Knowledge Brief Health, Nutrition and Population Global Practice BASIC PROFILE OF EARLY CHILDBIRTH IN GUINEA Chata Malé and Quentin Wodon March 2016 Child Marriage Series with Education Global Practice KEY MESSAGES:  Measures of early childbirth are high in Guinea. The share of women ages 18-22 who had a child before 18 is 41.0 percent and it has increased slightly over time. The share of girls who had a child before the age of 15, at just under ten percent, has 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 Guinea. 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  Four in every ten 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 Guinea for 2012, the latest or 17. Measures inspired from the poverty literature help DHS available. Table 1 provides basic statistics on the in capturing how early girls have children (see the annex). age at first birth. Two samples are considered: women The headcount (H) measures the share of girls with an ages 18 to 22, the youngest age group that can be used early childbirth. The early childbirth gap (ECG) measures to measure early childbirth1 and women 18-49 (the the “depth” of early childbirth, taking into accoun t how women’s questionnaire in the DHS collects data for early girls have children. The squared gap (SG) puts even women up to age 49). More than four in every ten women more weight on the girls who have children very early. have their first child before 18 and almost one in ten does so before 15. There is a decrease in the mean age at first Early childbirths have increased slightly 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 have a birth and is therefore not worrying in itself. But as shown below, there is also a slight increase early childbirth inspired by the poverty literature. Consider in measures of early child birth over time, which is first the age group 18-22. In that age group, more than four in ten women had their first child before the age of 18 worrying. (41.0 percent for the 18-22 age group). The early childbirth gap (CBG) is at 5.7 percent and the squared Table 1: Age at First Birth for Women (%) 18-22 years 18-49 years gap (SG) at 1.0 percent for that group. By estimating the No Birth 39.5 15.3 same measures on older groups, the table provides the 18 or Above 19.4 43.3 trend in early childbirth over time. There has been a slight Below 12 0.0 0.0 increase over time in early childbirth, at least comparing 12 0.8 0.9 the youngest with the oldest age groups. In other words, 13 3.4 3.3 while child marriage can be shown to have been reduced 14 5.1 6.0 very slightly, this is not be the case for early childbirth2. 15 9.2 9.8 With the 15 years threshold though, there has been a 16 10.8 10.8 slight decrease in extremely early childbirth over time. 17 11.7 10.6 Total 100.0 100.0 Mean age at first birth 16.6 18.3 Table 3: Trend in Early childbirth (%) Source: Authors’ estimation. 18 years 15 years H CMG SG H CMG SG All 18-49 years 41.4 6.0 1.1 10.2 1.0 0.1 Most early childbirths take place after marriage. Age group 18-22 years 41.0 5.7 1.0 9.3 1.0 0.1 In Guinea, there is a strong relationship between the age 23-30 years 41.6 6.0 1.1 10.7 1.0 0.1 at first birth and the age at first marriage as communities 31-40 years 43.6 6.4 1.2 10.2 1.1 0.1 do not look favorably at births out of wedlock. Table 2 41-49 years 37.7 5.7 1.1 10.6 1.0 0.1 displays the shares of girls with an early childbirth Source: Authors’ estimation. according to four categories in terms of the timing (or absence) of marriage among women ages 18-22. Most The incidence of early childbirth in Guinea in 2012 was early childbirths take place after marriage, hence delaying higher than that observed 25 years ago. There has been the age at marriage is essential to avoid early childbirth. an increase over time in how early girls have children, although not with the 15 years threshold. Table 2: Marriage and Early Childbirth, Age 18-22 (%) Share Early childbirth without marriage 12.7 Girls are more likely to have children early if they live Early childbirth before marriage 5.4 in rural areas and are from poorer backgrounds. Early childbirth in the same year as marriage 8.1 Early childbirth at least one year after marriage 73.9 As expected, early childbirth is much more prevalent in Total 100.0 rural than in urban areas. There are also large differences Source: Authors’ estimation. between regions, with the lowest measures observed in the capital city of Conakry, and the highest measures 1 observed (according to the headcount index with the 18 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  years threshold) in the Kankan, Kindia, and Faranah Early childbirth is associated with lower education regions. Early childbirth is less prevalent in the Labé attainment, lower likelihood of literacy, and labor region. The ranking of the regions in terms of the force participation. measures obtained with the 15 and 18 years thresholds tend to be similar. Table 6 provides data on early childbirth by level of education of the women, as well as literacy. Early 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 18-22 years 41.0 5.7 1.0 9.3 1.0 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 Boké 43.6 5.8 1.0 8.2 0.6 0.1 seen in table 6, early childbirth measures are strongly Conakry 22.7 2.9 0.5 4.0 0.4 - correlated with education levels. The same is observed Faranah 49.7 7.2 1.3 12.2 1.3 0.2 when considering literacy where three categories are Kankan 55.4 7.6 1.3 11.2 1.1 0.1 Kindia 50.9 7.6 1.4 12.6 1.3 0.2 considered: the woman cannot read at all, can read part Labé 36.3 4.4 0.7 5.7 0.6 0.1 of a sentence, or can read a full sentence. Mamou 42.8 6.4 1.3 13.7 1.5 0.2 N'Zérékoré 43.6 6.3 1.2 11.9 1.4 0.2 Table 6: Early childbirth by Education Level and Residence Literacy Status, Age 18-22 (%) Urban 27.8 3.5 0.6 4.4 0.4 - 18 years 15 years Rural 50.4 7.3 1.4 12.7 1.3 0.2 H CMG SG H CMG SG Source: Authors’ estimation. Values rounding to 0.0 not shown. All 18-22 years 41.0 5.7 1.0 9.3 1.0 0.1 Education Rural girls are much more likely to have children early No education 53.9 7.9 1.5 14.1 1.5 0.2 than urban girls. Girls from the bottom four quintiles of Primary, some 42.7 5.5 0.9 6.7 0.7 0.1 wealth are also more likely to have children early. The Primary, compl. 40.9 5.3 0.9 10.5 1.0 0.1 Secondary, some 23.1 2.8 0.4 2.9 0.3 - relationship between early childbirth, literacy, and Secondary, compl. 7.3 1.0 0.2 2.0 0.1 - education attainment is strong. Early childbirth measures Higher 3.6 0.5 0.1 0.5 - - are higher for women who work. Literacy Cannot read 52.9 7.7 1.4 13.3 1.4 0.2 Household welfare is measured through a wealth index Limited ability 28.8 2.6 0.3 0.4 - - with households categorized according to five quintiles of Full sentence 20.0 2.4 0.4 2.7 0.3 - 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 Guinea, early childbirth measures are higher measures of early childbirth differ much by quintile, and it among women who work. However, the type of work is only with the top two quintiles, and especially in the top associated most closely with early childbirth is work with quintile, that early childbirth is much less prevalent. payment in kind, which may be work with low productivity. Table 5: Early childbirth by Quintile, Age 18-22 (%) Table 7: Early childbirth by Labor Force Participation Status, 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 41.0 5.7 1.0 9.3 1.0 0.1 Wealth quintiles All 18-22 years 41.0 5.7 1.0 9.3 1.0 0.1 Poorest 50.0 7.0 1.3 12.1 1.2 0.1 Working Poorer 59.9 9.5 1.9 19.0 2.1 0.3 No 26.0 3.5 0.6 4.4 0.5 0.1 Middle 47.0 6.3 1.1 9.1 0.9 0.1 Yes 50.3 7.1 1.3 12.3 1.3 0.2 Richer 38.5 5.0 0.8 6.7 0.7 0.1 Type of work Richest 21.4 2.7 0.4 3.6 0.4 - Not paid 46.3 6.5 1.2 11.6 1.2 0.1 Cash only 46.1 6.3 1.1 10.4 1.0 0.1 Source: Authors’ estimation. Values rounding to 0.0 not shown. Cash and in-kind 63.2 9.5 1.9 18.3 2.1 0.3 In-kind only 55.0 7.7 1.3 10.7 0.9 0.1 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) Guinea. 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 41.0 percent and it has slightly increased over time. The gap if girls who have their first child early have that child a little share of women with their first child before 15 is at just less early. under 10 percent, with a slight decrease over time. Early childbirth is associated with lower wealth and lower Finally, the squared early childbirth gap measures the “severity” education levels, and employment without cash earnings. of early childbirth. While the early childbirth gap takes into These are however only correlations, not necessarily account the average number of years of early marriage for girls causal effects. Other briefs in this series look at potential who have their first child early, the squared gap takes into causal effects. account the square of that number, thereby putting more emphasis on girls who have their first child very early. Together the three measures provide a better diagnostic of early childbirth References than the headcount index alone. The measures also have attractive properties that are beyond the scope of this brief. Foster, J., J. Greer, and E. Thorbecke, 1984, A Class of Decomposable Poverty Measures, Econometrica 52: 761–776. The headcount index, early childbirth gap, and squared gap are the first three measures of the so-called FGT class (Foster et al., Nguyen, M. C., and Q. Wodon, 2012, Measuring Child Marriage, 2014). Denote by q the number of girls who have their first child Economics Bulletin, 32(1): 398-411. early and by n the number of girls in the overall population. Denote by yi the age at which girl i had her first child and by z Annex: Methodological Note the age threshold defining early childbirth (18 years of age, but a lower age threshold such as 15 can also be used to measure While many studies have discussed trends in child marriage, extremely early childbirth). The general formula for the FGT less work has been done on trends in early childbirth. When class of measures depends on a parameter α which takes a conducted, measurement of early childbirth (or early pregnancy) value of zero for the headcount, one for the early childbirth gap, has focused on one simple statistic such as the share of girls and two for the squared gap in: who have a live birth before the age of 18 or 15. Such statistics  1 q  z  yi  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 P   z  n i1   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 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 Foundation (CIFF). More details on the research can be found at the child marriage, this brief and its companion paper (available on project’s website: www.costsofchildmarriage.org. Partial funding for the request) rely on methods from the poverty literature to measure 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