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Benny mat nutradolpreg_9sept2016_session3d

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The Relationship of Maternal Nutrition and Adolescent Child-bearing with Child Development
Liza Benny, Quantitative Research Assistant
Paul Dornan, Senior Policy Officer
Andreas Georgiadis, Senior Research Officer
Adolescence, Youth and Gender conference
Oxford, 8-9 September 2016

Published in: Food
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Benny mat nutradolpreg_9sept2016_session3d

  1. 1. The Relationship of Maternal Nutrition and Adolescent Child-bearing with Child Development Liza Benny, Quantitative Research Assistant Paul Dornan, Senior Policy Officer Andreas Georgiadis, Senior Research Officer Adolescence, Youth and Gender conference Oxford, 8-9 September 2016
  2. 2. MOTIVATION • Maternal nutrition plays a key role in fetal growth and development • Maternal health outcomes (during and before pregnancy) are associated with pregnancy outcomes and child development – Kelly et al, 1996; Rayco-Solon et al, 2005; Ramakrishnan et al, 1999 – Dominguez-Salas et al, 2014; Dewey and Begum, 2011 – Martorell and Zangrone, 2012; Ozaltin et al, 2012 • Children born to teen mothers in developed country settings are at increased risk for adverse health, cognitive and behavioural outcomes in early childhood – Hofferth, 1987; Furstenberg et al, 1987; Coley & Chase-Lansdale, 1998; Corcoran, 1998 – King, 2003; Shaw et al, 2006; Fall et al, 2015 • Adolescence may be a particularly sensitive critical window where nutritional interventions may lead to catch up growth among stunted children. – Prentice et al, 2013
  3. 3. ANALYSIS • We investigate the links between two particular maternal risk factors [maternal undernutrition and adolescent childbearing] and child outcomes, and the degree to which they persist over childhood. • Maternal undernutrition reflects partly undernutrition during adolescence, and therefore, we also investigate the degree to which there is persistence of nutritional status in adolescent girls in order to examine the extent to which adult height reflects growth in adolescence
  4. 4. DEFINITIONS • An adolescent mother in our sample is defined as the mother of a Young Lives child who was aged 19y or younger when she gave birth to the index child • A mother is classified as stunted if her adult height is more than 2 standard deviations below the median compared to WHO reference of well-nourished individuals at the oldest age point (19y) The UN defines adolescents as individuals aged 10-19y UNICEF Report on State of the World’s Children , 2011 0 100 200 300 400 500 600 700 800 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Frequency Mother's age when she gave birth to Young Lives child Age of mother at birth of Young Lives child
  5. 5. DATA • Analysis uses data from the Young Lives study • Document intergenerational associations of maternal risk factors with child outcomes for the younger cohort: — Stunting — Underweight — Quantitative achievement (CDA at age 5y, Mathematics tests at ages 8y and 12y) • Examine the extent of plasticity of growth during adolescence using the sample of girls from the older cohort
  6. 6. DISTRIBUTION OF MATERNAL RISK FACTORS 7% 11% 27% 55% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ethiopia [n=1555] India [n=1834] Peru [n=1752] Vietnam [n=1765] Total [N=6906] Combined risk of maternal undernutrition and adolescent childbearing Stunted adolescent mother Non-stunted adolescent mother Stunted adult mother Non-stunted adult mother
  7. 7. MEAN CHILD OUTCOMES BY GROUP 0.00 0.10 0.20 0.30 0.40 0.50 0.60 Age 1y Age 5y Age 8y Age 12y Proportionofchildrenwhoarestunted Share of children stunted by group [N=6413] -0.2 -0.15 -0.1 -0.05 0 0.05 0.1 0.15 CDA at age 5 y Maths at age 8 y Maths at age 12 y Deviationfrommeanscoreforage Average deviation from mean score for age in quantitative tests [N=6213] by group Stunted mother who gave birth in adolescence Non-stunted mother who gave birth in adolescence Stunted mother who gave birth in adulthood Non-stunted mother who gave birth in adulthood 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 Age 1y Age 5y Age 8y Proportionofchildrenwhoare underweight Share of children underweight by group [N=6603]
  8. 8. ADJUSTED OUTCOMES BY GROUP 0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45 0.50 Age 1y Age 5y Age 8y Age 12y Proportionofchildrenstuntedineach group Adjusted proportion of children stunted by group [N=6413] 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 Age 1y Age 5y Age 8y Proportionofchildrenunderweightin eachgroup Adjusted proportion of children underweight by group [N=6603] -0.2 -0.15 -0.1 -0.05 0 0.05 0.1 0.15 CDA at age 5 y Maths at age 8 y Maths at age 12 y Deviationfrommeanscoreforage Adjusted average score deviations from mean for age in quantitative tests [N=6213] Stunted mother who gave birth in adolescence Non-stunted mother who gave birth in adolescence Stunted mother who gave birth in adulthood Non-stunted mother who gave birth in adulthood Graphs show coefficients from regressions of the outcomes on groups defined by maternal characteristics. Regressions include controls for child age in months, sex, birth order, household wealth index, parental education, mother’s ethnicity, urban site, and region of residence, as well as for language of administration for the quantitative tests.
  9. 9. KEY MESSAGES • Descriptively children born to older non-stunted mothers do best; children born to younger stunted mothers do worst • But, controlling for SES and other factors changes this pattern somewhat: – The relationship between mothers stunting and child stunting and underweight persists into middle childhood – The relationship between mothers’ age at birth and child stunting/underweight weakens and fades at older ages – The relationship between mothers stunting and age at birth and cognition mostly disappears, suggesting that SES matters more • Additional analysis – might investments in adolescence affect later outcomes? – Dominance of the first thousand days. Vital policy timing for prevention, but might opportunities be missed? – Investigate height plasticity in later adolescence
  10. 10. PERSISTENCE OF UNDERNUTRITION IN ADOLESCENT GIRLS 90.78% 34.46% 9.22% 65.54% 0 200 400 600 800 1000 1200 1400 Not stunted at 15y Stunted at 15y Frequency Change in stunting status for girls between 15y and 19y Not stunted at 19y Stunted at 19y
  11. 11. ADDITIONAL CHECKS • Lower the threshold age used to define teen pregnancy – Key patterns do not change when the threshold age is changed from 19 to 16 years – Differences in child stunting between children born to mothers in adolescence and adulthood become more marked. – Results for cognitive achievement do not change systematically. • Examine whether the weak association between maternal age at birth and child outcomes is accounted for by the inclusion of control variables – The association between adolescent childbearing and child outcomes manifests partly through mother’s education and household wealth. • Correct for measurement error in the regressions on plasticity in stunting status in adolescent girls – Regression to the mean can lead to reduced persistence of stunting over time – Measurement error does not explain the observed lack of persistence of nutritional status in adolescent girls
  12. 12. CONCLUSIONS • Maternal stunting is clearly linked with child stunting & underweight, with relationships that persist into middle childhood • Child stunting is more strongly associated with maternal undernutrition than with maternal age at birth • Once we control for child and household background characteristics, the relationship between the age of the mother at birth and child test scores largely fades out • We find evidence of plasticity of nutritional status in adolescent girls between 15 & 19 years old • Therefore, our findings indicate that there may be potential benefits arising to both adolescent girls and their children from interventions that promote their growth not just in early childhood and infancy, but also in adolescence.

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