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

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.