1. Discussant notes Monica Das Gupta Development Research Group The World Bank

2. Adolescent childbearing has many negative effects Bad for individual health: – Higher infant mortality – Higher maternal mortality E.g. UNFPA reports that in Bangladesh maternal mortality is 3x higher at ages 15-19 than at age 20-24, and IMR 34% higher than at age 20-29 (partly because higher proportion of first births, and lower maternal SES) Bad for population health: – Low birthweight children (studies in OECD find ass with lower education & income) – Maternal morbidity (damage to immature systems) Increases rate of population growth: – Shorter generations, builds population momentum that partly offsets gains of reducing the no. of children per woman Bad for girls’ prospects of economic security: – Schooling – labor-force participation – lifetime earnings

3. Adolescent childbearing has many negative effects Bad for individual health: – Higher infant mortality – Higher maternal mortality E.g. UNFPA reports that in Bangladesh maternal mortality is 3x higher at ages 15-19 than at age 20-24, and IMR 34% higher than at age 20-29 (partly because higher proportion of first births, and lower maternal SES) Bad for population health: – Low birthweight children (studies in OECD find ass with lower education & income) – Maternal morbidity (damage to immature systems) Increases rate of population growth: – Shorter generations, builds population momentum that partly offsets gains of reducing the no. of children per woman Bad for girls’ prospects of economic security: – Schooling – labor-force participation – lifetime earnings

4. Adolescent childbearing has many negative effects Bad for individual health: – Higher infant mortality – Higher maternal mortality E.g. UNFPA reports that in Bangladesh maternal mortality is 3x higher at ages 15-19 than at age 20-24, and IMR 34% higher than at age 20-29 (partly because higher proportion of first births, and lower maternal SES) Bad for population health: – Low birthweight children (studies in OECD find ass with lower education & income) – Maternal morbidity (damage to immature systems) Increases rate of population growth: – Shorter generations, builds population momentum that partly offsets gains of reducing the no. of children per woman Bad for girls’ prospects of economic security: – Schooling – labor-force participation – lifetime earnings

5. Adolescent childbearing has many negative effects Bad for individual health: – Higher infant mortality – Higher maternal mortality E.g. UNFPA reports that in Bangladesh maternal mortality is 3x higher at ages 15-19 than at age 20-24, and IMR 34% higher than at age 20-29 (partly because higher proportion of first births, and lower maternal SES) Bad for population health: – Low birthweight children (studies in OECD find ass with lower education & income) – Maternal morbidity (damage to immature systems) Increases rate of population growth: – Shorter generations, builds population momentum that partly offsets gains of reducing the no. of children per woman Bad for girls’ prospects of economic security: – Schooling – labor-force participation – lifetime earnings Intergenerational transmission of poverty

6. Adolescent childbearing is highest among the poor / disadvantaged Developing countries: data indicate teen pregnancy negatively ass with wealth quintile (Greene and Merrick citing Gwatkin et al 2007) Studies in the US indicate higher probability of teen pregnancy if low-income family, one-parent household, or less educated mother Orphans: Studies in Southern Africa indicate that girls more exposed to early sexual activity than boys. Exposed to HIV and conception

7. The poor / disadvantaged seem to have the least to lose from teen childbearing US studies show lower SES teens have less loss of income from early childbearing than others: – lifetime costs of childbearing, especially early childbearing are particularly high for skilled women (Ellwood et al 2004) – Cherlin (2001) summarizes this literature Parents also make similar calculation: India age at marriage – 19.7 for highest wealth quintile, 15.4 for lowest quintile – Lowest in poorest state (Bihar)

8. Policies need to build on the fact that the poor/disadvantaged have the least to lose from adolescent childbearing Importance of Bank’s Gender Action Plan, to increase poor women’s access to the labor market, agricultural resources, land, and credit BRAC model offers: – training followed by microfinance – even if no land, can train in e.g. poultry rearing; poultry and livestock vaccinator training; tailoring and other non-farm businesses (CCTs for schooling seems logistically complex for countries with low administrative capacity)

9. Policies also depend on who is the “decider” Most discussion relates to situation where teenagers make the choices that lead to teen pregnancy But simple policy handle if parents marry daughters young (e.g. India): NFHS shows parents flout law on minimum age at marriage (18 for women). Of women aged 20-24 in 2005-06: – nearly half (47%) were married before age 18, and 22% had given birth – (fell from 63.4% of women aged 35-39 married by age 18 and 32% gave birth) note early marriage often involves economic and physical support of joint family while raising young children, so may have less costs that Maynard documents (child abuse, crime, etc.) – Not hard to implement the marriage law more rigorously in India Efforts to raise women’s income (the perceived cost of early childbearing) important regardless of who is “the decider”