Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN SENEGAL Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in Senegal. The share of women ages 18-22 who had a child before 18 is 17.2 percent and it has decreased only slightly over time. The share of girls who had a child before the age of 15, at two percent, has also decreased slightly.  Early childbirth is associated with lower wealth, lower education levels, and higher labor force participation. 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 Senegal. 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 six 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 Senegal for 2014, 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). One in six 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 large part Table 3 provides trends over time in the measures of because many women ages 18 to 22 did not yet has a early childbirth inspired by the poverty literature. Consider birth, but it also reflects a decrease in early childbirth over time, as discussed below. first the age group 18-22. In that age group, one in every six women had their first child before the age of 18 (17.2 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 2.0 percent and the squared gap ( SG) at 0.3 No live birth 63.4 26.9 percent for that group. By estimating the same measures 18 or Above 19.4 53.4 on older groups, the table provides the trend in early Below 12 - - childbirth over time. There has been a decrease over time 12 0.2 0.3 in early childbirth. The same is observed when 13 0.7 0.6 considering very early childbirth before the age of 15 2. 14 1.0 1.6 15 2.9 3.7 Table 3: Trend in Early childbirth (%) 16 5.6 5.9 18 years 15 years 17 6.7 7.6 H CMG SG H CMG SG Total 100.0 100.0 All 18-49 years 19.6 2.3 0.4 2.5 0.2 - Mean age at first birth 17.6 20.4 Age group Source: Authors’ estimation. 18-22 years 17.2 2.0 0.3 2.0 0.2 - 23-30 years 20.4 2.4 0.4 2.7 0.3 - Most early childbirths take place after marriage. 31-40 years 19.7 2.3 0.3 2.3 0.2 - 41-49 years 22.1 2.7 0.4 3.5 0.3 - In Senegal, there is a strong relationship between the age Source: Authors’ estimation. Values rounding to 0.0 not shown. at first birth and the age at first marriage as communities do not look favorably at births out of wedlock. Table 2 The incidence of early childbirth in Senegal in 2014 was displays the shares of girls with an early childbirth lower than that observed 25 years ago. There has been a according to four categories in terms of the timing (or decrease over time in how early girls have children. absence) of marriage among women ages 18-22. Most early childbirths take place after marriage, hence delaying Girls are more likely to have children early if they live the age at marriage is essential to avoid early childbirth. in rural areas and are from poorer backgrounds. Table 2: Marriage and Early Childbirth, Age 18-22 (%) As expected, early childbirth is much more prevalent in Share Early childbirth without marriage 8.8 rural than in urban areas. There are also large differences Early childbirth before marriage 9.2 between regions, with the lowest measures observed in Early childbirth in the same year as marriage 16.6 the capital city of Dakar, and the highest measures Early childbirth at least one year after marriage 65.3 observed (according to the headcount index with the 18 Total 100.0 years threshold) in Kedougou, Kaffrine, and Source: Authors’ estimation. Tambacounda. Early childbirth is less prevalent in Thiès. 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 (%) Early childbirth is associated with lower education 18 years 15 years attainment, lower likelihood of literacy, and higher H CMG SG H CMG SG labor force participation. All 18-22 years 17.2 2.0 0.3 2.0 0.2 - Region Table 6 provides data on early childbirth by level of Dakar 4.7 0.5 - - - - education of the women, as well as literacy. Early Ziguinchor 14.0 1.8 0.3 3.1 0.3 - childbirth affects education attainment negatively, Diourbel 15.2 1.5 0.2 - - - because girls often drop out of school when they have Saint-louis 20.1 2.4 0.4 3.3 0.3 - Tambacounda 34.0 4.7 0.8 5.3 0.6 0.1 their first child. The causality goes the other way as well, Kaolack 28.4 3.0 0.4 2.1 0.2 - as the ability to pursue one’s education may help delay Thiès 12.1 1.5 0.3 1.9 0.3 - the age at marriage and thereby the age at first birth. As Louga 18.6 2.5 0.4 5.1 0.4 - seen in table 6, early childbirth measures are strongly Fatick 14.6 1.5 0.2 1.2 0.1 - correlated with education levels. The same is observed Kolda 30.4 3.2 0.4 1.3 0.1 - when considering literacy where three categories are Matam 27.6 3.4 0.6 5.1 0.6 0.1 considered: the woman cannot read at all, can read part Kaffrine 41.5 4.7 0.7 2.8 0.3 - of a sentence, or can read a full sentence. Kedougou 44.5 5.0 0.7 5.0 0.3 - Sedhiou 20.7 2.0 0.2 0.8 0.1 - Residence Table 6: Early childbirth by Education Level and Urban 10.1 1.1 0.2 0.9 0.1 - Literacy Status, Age 18-22 (%) Rural 25.9 3.1 0.5 3.2 0.3 - 18 years 15 years Source: Authors’ estimation. Values rounding to 0.0 not shown. H CMG SG H CMG SG All 18-22 years 17.2 2.0 0.3 2.0 0.2 - Education Rural girls are much more likely to have children early No education 30.0 3.5 0.5 3.8 0.4 - than urban girls. Girls from the bottom four quintiles of Primary, some 17.4 1.9 0.3 1.7 0.2 - wealth are also more likely to have children early. The Primary, compl. 31.1 4.0 0.6 - - - relationship between early childbirth, literacy, and Secondary, some 5.2 0.6 0.1 0.5 0.1 - education attainment is strong. Early childbirth measures Secondary, compl. - - - - - - are slightly higher among women who work. Higher - - - - - - Literacy Cannot read 27.7 3.3 0.5 3.3 0.4 - Household welfare is measured through a wealth index Limited ability 16.1 1.9 0.3 1.4 0.1 - with households categorized according to five quintiles of Full sentence 6.9 0.7 0.1 0.7 0.1 - wealth. Women who had a birth tend to be married, hence Source: Authors’ estimation. Values rounding to 0.0 not shown. the level of wealth is that of the household in which the 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 Senegal, early childbirth measures are slightly measures of early childbirth differ by quintile, but it is only higher among women who work. with the top quintiles that early childbirth is much less prevalent. Table 7: Early childbirth by Labor Force Participation Status, 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 17.2 2.0 0.3 2.0 0.2 - All 18-22 years 17.2 2.0 0.3 2.0 0.2 - Working Wealth quintile No 15.5 1.8 0.3 1.7 0.2 - Poorest 33.1 4.1 0.6 3.4 0.4 0.1 Yes 19.6 2.2 0.3 2.3 0.3 - Poorer 25.6 2.8 0.4 2.6 0.3 - Type of work Middle 20.2 2.4 0.4 3.4 0.4 - Not paid 14.9 1.9 0.3 1.8 0.1 - Richer 11.2 1.2 0.2 1.4 0.1 - Cash only 21.9 2.4 0.4 2.6 0.3 0.1 Richest 3.5 0.3 - - - - Cash and in-kind 22.7 2.9 0.4 3.8 0.3 - Source: Authors’ estimation. Values rounding to 0.0 not shown. In-kind only 22.7 1.9 0.2 - - - 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) Senegal. Measures of early childbirth are high. The share at which girls had their first child. This matters because even if of women ages 18-22 who had their first child before 18 is the share of girls who have their first child early does not change, there may still be improvements in the early childbirth 17.2 percent, but it has decreased over time. The share of gap if girls who have their first child early have that child a little women with their first child before 15 is 2.0 percent. Early less early. childbirth is associated with lower wealth and lower education levels, and higher labor force participation. Finally, the squared early childbirth gap measures the “severity” These are however only correlations, not necessarily of early childbirth. While the early childbirth gap takes into causal effects. Other briefs in this series look at potential account the average number of years of early marriage for girls causal effects. who have their first child early, the squared gap takes into account the square of that number, thereby putting more emphasis on girls who have their first child very early. Together References the three measures provide a better diagnostic of early childbirth than the headcount index alone. The measures also have Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of attractive properties that are beyond the scope of this brief. Decomposable Poverty Measures, Econometrica 52: 761–776. The headcount index, early childbirth gap, and squared gap are Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, the first three measures of the so-called FGT class (Foster et al., Economics Bulletin 32(1): 398-411. 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. Annex: Methodological Note 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 While many studies have discussed trends in child marriage, lower age threshold such as 15 can also be used to measure less work has been done on trends in early childbirth. When extremely early childbirth). The general formula for the FGT conducted, measurement of early childbirth (or early pregnancy) class of measures depends on a parameter α which takes a has focused on one simple statistic such as the share of girls value of zero for the headcount, one for the early childbirth gap, who have a live birth before the age of 18 or 15. Such statistics and two for the squared gap in: are useful, but they do not capture well the distribution of the  1 q  z  yi   z  age at first birth in the form of aggregate statistics that tell us P  about the depth and severity of the problem. Basic statistics on the share of girls having an early childbirth also do not facilitate n i1   testing for the robustness of comparisons of trends in early childbirth between countries, between groups within countries, This brief was produced as part of the Economic Impacts of Child or between time periods. Marriage study, a joint project of the International Center for Research on Women (ICRW) and the World Bank, which is supported by the Bill & Following the approach used by Ngyuen and Wodon (2012) for Melinda Gates Foundation and the Children’s Investment Fund child marriage, this brief and its companion paper (available on Foundation (CIFF). More details on the research can be found at the request) rely on methods from the poverty literature to measure project’s website: www.costsofchildmarriage.org. Partial funding for the work related to child marriage and education, labor force participation, early childbirth. Three measures are used: the incidence of early earnings, and program responses has been provided by the Global childbirth or headcount index, the early childbirth gap, and the Partnership for Education. Comments from Jeff Edmeades and Michele squared early childbirth gap. The headcount index is simply the Gragnolati are gratefully acknowledged. The opinions expressed in this share of the girls who have their first live birth before the age of brief are those of the authors only and need not reflect the views of the 18. The headcount index can be computed for other age World Bank, its Executive Directors, of the countries they represent. 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