Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN INDONESIA Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are moderate in Indonesia. The share of women ages 18-22 who had a child before 18 is 6.4 percent and it has decreased over time. The share of girls who had a child before the age of 15, less than one 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 Indonesia. 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  Six percent 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 Indonesia for 2012, 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). Six percent of women have their first child before 18, and less than one percent do so Early childbirths have decreased over time. before 15. There is a decrease in the mean age at first birth between the 18-49 sample and the 18-22 sample. Table 3 provides trends over time in the measures of This is in large part because many women ages 18 to 22 early childbirth inspired by the poverty literature. Consider did not yet has a birth, but also because measures of early childbirth have been reduced over time. first the age group 18-22. In that age group, six percent of women had their first child before the age of 18 (6.4 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 0.6 percent and the squared gap (SG) at 0.1 No Birth 70.4 20.5 percent for that group. By estimating the same measures 18 or Above 23.2 65.6 on older groups, the table provides the trend in early Below 12 0.0 0.5 childbirth over time. There has been a sharp decrease 12 0.0 0.5 over time in early childbirth. The same is observed when 13 0.2 0.6 considering very early childbirth before the age of 152. 14 0.2 1.3 15 0.7 1.9 Table 3: Trend in Early childbirth (%) 16 1.5 3.6 18 years 15 years 17 3.8 5.6 H CMG SG H CMG SG Total 100.0 100.0 All 18-49 years 13.9 1.84 0.36 2.9 0.41 0.08 Mean age at first birth 18.8 21.2 Age group Source: Authors’ estimation. 18-22 years 6.4 0.60 0.08 0.4 0.05 0.01 23-30 years 9.6 1.07 0.17 1.1 0.14 0.02 Most early childbirths take place after marriage. 31-40 years 13.8 1.75 0.33 2.6 0.35 0.06 41-49 years 23.2 3.52 0.79 6.6 1.00 0.20 In Indonesia, there is a strong relationship between the Source: Authors’ estimation. Values rounding to 0.0 not shown. age at first birth and the age at first marriage as communities do not look favorably at births out of The incidence of early childbirth in 2012 was much lower wedlock. Table 2 displays the shares of girls with an early than that observed 25 years ago. There has been a childbirth according to four categories in terms of the decrease over time in how early girls have children. timing (or absence) of marriage among women ages 18- 22. Most early childbirths take place after marriage, hence Girls are more likely to have children early if they live delaying the age at marriage is essential to avoid early in rural areas and are from poorer backgrounds. childbirth. Table 2: Marriage and Early Childbirth, Age 18-22 (%) As expected, early childbirth is much more prevalent in rural than in urban areas. There are also large differences Share Early childbirth without marriage 0.03 between provinces, with the lowest measures observed in Early childbirth before marriage 3.17 the West Sumatera and Central Java provinces, and the Early childbirth in the same year as marriage 23.92 highest measures observed (according to the headcount Early childbirth at least one year after marriage 72.88 index with the 18 years threshold) in the Central Sulawesi, Total 100.00 Papua, and West Sulawesi provinces. Early childbirth is Source: Authors’ estimation. less prevalent in the capital city of Jakarta. The ranking of the regions in terms of the measures obtained with the 15 and 18 years thresholds tends to be similar. 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  Table 4: Early childbirth by Location, Age 18-22 (%) Table 5: Early childbirth by Quintile, 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 6.4 0.60 0.08 0.4 0.05 0.01 All 18-22 years 6.4 0.60 0.08 0.4 0.05 0.01 Region Wealth quintiles Aceh 2.7 0.17 0.01 - - - Poorest 15.6 1.64 0.25 1.7 0.20 0.03 North Sumatera 3.7 0.29 0.03 - - - Poorer 7.7 0.79 0.11 0.6 0.07 0.01 West Sumatera 2.1 0.23 0.04 0.7 0.05 - Middle 5.9 0.48 0.05 0.1 0.01 - Riau 2.9 0.23 0.02 - - - Richer 3.9 0.26 0.02 - - - Jambi 15.7 1.46 0.20 0.5 0.10 0.02 Richest 1.6 0.13 0.01 0.1 - - South Sumatera 12.4 1.43 0.22 1.4 0.14 0.02 Source: Authors’ estimation. Values rounding to 0.0 not shown. Bengkulu 8.6 0.67 0.06 - - - Lampung 7.8 0.80 0.10 0.4 0.03 - Early childbirth is associated with lower education Bangka Belitung 9.9 1.26 0.28 2.2 0.40 0.09 attainment, lower likelihood of literacy, and lower Riau Islands 4.0 0.36 0.04 - - - labor force participation. Jakarta 2.7 0.24 0.03 0.3 0.02 - West Java 5.5 0.49 0.06 0.4 0.05 0.01 Central Java 2.1 0.12 0.01 - - - Table 6 provides data on early childbirth by level of Yogyakarta 4.2 0.37 0.04 - - - education of the women, as well as literacy. Early East Java 6.3 0.58 0.08 0.4 0.05 0.01 childbirth affects education attainment negatively, Banten 6.0 0.44 0.04 - - - because girls often drop out of school when they have Bali 8.5 0.52 0.03 - - - their first child. The causality goes the other way as well, West Nusa Tenggara 7.5 0.63 0.07 0.5 0.03 - as the ability to pursue one’s education may help delay East Nusa Tenggara 4.3 0.35 0.04 0.3 0.02 - the age at marriage and thereby the age at first birth. As West Kalimantan 14.5 1.52 0.23 1.1 0.18 0.03 seen in table 6, early childbirth measures are strongly Central Kalimantan 13.3 1.45 0.19 0.6 0.04 - correlated with education levels. The same is observed South Kalimantan 8.7 0.92 0.11 0.5 0.04 - East Kalimantan 6.0 0.40 0.03 - - - when considering literacy where three categories are North Sulawesi 12.4 1.00 0.10 0.5 0.04 - considered: the woman cannot read at all, can read part Central Sulawesi 20.3 1.83 0.22 1.3 0.09 0.01 of a sentence, or can read a full sentence. South Sulawesi 11.1 1.04 0.12 0.4 0.03 - Southeast Sulawesi 12.3 1.23 0.15 - - - Table 6: Early childbirth by Education Level and Gorontalo 13.8 1.60 0.25 2.6 0.22 0.02 Literacy Status, Age 18-22 (%) West Sulawesi 16.6 1.95 0.34 2.1 0.33 0.05 18 years 15 years Maluku 6.7 0.76 0.11 0.5 0.07 0.01 H CMG SG H CMG SG North Maluku 9.8 1.30 0.19 1.2 0.08 0.01 All 18-22 years 6.4 0.60 0.08 0.4 0.05 0.01 West Papua 16.2 1.71 0.27 2.2 0.25 0.03 Education Papua 20.0 3.22 0.66 6.5 0.72 0.11 No education 20.5 2.76 0.50 5.7 0.52 0.06 Residence Primary, some 19.8 2.69 0.49 4.4 0.51 0.07 Urban 3.9 0.34 0.04 0.2 0.03 - Primary, compl. 16.4 1.64 0.23 1.1 0.13 0.02 Rural 9.7 0.95 0.13 0.7 0.08 0.01 Secondary, some 10.5 0.81 0.08 0.2 0.02 - Source: Authors’ estimation. Values rounding to 0.0 not shown. Secondary, compl. 1.4 0.12 0.01 0.1 0.01 - Higher 0.3 0.02 - - - - Rural girls are much more likely to have children early Literacy than urban girls. Girls from the bottom four quintiles of Cannot read 23.9 3.49 0.70 7.4 0.87 0.12 wealth are also more likely to have children early. The Limited ability 19.7 2.76 0.49 3.9 0.47 0.06 relationship between early childbirth, literacy, and Full sentence 5.8 0.51 0.06 0.3 0.03 - Source: Authors’ estimation. Values rounding to 0.0 not shown. education attainment is strong. Early childbirth measures are lower among women who work. Table 7 provides data on labor force participation. One would expect early childbirth to reduce women’s labor Household welfare is measured through a wealth index force participation, for example through higher fertility. But with households categorized according to five quintiles of if early childbirth is associated with poverty, women may wealth. Women who had a birth tend to be married, hence leave little choice but to work. Other effects could also be the level of wealth is that of the household in which the at work. In Indonesia, early childbirth measures are lower women married, not that of the household or origin. Yet among women who work. The type of work associated the quintile of wealth after marriage and first birth may not most closely with early childbirth is work without cash be very different from that of the household of origin. On earnings (no pay or in-kind benefits only), which may be the other hand, since early childbirth measures are based work with low productivity. on young women ages 18-22, their level of assets may be lower than would be the case later in life. In any case, the measures of early childbirth differ substantially by quintile. Page 3 HNPGP Knowledge Brief  Table 7: Early childbirth by Labor Force Participation early childbirth. Three measures are used: the incidence of early Status, Age 18-22 (%) childbirth or headcount index, the early childbirth gap, and the 18 years 15 years squared early childbirth gap. The headcount index is simply the H CMG SG H CMG SG share of the girls who have their first live birth before the age of All 18-22 years 6.4 0.60 0.08 0.4 0.05 0.01 18. The headcount index can be computed for other age Working thresholds, such as 15 years of age. No 7.3 0.67 0.09 0.5 0.06 0.01 Yes 5.7 0.54 0.07 0.4 0.04 0.01 The early childbirth gap represents the “depth” of early childbirth. Type of work It takes into account not only the share of girls who had their first Not paid 12.6 1.20 0.16 0.8 0.10 0.02 child early, but also the mean number of years below 18 (or 15) Cash only 4.0 0.38 0.05 0.3 0.03 - at which girls had their first child. This matters because even if Cash and in-kind 5.0 0.48 0.06 - - - the share of girls who have their first child early does not In-kind only 7.5 0.81 0.11 - - - change, there may still be improvements in the early childbirth Source: Authors’ estimation. Values rounding to 0.0 not shown. gap if girls who have their first child early have that child a little less early. Conclusion Finally, the squared early childbirth gap measures the “severity” of early childbirth. While the early childbirth gap takes into This brief has provided a basic profile of early childbirth in account the average number of years of early marriage for girls Indonesia. Measures of early childbirth are moderate. The who have their first child early, the squared gap takes into share of women ages 18-22 who had their first child account the square of that number, thereby putting more before 18 is 6.4 percent and it has decreased dramatically emphasis on girls who have their first child very early. Together over time. The share of women with their first child before the three measures provide a better diagnostic of early childbirth 15 is less than one percent. Early childbirth is associated than the headcount index alone. The measures also have with lower wealth and lower education levels, and attractive properties that are beyond the scope of this brief. employment without cash earnings. These are however The headcount index, early childbirth gap, and squared gap are only correlations, not necessarily causal effects. Other the first three measures of the so-called FGT class (Foster et al., briefs in this series look at potential causal effects. 2014). Denote by q the number of girls who have their first child early and by n the number of girls in the overall population. References 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 Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of lower age threshold such as 15 can also be used to measure Decomposable Poverty Measures, Econometrica 52: 761–776. extremely early childbirth). The general formula for the FGT class of measures depends on a parameter α which takes a Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, value of zero for the headcount, one for the early childbirth gap, Economics Bulletin 32(1): 398-411. and two for the squared gap in:  1 q  z  yi   z  Annex: Methodological Note P  While many studies have discussed trends in child marriage, n i1   less work has been done on trends in early childbirth. When conducted, measurement of early childbirth (or early pregnancy) This brief was produced as part of the Economic Impacts of Child has focused on one simple statistic such as the share of girls Marriage study, a joint project of the International Center for Research who have a live birth before the age of 18 or 15. Such statistics on Women (ICRW) and the World Bank, which is supported by the Bill & are useful, but they do not capture well the distribution of the Melinda Gates Foundation and the Children’s Investment Fund age at first birth in the form of aggregate statistics that tell us Foundation (CIFF). More details on the research can be found at the project’s website: www.costsofchildmarriage.org. Partial funding for the about the depth and severity of the problem. Basic statistics on work related to child marriage and education, labor force participation, the share of girls having an early childbirth also do not facilitate earnings, and program responses has been provided by the Global testing for the robustness of comparisons of trends in early Partnership for Education. Comments from Jeff Edmeades and Michele childbirth between countries, between groups within countries, Gragnolati are gratefully acknowledged. The opinions expressed in this or between time periods. 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. Following the approach used by Ngyuen and Wodon (2012) for child marriage, this brief and its companion paper (available on request) rely on methods from the poverty literature to measure 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