Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN THE DEMOCRATIC REPUBLIC OF CONGO Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in the DRC. The share of women ages 18-22 who had a child before 18 is 25.6 percent and it has decreased only slightly over time. The share of girls who had a child before the age of 15, at four percent, has 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 the DRC. 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 DRC for 2013-14, the latest in capturing how early girls have children (see the annex). DHS available. Table 1 provides basic statistics on the The headcount (H) measures the share of girls with an 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). More than a fourth of women have their first child before 18, and four percent do so before Early childbirths have decreased over time. 15. There is a decrease in the mean age at first birth between the 18-49 sample and the 18-22 sample. This is Table 3 provides trends over time in the measures of in large part because many women ages 18 to 22 did not early childbirth inspired by the poverty literature. Consider yet has a birth, but it also suggests a decrease in early childbirth over time, as will be discussed below. first the age group 18-22. In that age group, more than one quarter of women had their first child before the age Table 1: Age at First Birth for Women (%) of 18 (25.6 percent for the 18-22 age group). The early 18-22 years 18-49 years childbirth gap (CBG) is at 3.1 percent and the squared No live Birth 45.05 16.9 gap (SG) at 0.5 percent for that group. By estimating the 18 or Above 29.35 55.5 same measures on older groups, the table provides the Below 12 0.06 0.1 trend in early childbirth over time. There has been a 12 0.67 0.8 decrease over time in early childbirth. In other words, as 13 1.01 1.5 for child marriage, early childbirth has been reduced over 14 2.61 2.9 time. The same is observed when considering very early 15 4.07 4.9 childbirth before the age of 152, but the reduction is small. 16 7.28 7.2 17 9.91 10.1 Table 3: Trend in Early childbirth (%) Total 100 100.0 Mean age at first birth 17.5 19.3 18 years 15 years Source: Authors’ estimation. H CMG SG H CMG SG All 18-49 years 27.6 3.6 0.6 5.4 0.6 0.1 Age group Most early childbirths take place after marriage. 18-22 years 25.6 3.1 0.5 4.3 0.5 0.1 23-30 years 26.3 3.5 0.6 5.2 0.6 0.1 In the DRC, there is a strong relationship between the age 31-40 years 28.6 3.7 0.7 5.7 0.6 0.1 at first birth and the age at first marriage as communities 41-49 years 32.6 4.3 0.8 6.9 0.8 0.1 do not look favorably at births out of wedlock. Table 2 Source: Authors’ estimation. displays the shares of girls with an early childbirth according to three categories in terms of the timing (or The incidence of early childbirth in the DRC in 2013-14 absence) of marriage among women ages 18-22. Most was lower than that observed 25 years ago. There has early childbirths take place after marriage, hence delaying been a decrease over time in how early girls have the age at marriage is essential to avoid early childbirth. children. Table 2: Marriage and Early Childbirth, Age 18-22 (%) Girls are more likely to have children early if they live Share Early childbirth without marriage 12.6 in rural areas and are from poorer backgrounds. Early childbirth before marriage 8.8 Early childbirth in the same year as marriage 18.8 As expected, early childbirth is much more prevalent in Early childbirth at least one year after marriage 59.8 rural than in urban areas. There are also large differences Total 100.0 between regions, with the lowest measures observed in Source: Authors’ estimation. the capital city of Kinshasa, and the highest measures observed (according to the headcount index with the 18 years threshold) in the Equateur, Bas-Congo, and Maniema regions. Early childbirth is less prevalent in 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  Bandundu. The ranking of the regions in terms of the Early childbirth is associated with lower education measures obtained with the 15 and 18 years is 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 25.6 3.1 0.5 4.3 0.5 0.1 childbirth affects education attainment negatively, Province because girls often drop out of school when they have Kinshasa 13.2 1.5 0.3 1.7 0.3 - their first child. The causality goes the other way as well, Bandundu 18.8 2.3 0.4 3.6 0.4 - as the ability to pursue one’s education may help delay Bas-Congo 33.8 3.6 0.5 2.3 0.2 - the age at marriage and thereby the age at first birth. As Equateur 34.6 4.0 0.7 6.1 0.6 0.1 seen in table 6, early childbirth measures are strongly Kasai-Occidental 28.2 3.2 0.5 2.8 0.2 - Kasai-Oriental 22.2 2.7 0.5 3.6 0.4 0.1 correlated with education levels. The same is observed Katanga 26.9 3.1 0.5 4.7 0.5 0.1 when considering literacy where three categories are Maniema 33.1 4.1 0.7 5.3 0.6 0.1 considered: the woman cannot read at all, can read part Nord-Kivu 24.2 3.2 0.6 4.2 0.5 0.1 of a sentence, or can read a full sentence. Orientale 31.6 4.5 0.9 8.0 0.9 0.1 Sud-Kivu 28.4 3.5 0.5 4.1 0.3 - Table 6: Early childbirth by Education Level and Residence Literacy Status, Age 18-22 (%) Urban 19.0 2.3 0.4 3.2 0.3 - 18 years 15 years Rural 29.8 3.7 0.6 5.1 0.5 0.1 H CMG SG H CMG SG Source: Authors’ estimation. Values rounding to 0.0 not shown. All 18-22 years 25.6 3.1 0.5 4.3 0.5 0.1 Education Rural girls are much more likely to have children early No education 37.1 5.4 1.0 10.3 1.1 0.1 than urban girls. Girls from the bottom four quintiles of Some primary 36.8 4.9 0.9 8.2 0.9 0.1 wealth are also more likely to have children early. The Primary compl. 36.3 4.3 0.6 3.4 0.3 - relationship between early childbirth, literacy, and Some secondary 20.7 2.1 0.3 1.9 0.2 - Secondary compl. 9.7 1.3 0.2 1.8 0.2 - education attainment is strong. Early childbirth measures Higher 4.5 0.5 0.1 0.9 0.1 - are higher for women who work. Literacy Cannot read 38.1 5.4 1.0 9.8 1.1 0.1 Household welfare is measured through a wealth index Limited ability 35.1 3.9 0.5 3.3 0.3 - with households categorized according to five quintiles of Full sentence 19.0 2.1 0.3 2.1 0.2 - wealth. Women who had a birth tend to be married, hence No card available 73.0 12.9 2.6 40.0 2.7 0.2 the level of wealth is that of the household in which the Source: Authors’ estimation. Values rounding to 0.0 not shown. women married, not that of the household or origin. Yet Table 7 provides data on labor force participation. One the quintile of wealth after marriage and first birth may not would expect early childbirth to reduce women’s labor be very different from that of the household of origin. On force participation, for example through higher fertility. But the other hand, since early childbirth measures are based if early childbirth is associated with poverty, women may on young women ages 18-22, their level of assets may be leave little choice but to work. Other effects could also be lower than would be the case later in life. In any case, the at work. In DRC, early childbirth measures are higher measures of early childbirth differ by quintile, but it is only among women who work. However, the type of work with the top two quintiles that early childbirth is much less associated most closely with early childbirth is work prevalent. without payment at least in part in kind, which may be work with low productivity. Table 5: Early childbirth by Quintile, Age 18-22 (%) 18 years 15 years Table 7: Early childbirth by Labor Force Participation H CMG SG H CMG SG Status, Age 18-22 (%) All 18-22 years 25.6 3.1 0.5 4.3 0.5 0.1 18 years 15 years Wealth quintiles H CMG SG H CMG SG Poorest 34.1 4.5 0.8 7.3 0.7 0.1 Poorer 26.6 3.2 0.5 4.5 0.5 0.1 All 18-22 years 25.6 3.1 0.5 4.3 0.5 0.1 Middle 30.3 3.7 0.6 5.5 0.5 0.1 Working Richer 24.0 2.9 0.4 2.3 0.3 - No 16.7 2.0 0.3 2.5 0.3 - Richest 16.7 2.0 0.3 2.8 0.3 - Yes 31.3 3.9 0.7 5.5 0.6 0.1 Type of work Source: Authors’ estimation. Values rounding to 0.0 not shown. Not paid 18.0 2.2 0.4 3.4 0.4 - Cash only 28.4 3.6 0.6 4.3 0.5 0.1 Cash and in-kind 36.8 4.5 0.8 6.6 0.7 0.1 In-kind only 32.7 4.3 0.8 7.9 0.8 0.1 Source: Authors’ estimation. Values rounding to 0.0 not shown. Page 3 HNPGP Knowledge Brief  Conclusion child early, but also the mean number of years below 18 (or 15) at which girls had their first child. This matters because even if This brief has provided a basic profile of early childbirth in the share of girls who have their first child early does not the DRC. Measures of early childbirth are high. The share change, there may still be improvements in the early childbirth gap if girls who have their first child early have that child a little of women ages 18-22 who had their first child before 18 is less early. 25.6 percent and it has decreased over time. The share of women with their first child before 15 is at four percent. Finally, the squared early childbirth gap measures the “severity” Early childbirth is associated with lower wealth and lower of early childbirth. While the early childbirth gap takes into education levels, and employment without cash earnings. account the average number of years of early marriage for girls These are however only correlations, not necessarily who have their first child early, the squared gap takes into causal effects. Other briefs in this series look at potential account the square of that number, thereby putting more causal effects. emphasis on girls who have their first child very early. Together the three measures provide a better diagnostic of early childbirth than the headcount index alone. The measures also have References attractive properties that are beyond the scope of this brief. Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of The headcount index, early childbirth gap, and squared gap are Decomposable Poverty Measures, Econometrica 52: 761–776. the first three measures of the so-called FGT class (Foster et al., 2014). Denote by q the number of girls who have their first child Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, early and by n the number of girls in the overall population. Economics Bulletin 32(1): 398-411. Denote by yi the age at which girl i had her first child and by z the age threshold defining early childbirth (18 years of age, but a Annex: Methodological Note lower age threshold such as 15 can also be used to measure extremely early childbirth). The general formula for the FGT While many studies have discussed trends in child marriage, class of measures depends on a parameter α which takes a less work has been done on trends in early childbirth. When value of zero for the headcount, one for the early childbirth gap, conducted, measurement of early childbirth (or early pregnancy) and two for the squared gap in: has focused on one simple statistic such as the share of girls  1 q  z  yi  P    who have a live birth before the age of 18 or 15. Such statistics n i1  z  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  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 early childbirth gap represents the “depth” of early childbirth. It takes into account not only the share of girls who had their first 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