Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN THE 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 Republic of Congo. The share of women ages 18- 22 who had a child before 18 is 31.8 percent, and it has decreased only slightly over time. The share of girls with a child before the age of 15 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 Republic of Congo. 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  A third 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 the Republic of Congo for in capturing how early girls have children (see the annex). 2011-12, the latest DHS available. Table 1 provides basic The headcount (H) measures the share of girls with an statistics on the age at first birth. Two samples are early childbirth. The early childbirth gap (ECG) measures considered: women ages 18 to 22, the youngest age the “depth” of early childbirth, taking into account how group that can be used to measure early childbirth1 and early girls have children. The squared gap (SG) puts even women 18-49 (the women’s questionnaire in the DHS more weight on the girls who have children very early. collects data for women up to age 49). Almost one third of women have their first child before 18, and 2.6 percent do Early childbirths have decreased slightly 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 it also reflects a slight decrease in early childbirth as discussed below. first the age group 18-22. In that age group, almost a third of women had their first child before the age of 18 (31.8 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 3.6 percent and the squared gap ( SG) at 0.5 No live birth 39.25 14.6 percent for that group. By estimating the same measures 18 or Above 28.95 54.41 on older groups, the table provides the trend in early 12 0.33 0.76 childbirth over time. There has been a slight decrease 13 1.05 1.17 over time in early childbirth, at least comparing the 14 1.2 2.59 youngest with the two oldest age groups. The decrease is 15 6.07 5.93 stronger when considering very early childbirth before the 16 10.66 9 age of 152. 17 12.48 11.53 Total 100.0 100.0 Table 3: Trend in Early childbirth (%) Mean age at first birth 17.4 19.2 18 years 15 years Source: Authors’ estimation. H CMG SG H CMG SG All 18-49 years 31.0 3.8 0.6 4.5 0.48 0.06 Most early childbirths take place after marriage. Age group 18-22 years 31.8 3.6 0.5 2.6 0.29 0.04 In the Republic of Congo, there is a strong relationship 23-30 years 28.0 3.3 0.5 4.0 0.42 0.05 between the age at first birth and the age at first marriage 31-40 years 31.7 4.1 0.7 5.6 0.58 0.07 as communities do not look favorably at births out of 41-49 years 34.7 4.6 0.8 6.5 0.70 0.10 wedlock. Table 2 displays the shares of girls with an early Source: Authors’ estimation. Values rounding to 0.0 not shown. childbirth according to four categories in terms of the timing (or absence) of marriage among women ages 18- The incidence of early childbirth in Congo in 2011-12 was 22. Most early childbirths take place after marriage, hence lower than that observed 25 years ago. There has been a delaying the age at marriage is essential to avoid early decrease over time in how early girls have children. 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 19.7 Early childbirth before marriage 18.9 As expected, early childbirth is much more prevalent in Early childbirth in the same year as marriage 17.3 rural than in urban areas. There are also large differences Early childbirth at least one year after marriage 44.1 between regions, with the lowest measures observed in Total 100.0 the capital city of Brazzaville, and the highest measures Source: Authors’ estimation. observed (according to the headcount index with the 18 years threshold) in Pool, Cuvette-Ouest, and Cuvette. Early childbirth is less prevalent in Pointe-Noire. The ranking of the regions in terms of the measures obtained 1 with the 15 and 18 years thresholds tends to be similar. 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 CMG SG H CMG SG their first child. The causality goes the other way as well, All 18-49 years 31.0 3.8 0.6 4.5 0.5 0.1 as the ability to pursue one’s education may help delay Region the age at marriage and thereby the age at first birth. As Kouilou 43.9 4.6 0.6 3.5 0.36 0.04 seen in table 6, early childbirth measures are strongly Niari 38.9 4.3 0.6 2.4 0.26 0.03 correlated with education levels. The same is observed Lekoumou 44.1 5.2 0.8 6.4 0.77 0.12 when considering literacy where three categories are Bouenza 31.7 3.4 0.5 2.6 0.31 0.04 Pool 50.1 6.0 0.9 7.8 0.74 0.08 considered: the woman cannot read at all, can read part Plateaux 37.6 5.1 0.9 8.7 0.87 0.11 of a sentence, or can read a full sentence. Cuvette 44.9 5.7 1.0 6.2 0.90 0.14 Cuvette-Ouest 45.0 5.4 0.9 7.2 0.79 0.10 Table 6: Early childbirth by Education Level and Sangha 41.5 5.2 0.9 7.4 0.80 0.10 Literacy Status, Age 18-22 (%) Likouala 42.1 4.9 0.8 5.1 0.65 0.10 18 years 15 years Brazzaville 25.9 2.9 0.4 1.5 0.18 0.02 H CMG SG H CMG SG Pointe-Noire 29.2 3.1 0.4 1.1 0.10 0.01 All 18-22 years 31.8 3.6 0.5 2.6 0.29 0.04 Residence Education Urban 27.5 3.0 0.4 1.5 0.15 0.02 No education 45.2 5.5 1.0 8.9 1.10 0.16 Rural 43.4 5.1 0.8 5.6 0.65 0.09 Primary, some 45.5 5.6 0.9 6.0 0.72 0.10 Source: Authors’ estimation. Values rounding to 0.0 not shown. Primary, compl. 52.6 5.5 0.7 3.5 0.28 0.03 Secondary, some 28.9 3.2 0.4 1.6 0.17 0.02 Rural girls are much more likely to have children early than Secondary, compl. 9.3 0.5 - - - - urban girls. Girls from the bottom four quintiles of wealth are Higher 7.8 0.4 - - - - also more likely to have children early. The relationship Literacy between early childbirth, literacy, and education attainment is Cannot read 44.9 5.5 0.9 6.4 0.81 0.12 strong. Early childbirth measures are higher for women who Limited ability 45.1 5.4 0.8 5.6 0.56 0.06 Full sentence 27.5 3.0 0.4 1.5 0.15 0.02 work. No card available 71.2 4.2 0.3 - - - Source: Authors’ estimation. Values rounding to 0.0 not shown. Household welfare is measured through a wealth index with households categorized according to five quintiles of Table 7 provides data on labor force participation. One wealth. Women who had a birth tend to be married, hence would expect early childbirth to reduce women’s labor the level of wealth is that of the household in which the force participation, for example through higher fertility. But women married, not that of the household or origin. Yet if early childbirth is associated with poverty, women may the quintile of wealth after marriage and first birth may not leave little choice but to work. Other effects could also be be very different from that of the household of origin. On at work. In Congo, early childbirth measures are higher the other hand, since early childbirth measures are based among women who work, suggesting a positive on young women ages 18-22, their level of assets may be association between early childbirth and labor force lower than would be the case later in life. In any case, the participation. However, the type of work associated most measures of early childbirth differ by quintile, but it is only closely with early childbirth is work with payment in kind with the top quintiles that early childbirth is much less (with or without cash earnings). which may be work with prevalent. 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 CMG SG H CMG SG 18 years 15 years All 18-22 years 31.8 3.6 0.5 2.6 0.29 0.04 H CMG SG H CMG SG Wealth quintiles All 18-22 years 31.8 3.6 0.5 2.6 0.29 0.04 Poorest 45.4 5.4 0.9 6.4 0.73 0.10 Working Poorer 39.8 4.9 0.8 4.7 0.53 0.07 No 22.1 2.1 0.3 1.1 0.14 0.02 Middle 36.0 4.0 0.6 1.4 0.16 0.02 Yes 41.8 5.0 0.8 4.1 0.44 0.06 Richer 27.3 2.8 0.4 1.4 0.13 0.01 Type of work Richest 16.2 1.5 0.2 0.9 0.10 0.01 Not paid 39.5 4.4 0.6 2.4 0.18 0.01 Source: Authors’ estimation. Values rounding to 0.0 not shown. Cash only 41.5 5.0 0.8 4.0 0.43 0.05 Cash and in-kind 48.3 6.2 1.1 7.4 0.95 0.15 Early childbirth is associated with lower education In-kind only 47.5 6.3 1.1 8.5 1.02 0.16 attainment, lower likelihood of literacy, and higher Source: Authors’ estimation. Values rounding to 0.0 not shown. 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  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) Congo. 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 31.8 percent and it has decreased only slightly over time. gap if girls who have their first child early have that child a little The share of women with their first child before 15 is 2.6 less early. percent, and has decreased more substantially. Early childbirth is associated with lower wealth, lower education Finally, the squared early childbirth gap measures the “severity” levels, and higher labor force participation. These are of early childbirth. While the early childbirth gap takes into however only correlations, not necessarily causal effects. account the average number of years of early marriage for girls Other briefs in this series look at potential 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, or between time periods. This brief was produced as part of the Economic Impacts of Child Marriage study, a joint project of the International Center for Research Following the approach used by Ngyuen and Wodon (2012) for on Women (ICRW) and the World Bank, which is supported by the Bill & child marriage, this brief and its companion paper (available on Melinda Gates Foundation and the Children’s Investment Fund request) rely on methods from the poverty literature to measure Foundation (CIFF). More details on the research can be found at the project’s website: www.costsofchildmarriage.org. Partial funding for the early childbirth. Three measures are used: the incidence of early work related to child marriage and education, labor force participation, childbirth or headcount index, the early childbirth gap, and the earnings, and program responses has been provided by the Global squared early childbirth gap. The headcount index is simply the Partnership for Education. Comments from Jeff Edmeades and Michele share of the girls who have their first live birth before the age of Gragnolati are gratefully acknowledged. The opinions expressed in this 18. The headcount index can be computed for other age brief are those of the authors only and need not reflect the views of the thresholds, such as 15 years of age. World Bank, its Executive Directors, of the countries they represent. 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