Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN CHAD Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in Chad. The share of women ages 18-22 who had a child before 18 is 44.8 percent and it has increased slightly over time. The share of girls who had a child before the age of 15, at eleven percent, has remained the same over time.  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 Chad. 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  Almost one in two 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 is based on data from the 2004 or 17. Measures inspired from the poverty literature help Demographic and Health Survey (DHS) for Chad (unit in capturing how early girls have children (see the annex). level data from the 2014 survey were not yet available for The headcount (H) measures the share of girls with an analysis at the time of writing). Table 1 provides basic early childbirth. The early childbirth gap (ECG) measures statistics on the age at first birth. Two samples are the “depth” of early childbirth, taking into account how considered: women ages 18 to 22, the youngest age early girls have children. The squared gap (SG) puts even group that can be used to measure early childbirth1 and more weight on the girls who have children very early. women 18-49 (the women’s questionnaire in the DHS collects data for women up to age 49). Almost one in two Early childbirths have increased over time. women have their first child before 18, and one in ten do so before 15. There is a decrease in the mean age at first Table 3 provides trends over time in the measures of birth between the 18-49 sample and the 18-22 sample. early childbirth inspired by the poverty literature. Consider This is in part because many women ages 18 to 22 did not yet have a birth and is therefore not worrying. But as first the age group 18-22. In that age group, almost one in will be shown below, there is no substantial change in two women had their first child before the age of 18 (44.8 percent for the 18-22 age group). The early childbirth gap measures of early child birth over time, which is worrying. (CBG) is at 6.3 percent and the squared gap ( SG) at 1.1 Table 1: Age at First Birth for Women (%) percent for that group. By estimating the same measures 18-22 years 18-49 years on older groups, the table provides the trend in early No Birth 30.4 9.9 childbirth over time. There has been an increase over 18 or Above 24.9 43.5 time in early childbirth, at least comparing the youngest Below 12 0.6 with the two oldest age groups, but the overall trend is 12 0.9 1.3 fairly flat. In other words, there has been no substantial 13 3.8 3.4 reduction in early childbirth. The same is observed when 14 6.4 6.3 considering very early childbirth before the age of 15 2. 15 8.5 10.5 16 12.9 12.5 Table 3: Trend in Early childbirth (%) 17 12.3 12.0 18 years 15 years Total 100.0 100.0 H CMG SG H CMG SG Mean age at first birth 16.7 17.9 All 18-49 years 46.6 6.8 1.3 11.6 1.3 0.2 Source: Authors’ estimation. Age group 18-22 years 44.8 6.3 1.1 11.1 1.1 0.1 Most early childbirths take place after marriage. 23-30 years 49.0 7.1 1.3 11.6 1.3 0.2 31-40 years 48.9 7.3 1.4 12.0 1.4 0.2 In Chad, there is a strong relationship between the age at 41-49 years 40.3 6.2 1.2 11.5 1.3 0.2 first birth and the age at first marriage as communities do Source: Authors’ estimation. not look favorably at births out of wedlock. Table 2 displays the shares of girls with an early childbirth The incidence of early childbirth in Chad in 2004 has not according to four categories in terms of the timing (or been reduced substantially. There has been no decrease absence) of marriage among women ages 18-22. Most over time in how early girls have children. early childbirths take place after marriage, hence delaying the age at marriage is essential to avoid early childbirth. Girls are more likely to have children early if they live Table 2: Marriage and Early Childbirth, Age 18-22 (%) in rural areas and are from poorer backgrounds. Share Early childbirth without marriage 0.1 As expected, early childbirth is much more prevalent in Early childbirth before marriage 1.4 rural than in urban areas. There are also large differences Early childbirth in the same year as marriage 13.9 between regions, with the lowest measures observed in Early childbirth at least one year after marriage 84.7 the Moyen Chari region, and the highest measures Total 100.0 observed (according to the headcount index with the 18 Source: Authors’ estimation. years threshold) in the Chari Baguirmi, B.E.T., and Logone Occidental regions. Early childbirth is less 1 prevalent in the capital city of N'Djaména. The ranking of 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  regions in terms of the measures obtained with the 15 the Early childbirth is associated with lower education 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 44.8 6.3 1.1 11.1 1.1 0.1 childbirth affects education attainment negatively, Region because girls often drop out of school when they have Bar Azou 40.3 6.2 1.2 14.0 1.4 0.2 their first child. The causality goes the other way as well, B. E. T. 55.8 8.4 1.5 11.9 1.3 0.2 as the ability to pursue one’s education may help delay Centre Est 53.2 9.4 2.1 23.0 2.6 0.4 the age at marriage and thereby the age at first birth. As Chari Baguirmi 61.1 9.2 1.7 18.9 1.6 0.1 Logone Occidental 49.3 7.1 1.3 13.5 1.4 0.2 seen in table 6, early childbirth measures are strongly Mayo Kebbi 47.8 5.9 0.9 7.9 0.7 0.1 correlated with education levels, with less risk of early Moyen Chari 19.2 1.6 0.2 0.9 0.1 - childbirth for women with secondary education. The same Ouaddai Est 37.2 4.5 0.7 7.3 0.7 0.1 is observed when considering literacy where three N'Djaména 30.8 3.8 0.6 5.0 0.4 - categories are considered: the woman cannot read at all, Residence can read part of a sentence, or can read a full sentence. Urban 38.1 4.9 0.8 6.4 0.7 0.1 Rural 46.8 6.7 1.2 12.5 1.2 0.1 Table 6: Early childbirth by Education Level and Source: Authors’ estimation. Literacy Status, Age 18-22 (%) 18 years 15 years Rural girls are much more likely to have children early H CMG SG H CMG SG than urban girls. Girls from the bottom four quintiles of All 18-22 years 44.8 6.3 1.1 11.1 1.1 0.1 wealth are also more likely to have children early. The Education relationship between early childbirth, literacy, and No education 50.9 7.5 1.4 14.2 1.5 0.2 education attainment is strong. Early childbirth measures Primary, some 39.5 4.8 0.7 7.3 0.5 - are higher for women who work and those who do not. Primary, compl. 53.7 6.0 0.8 0.7 0.1 - Secondary, some 15.4 1.7 0.2 1.2 0.1 - Secondary, compl. 5.7 0.6 0.1 0.0 - - Household welfare is measured through a wealth index Higher 30.6 3.4 0.4 0.0 - - with households categorized according to five quintiles of Literacy wealth. Women who had a birth tend to be married, hence Cannot read 49.0 7.0 1.3 12.8 1.3 0.2 the level of wealth is that of the household in which the Limited ability 29.0 3.6 0.6 7.7 0.5 - women married, not that of the household or origin. Yet Full sentence 20.5 2.4 0.3 0.9 0.1 - the quintile of wealth after marriage and first birth may not Source: Authors’ estimation. Values rounding to 0.0 not shown. be very different from that of the household of origin. On Table 7 provides data on labor force participation. One the other hand, since early childbirth measures are based would expect early childbirth to reduce women’s labor on young women ages 18-22, their level of assets may be force participation, for example through higher fertility. But lower than would be the case later in life. In any case, the if early childbirth is associated with poverty, women may measures of early childbirth do not differ much between leave little choice but to work. Other effects could also be the four bottom quintiles, and it is only with the top quintile at work. In Chad, early childbirth measures are higher that early childbirth is (slightly) less prevalent. among women who work. However, the type of work associated most closely with early childbirth is work with Table 5: Early childbirth by Quintile, Age 18-22 (%) payment in kind, which may be work with low productivity. 18 years 15 years H CMG SG H CMG SG All 18-22 years 44.8 6.3 1.1 11.1 1.1 0.1 Table 7: Early childbirth by Labor Force Participation Wealth quintiles Status, Age 18-22 (%) Poorest 44.1 6.4 1.2 12.2 1.2 0.1 18 years 15 years Poorer 48.1 7.5 1.5 15.5 1.7 0.2 H CMG SG H CMG SG Middle 49.5 6.4 1.1 9.7 1.0 0.1 All 18-22 years 44.8 6.3 1.1 11.1 1.1 0.1 Richer 46.4 6.7 1.2 13.5 1.1 0.1 Working Richest 36.7 4.6 0.7 5.2 0.6 0.1 No 39.7 5.5 1.0 9.6 0.9 0.1 Source: Authors’ estimation. Yes 46.4 6.6 1.2 11.6 1.2 0.1 Type of work Not paid 42.3 7.1 1.5 17.3 1.8 0.2 Cash only 37.4 5.4 1.1 11.0 1.3 0.2 Cash and in-kind 51.4 6.9 1.1 8.3 0.8 0.1 In-kind only 49.5 6.7 1.2 12.2 1.2 0.1 Source: Authors’ estimation. 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 Chad. Measures of early childbirth are high. The share of change, there may still be improvements in the early childbirth gap if girls who have their first child early have that child a little women ages 18-22 who had their first child before 18 is less early. 44.8 percent and it has not decreased substantially over time. The share of women with their first child before 15 is Finally, the squared early childbirth gap measures the “severity” 11.1 percent. Early childbirth is associated with lower of early childbirth. While the early childbirth gap takes into wealth and lower education levels, and employment account the average number of years of early marriage for girls without cash earnings. These are however only who have their first child early, the squared gap takes into correlations, not necessarily causal effects. Other briefs in account the square of that number, thereby putting more this series look at potential 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 Following the approach used by Ngyuen and Wodon (2012) for Foundation (CIFF). More details on the research can be found at the 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