little over time. The share of women with their first child before less early. 15 is at just under 2 percent. Early childbirth is associated with lower wealth and lower education levels, and Finally, the squared early childbirth gap measures the “severity” employment with payment both in cash and kind. These of early childbirth. While the early childbirth gap takes into are however only correlations, not necessarily causal account the average number of years of early marriage for girls effects. Other briefs in this series look at potential causal who have their first child early, the squared gap takes into effects. account the square of that number, thereby putting more emphasis on girls who have their first child very early. Together the three measures provide a better diagnostic of early childbirth References than the headcount index alone. The measures also have attractive properties that are beyond the scope of this brief. Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of Decomposable Poverty Measures, Econometrica 52: 761–776. The headcount index, early childbirth gap, and squared gap are the first three measures of the so-called FGT class (Foster et al., Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, 2014). Denote by q the number of girls who have their first child Economics Bulletin, 32(1): 398-411. early and by n the number of girls in the overall population. Denote by yi the age at which girl i had her first child and by z Annex: Methodological Note the age threshold defining early childbirth (18 years of age, but a lower age threshold such as 15 can also be used to measure While many studies have discussed trends in child marriage, extremely early childbirth). The general formula for the FGT less work has been done on trends in early childbirth. When class of measures depends on a parameter α which takes a conducted, measurement of early childbirth (or early pregnancy) value of zero for the headcount, one for the early childbirth gap, has focused on one simple statistic such as the share of girls and two for the squared gap in: who have a live birth before the age of 18 or 15. Such statistics  1 q  z  yi  are useful, but they do not capture well the distribution of the age at first birth in the form of aggregate statistics that tell us P   z  n i1   about the depth and severity of the problem. Basic statistics on the share of girls having an early childbirth also do not facilitate testing for the robustness of comparisons of trends in early This brief was produced as part of the Economic Impacts of Child childbirth between countries, between groups within countries, Marriage study, a joint project of the International Center for Research or between time periods. on Women (ICRW) and the World Bank, which is supported by the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation (CIFF). More details on the research can be found at the Following the approach used by Ngyuen and Wodon (2012) for project’s website: www.costsofchildmarriage.org. Partial funding for the child marriage, this brief and its companion paper (available on work related to child marriage and education, labor force participation, request) rely on methods from the poverty literature to measure earnings, and program responses has been provided by the Global early childbirth. Three measures are used: the incidence of early Partnership for Education. Comments from Jeff Edmeades and Michele childbirth or headcount index, the early childbirth gap, and the Gragnolati are gratefully acknowledged. The opinions expressed in this squared early childbirth gap. The headcount index is simply the brief are those of the authors only and need not reflect the views of the share of the girls who have their first live birth before the age of World Bank, its Executive Directors, of the countries they represent. 18. The headcount index can be computed for other age thresholds, such as 15 years of 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