Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN THE DOMINICAN REPUBLIC Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in the Dominican Republic. The share of women ages 18-22 who had a child before 18 is 20.4 percent and it has not decreased much over time. The share of girls who had a child before the age of 15, at just under two percent, 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 the Dominican Republic. of girls affected by it, but also in terms of how early births occur? The brief documents the extent of early childbirth, its trend over time, in which areas it is most prevalent, and what How is the question answered? Measures and a profile of some 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  One in five women have an early childbirth. The consequences of early childbirth for girls and their The analysis relies on data from the latest Demographic children are not the same whether girls have a child at 12 and Health Survey (DHS) for the Dominican Republic for or 17. Measures inspired from the poverty literature help 2013, the latest DHS available. Table 1 provides basic in capturing how early girls have children (see the annex). statistics on the age at first birth. Two samples are The headcount (H) measures the share of girls with an considered: women ages 18 to 22, the youngest age early childbirth. The early childbirth gap (ECG) measures group that can be used to measure early childbirth1 and the “depth” of earl y childbirth, taking into account how women 18-49 (the women’s questionnaire in the DHS early girls have children. The squared gap (SG) puts even collects data for women up to age 49). One in five women more weight on the girls who have children very early. have their first child before 18, and 1.8 percent do so before 15. There is a decrease in the mean age at first Early childbirths have not declined much over time. birth between the 18-49 sample and the 18-22 sample. This is in large part because many women ages 18 to 22 Table 3 provides trends over time in the measures of did not yet has a birth, but it also suggests a decline in early childbirth inspired by the poverty literature. Consider very early childbirth, as discussed below. first the age group 18-22. In that age group, one in five women had their first child before the age of 18 (20.4 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 2.1 percent and the squared gap ( SG) at 0.3 No live birth 59.4 21.7 percent for that group. By estimating the same measures 18 or above 20.2 54.6 on older groups, the table provides the trend in early Below 12 0.1 childbirth over time. There has been no substantial 12 0.0 0.4 decrease over time in early childbirth, at least comparing 13 0.3 0.8 the youngest with the oldest age groups. However, there 14 1.5 2.7 has been a decline when considering very early childbirth 15 3.2 3.7 before the age of 152. 16 6.1 7.3 17 9.3 8.9 Table 3: Trend in Early childbirth (%) Total 100.0 100.0 18 years 15 years Mean age at 1st birth 17.6 20.2 H CBG SG H CBG SG Source: Authors’ estimation. All 18-49 years 23.7 2.9 0.5 3.89 0.37 0.05 Age group Most early childbirths take place after marriage. 18-22 years 20.4 2.1 0.3 1.83 0.15 0.01 In the Dominican Republic, there is a strong relationship 23-30 years 27.1 3.4 0.6 5.02 0.52 0.07 between the age at first birth and the age at first marriage 31-40 years 25.1 2.9 0.5 3.42 0.31 0.04 41-49 years 20.9 2.8 0.5 5.14 0.49 0.06 as communities do not look favorably at births out of Source: Authors’ estimation. Values rounding to 0.0 not shown. wedlock. Table 2 displays the shares of girls with an early childbirth according to four categories in terms of the timing (or absence) of marriage among women ages 18- The incidence of early childbirth in the Dominican 22. Most early childbirths take place after marriage, hence Republic in 2013 was only marginally lower than that delaying the age at marriage is essential to avoid early observed 25 years ago. But there has been a decline over childbirth. time in how early girls have children (below age 15). Table 2: Marriage and Early Childbirth, Age 18-22 (%) Girls are more likely to have children early if they live Categories Share in rural areas and are from poorer backgrounds. Early childbirth without marriage or before marriage 4.5 Early childbirth without marriage or before marriage 8.6 As expected, early childbirth is much more prevalent in Early childbirth in the same year as marriage 15.4 rural than in urban areas. There are also large differences Early childbirth at least one year after marriage 71.5 between regions (see the note at the bottom of table 4 for Total 100.0 the definition of regions). The ranking of the regions in Source: Authors’ estimation. 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 (%) childbirth affects education attainment negatively, 18 years 15 years because girls often drop out of school when they have H CBG SG H CBG SG their first child. The causality goes the other way as well, All 18-22 years 20.4 2.1 0.3 1.83 0.15 0.01 as the ability to pursue one’s education may help delay Region the age at marriage and thereby the age at first birth. As 0 18.9 1.7 0.2 0.87 0.06 - seen in table 6, early childbirth measures are strongly I 20.9 2.5 0.3 1.45 0.10 0.01 correlated with education levels. The same is observed II 16.4 2.1 0.3 2.79 0.21 0.02 when considering literacy where three categories are III 20.4 2.3 0.4 3.97 0.29 0.02 considered: the woman cannot read at all, can read part IV 32.1 4.1 0.7 5.65 0.57 0.07 of a sentence, or can read a full sentence. V 25.1 2.5 0.3 1.82 0.17 0.02 VI 25.2 2.6 0.3 1.50 0.13 0.01 Table 6: Early childbirth by Education Level and VII 19.6 2.4 0.4 3.00 0.35 0.04 Literacy Status, Age 18-22 (%) VIII 20.2 2.0 0.3 1.16 0.11 0.01 18 years 15 years Residence H CBG SG H CBG SG Urban 18.6 1.9 0.3 1.85 0.15 0.01 All 18-22 years 20.4 2.1 0.3 1.83 0.15 0.01 Rural 25.9 2.8 0.4 1.76 0.16 0.02 Education Source: Authors’ estimation. Values rounding to 0.0 not shown. Region 0: National District, Santo Domingo and Monte Plata; No education 69.6 9.0 1.4 12.07 1.25 0.16 Region I: Peravia, San Cristóbal and San José de Ocoa; Region Primary, some 51.2 6.2 1.0 8.67 0.79 0.08 II: Santiago, Puerto Plata and Espaillat; Region III: Duarte, Primary, compl. 47.0 4.5 0.6 2.68 0.18 0.01 Samana, Maria Trinidad Sanchez and Hermanas Mirabal; Secondary, some 26.0 2.5 0.3 1.88 0.13 0.01 Region IV: Independencia, Bahoruco, Barahona and Secondary, compl. 13.3 1.5 0.2 0.42 0.03 - Pedernales; Region V: La Altagracia, La Romana, El Seibo, San Higher 4.4 0.4 - 0.20 0.01 - Pedro de Macoris and Hato Mayor; Region VI: Azua, San Juan Literacy and Elías Piña; Region VII: Dajabón, Monte Cristi, Santiago Cannot read 45.1 6.0 0.9 5.92 0.55 0.06 Rodriguez and Valverde; Region VIII: La Vega, Monseñor Nouel Limited ability 57.8 7.1 1.3 15.16 1.36 0.14 and Sanchez Ramirez. Full sentence 18.7 1.9 0.3 1.41 0.11 0.01 No card available 39.6 3.9 0.5 1.49 0.10 0.01 Household welfare is measured through a wealth index Source: Authors’ estimation. Values rounding to 0.0 not shown. with households categorized according to five quintiles of wealth. Women who had a birth tend to be married, hence Table 7 provides data on labor force participation. One the level of wealth is that of the household in which the would expect early childbirth to reduce women’s labor women married, not that of the household or origin. Yet force participation, for example through higher fertility. But the quintile of wealth after marriage and first birth may not if early childbirth is associated with poverty, women may be very different from that of the household of origin. On leave little choice but to work. Other effects could also be the other hand, since early childbirth measures are based at work. In Dominican Republic, early childbirth measures on young women ages 18-22, their level of assets may be are slightly lower among women who work. However, the lower than would be the case later in life. Measures of type of work associated most closely with early childbirth early childbirth differ by quintiles, but it is only with the top is work without cash earnings (in-kind benefits only), quintiles that early childbirth is much less prevalent. which may be work with low productivity. Table 5: Early childbirth by Quintile, Age 18-22 (%) Table 7: Early childbirth by Labor Force Participation 18 years 15 years Status, Age 18-22 (%) H CBG SG H CBG SG 18 years 15 years All 20.4 2.1 0.3 1.83 0.15 0.01 H CBG SG H CBG SG Wealth quintiles All 18-22 years 20.4 2.1 0.3 1.83 0.15 0.01 Poorest 35.6 4.0 0.6 4.37 0.39 0.04 Working Poorer 32.2 3.4 0.5 3.61 0.28 0.02 Not working 21.0 2.3 0.3 2.02 0.17 0.02 Middle 16.5 1.8 0.2 0.58 0.04 - Working 19.8 2.0 0.3 1.63 0.13 0.01 Richer 13.8 1.3 0.2 0.60 0.05 - Type of work Richest 6.0 0.5 0.1 0.31 0.02 - Not paid 14.2 2.4 0.5 8.98 0.60 0.04 Source: Authors’ estimation. Values rounding to 0.0 not shown. Cash only 20.0 2.0 0.3 1.49 0.12 0.01 Cash and in-kind 15.9 1.5 0.2 0.90 0.12 0.02 Early childbirth is associated with lower education In-kind only 43.4 3.3 0.3 - - - attainment, lower likelihood of literacy, and slightly Source: Authors’ estimation. Values rounding to 0.0 not shown. lower labor force participation. Table 6 provides data on early childbirth by level of education of the women, as well as literacy. Early Page 3 HNPGP Knowledge Brief  Rural girls are much more likely to have children early 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 than urban girls. Girls from the bottom four quintiles of the share of girls who have their first child early does not wealth are also more likely to have children early. The change, there may still be improvements in the early childbirth relationship between early childbirth, literacy, and gap if girls who have their first child early have that child a little education attainment is strong. Early childbirth measures less early. are slightly lower for women who work. Finally, the squared early childbirth gap measures the “severity” of early childbirth. While the early childbirth gap takes into Conclusion account the average number of years of early marriage for girls who have their first child early, the squared gap takes into This brief has provided a basic profile of early childbirth in account the square of that number, thereby putting more the Dominican Republic. Measures of early childbirth are emphasis on girls who have their first child very early. Together high. The share of women ages 18-22 who had their first the three measures provide a better diagnostic of early childbirth child before 18 is 20.4 percent and it has not declined than the headcount index alone. The measures also have substantially over time. The share of women with their first attractive properties that are beyond the scope of this brief. child before 15 is at just under two percent. Early childbirth is associated with lower wealth and lower The headcount index, early childbirth gap, and squared gap are the first three measures of the so-called FGT class (Foster et al., education levels, and employment without cash earnings. 2014). Denote by q the number of girls who have their first child These are however only correlations, not necessarily early and by n the number of girls in the overall population. causal effects. Other briefs in this series look at potential Denote by yi the age at which girl i had her first child and by z causal effects. the age threshold defining early childbirth (18 years of age, but a lower age threshold such as 15 can also be used to measure References extremely early childbirth). The general formula for the FGT class of measures depends on a parameter α which takes a Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of value of zero for the headcount, one for the early childbirth gap, Decomposable Poverty Measures, Econometrica 52: 761–776. and two for the squared gap in:  1 q  z  yi  Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, P    Economics Bulletin 32(1): 398-411. n i1  z   Annex: Methodological Note This brief was produced as part of the Economic Impacts of Child Marriage study, a joint project of the International Center for Research While many studies have discussed trends in child marriage, on Women (ICRW) and the World Bank, which is supported by the Bill & less work has been done on trends in early childbirth. When Melinda Gates Foundation and the Children’s Investment Fund conducted, measurement of early childbirth (or early pregnancy) Foundation (CIFF). More details on the research can be found at the has focused on one simple statistic such as the share of girls project’s website: www.costsofchildmarriage.org. Partial funding for the who have a live birth before the age of 18 or 15. Such statistics work related to child marriage and education, labor force participation, are useful, but they do not capture well the distribution of the earnings, and program responses has been provided by the Global age at first birth in the form of aggregate statistics that tell us Partnership for Education. Comments from Jeff Edmeades and Michele Gragnolati are gratefully acknowledged. The opinions expressed in this about the depth and severity of the problem. Basic statistics on brief are those of the authors only and need not reflect the views of the the share of girls having an early childbirth also do not facilitate World Bank, its Executive Directors, of the countries they represent. testing for the robustness of comparisons of trends in early childbirth between countries, between groups within countries, or between time periods. 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 early childbirth. Three measures are used: the incidence of early childbirth or headcount index, the early childbirth gap, and the squared early childbirth gap. The headcount index is simply the share of the girls who have their first live birth before the age of 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