1.

INTRODUCTION

The age at which women have their first birth can have implications for schooling, labor force
participation, and overall family size (NRCIM, 2005). For one, women who experienced early
childbearing would more likely have larger families (Freedman et al., 1981). In contrast to this, delaying
the first birth was shown to increase the likelihood of participating in the labor market (Bratti and
Cavalli, 2013). On a larger scale, trends in the age at first birth have important effects even on the state
of the economy (Rindfuss, 1983). Women who already experienced childbearing in or shortly after
puberty were also shown to have high levels of current health problems (Mirowsky, 2005).

There are factors affecting a woman’s entry into motherhood. A study on adulthood among
developing countries suggested that young people who grow up in poor households are more likely to
work as children, more likely to drop out of primary school (and in some cases never have a chance to
go to school at all), more likely to engage in risky sexual behavior (not always voluntary), more likely to
marry and bear children early and less likely to find stable and remunerative employment as adults
(NRCIM, 2005).

Meanwhile, Rindfuss and John (1983) studied the social determinants of age at first birth
among women in the US using classical regression analysis. While other demographic variables were
found to be significant, their findings revealed that education strongly affects the timing of first birth,
and their relationship is reciprocal.

In addition, a research showed that among women of Madagascar aged 12-25, an additional
year of schooling resulted in a delay of marriage by 1.5 years, and marrying one year later delayed the
age of first birth by 0.5 years. Among other findings, a woman’s first birth was delayed by 0.75 years for
four additional years of schooling of her mother (Glick et al., 2015). Meanwhile, in Malawi, a study
revealed that there is a significant and positive association between years of schooling completed and
age at first birth, controlling for ethnicity, religion, urban residence, and district (Grant, 2015).

Moreover, it is notable that a study among 1026 African-American women uncovered factors
such as parental separation, urban residence, age of menarche, and teen smoking, sexual abuse during
childhood being associated with younger age at first sex and younger age at first pregnancy. Also,
incidents of physical abuse showed minimal effect on age at first sex and no effect on age of first
pregnancy (Fiscella, 1998).

The mean age of first birth varies across nations, with women from developed countries
showing greater tendency to first bear a child later than women from the developing world (see
Packham, 2016). In the Philippines, the mean age of first birth among Filipino women aged 25-29 is 23
years old (CIA Factbook,n.d.). However, while teen pregnancy rates in most countries are declining,
teenage pregnancy in the Philippines is on the rise, with an estimated 500 Filipino children becoming
mothers every day (Jolley, 2018).

This serves as motivation to study the dynamics of first childbearing among women in the
Philippines through the lens of survival analysis. Of primary interest to the researchers is to determine
the factors that affect time to women’s first birth. The researchers will also give a special look into the
characteristics of teenage pregnancy in the Philippines.

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1.1. Statement of the Problem and Objectives:

Using techniques from survival analysis, the study attempts to understand time to first birth of
Filipino women using various indicators from the 2013 National Health and Demographic Survey. This
study is specifically guided by the following objectives:

1. Determine the mean and median time to first birth of Filipino women
2. Describe the nature of teenage childbearing among women using survival analysis
3. Determine differences between time to first birth by all women classified according to education
level and wealth status
4. Predict time to first childbearing of women across all ages using the Cox proportional hazards
model

1.2. Significance of the Study:

This research gives importance to the crucial moment of childbearing among women. Findings
of this study sheds light on the nature of first pregnancy among women in the Philippines, and the
factors which affect it. Considering the social and economic impact of early childbearing among
women, this study will help policymakers design programs meant to prevent teenage pregnancy.

2. METHODOLOGY

2.1. Data

This study employs data from the Women’s Questionnaire of the 2013 National Demographic
and Health Survey. All cases with missing values were removed from the data, and the initial data set
consists of 16,125 observations.

The response variable in survival analysis is composed of two parts: the time to event, and the
event status, or whether or not the event took place. To view the data from the lens of survival analysis,
the reported age at first birth will serve as the time of interest for event status = 1. For women who have
not given birth at all (status = 0), their age at the time of the interview will serve as the event time.

Meanwhile, to avoid the bias of length-biased sampling, the researchers set the age at first
menstrual period as the entry time of the observations into the study, instead of the natural entry age 0--
assuming that conception is only possible after menarche. Considering this, the data set is truncated
into 15,776 observations. The following variables, with each corresponding code and description, are
used in this study:

1. Age at first birth (fbirth): This is not the same as age at first pregnancy-- for which there is no
available data--since pregnancy does not necessarily assure live birth.
2. Educational level (educ_level) - a four-category variable used to represent the highest
educational attainment of the respondent at the time of the interview. A value of 0 means the
respondent failed to complete any schooling, 1 means she has completed primary school, 2
implies she has graduated from secondary school, while 3 means the respondent completed
college or some other form of higher education.
3. Wealth level (wealth_level) - a five-point scale used to represent the wealth of the households
interviewed. The wealth index is constructed using household asset data, including ownership
of consumer items ranging from a television to a bicycle or car, as well as dwelling

2
 characteristics, such as source of drinking water, sanitation facilities, and type of flooring
material. In the dataset, an index of 1 represents the poorest households, 2 represents the 2nd
quintile (poorer), 3 represents the middle group, 4 means richer, while the richest households
belong to 5.
4. Experience of forced sex (forcedsex) - this represents whether or not the respondent has ever
been forced into sex. The researchers calculated this by assigning a value of 1 if the respondent
gave the exact age she was forced into sex or if she was able to recall one instance but cannot
remember when; 0 otherwise.
5. Age at menarche (s238) - the respondent’s age at her first menstruation

3.1. Kaplan-Meier Estimation

We use Kaplan and Meier’s method (1958) to estimate the population survival curve from a
sample. This standard method allows estimation of survival over time despite censoring of data, e.g.
points drop out or are studied for different lengths of time. This estimator is defined as follows for all
values of t in the range where there is data:

where at time ti, di is the number of events occuring, and Yi is the number of individuals at risk.

3.2. Log-rank Test

The log-rank test is a nonparametric test of the null hypothesis that there is no difference in
survival probabilities between two groups. The general form of the test statistic is given by

where the weight function W(t) = Y(t) for the one-sample log-rank test.

3.3. Cox Proportional Hazards model

The proportional hazards model due to Cox (1972) is a regression model which investigates the
association between survival time and one or more predictors often referred to as covariates, either
categorical or continuous. For survival time t, covariates (x 1,x2,...,xp), and coefficients (b1,b2,...,bp), the
model is expressed by the hazard function, given by:

3
 The model is “proportional” because it assumes that the hazard of the event in any group is a
constant multiple of the hazard in any other. This assumption implies that the hazard curves for the
groups should be proportional and cannot cross.

4. RESULTS AND DISCUSSION

4.1. Descriptives Figure 1. Histogram of Age at First Birth

Of the 15,776 respondents in the data

set, 63.1% or 9,951 indicated that they already
experienced giving birth. The mean age at first
birth is about 22 years old (stdev = 5.797). Most
respondents were women who completed
secondary education, and a majority of them
gave their first birth within 15-19 years of age.
Meanwhile, among the poorest households,
majority of the women gave birth during their
teenage years, while most women from the
richest households had their first childbearing
within 21-30 years. Lastly, 5.3% of the
respondents have been forced into sex, and 52%
of them gave birth during their teenage years.

Table 1. Distribution of Respondents by Factors

and Summaries of the Age at First Birth

Age at first birth (in years) Mean Median

Factors N
≤ 20 21-30 31 + age age
Education Level
No education 231 124 90 17 22 20
Primary 2714 1582 983 149 21 20
Secondary 7523 4316 2788 419 21 20
Higher 5308 1478 3158 672 24 23
Wealth Index
Poorest 3079 1862 1116 101 20 19
Poorer 3000 1676 1163 161 21 20
Middle 3060 1462 1370 228 22 21
Richer 3223 1326 1579 318 23 21
Richest 3414 1174 1791 449 24 23
Age at first menstruation
<15 13054 6383 5639 1032 22 21
16-20 2718 1117 1376 225 23 21
21+ 4 0 4 0 26 26
Experienced forced sex
No 14944 7066 6659 1219 22 21
Yes 832 434 360 38 21 20

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4.2. Log-rank test

At 5% level of significance, we have sufficient evidence to conclude that the survival curves
within education level, wealth index, age at first menstruation, and experience of forced sex are
different. This is supported by the survival plots per variable.

Table 2. Univariate Chi-Squares for Log-Rank Test

Variable Test Statistic Standard Chi-Square Pr > Chi-Square

Error
Education Level 2605.0 74.6515 -201.1 <0.0001
Wealth Index 4707.3 138.4 -1068.9 <0.0001
Age at first menstruation -626.2 161.5 26085.9 <0.0001
Experienced forced sex -216.3 20.8383 56.5 <0.0001

4.3. Model Fitting

For the model-building process, education level, wealth index, age at first menstruation and
experience of forced sex were considered. Result of the global test indicates that the model is
significant. Local tests, meanwhile, show that all variables under consideration have significant impact
on the time to first birth (see Appendix for the model fit statistics). Table 3 shows the parameter
estimates.

Table 3. Analysis of Maximum Likelihood Estimate

Parameter DF Parameter SE Chi-Square Pr > Hazard 95% CI of HR

Estimate ChiSq Ratio
Educational level
None (E0) 1 0.4636 0.0768 36.4210 <0.0001 1.590 1.368 - 1.848
Primary (E1) 1 0.6421 0.0323 395.2628 <0.0001 1.900 1.784 - 2.025
Secondary (E2) 1 0.4695 0.0255 338.2628 <0.0001 1.599 1.521 - 1.681
Wealth Index
Poorest (W1) 1 0.5780 0.0363 253.9657 <0.0001 1.782 1.660 - 1.914
Poorer (W2) 1 0.4545 0.0363 253.6790 <0.0001 1.575 1.471 - 1.687
Middle (W3) 1 0.3178 0.0342 86.4268 <0.0001 1.374 1.285 - 1.469
Richer (W4) 1 0.1575 0.0335 22.0859 <0.0001 1.171 1.096 - 1.250
S238 (M) 1 0.0294 0.0063 21.9248 <0.0001 1.030 1.017 - 1.043
Forcedsex (F) 1 0.2491 0.0402 38.3435 <0.0001 1.283 1.186 - 1.388

All variables in the model proved to be significant in predicting the survival time to first birth of
Filipino women. The table below shows the model estimates. Notice how the parameter estimates do
not follow the ordinality of educational level. Completion of primary education showed the greatest
effect on the hazards model, which may be reflective of their conditions and attitude toward
childbearing. At any fixed point in time, the estimated risks of childbearing for women who completed
none, primary and secondary education compared to those who completed higher education are 1.6
(95% CI: 1.368-1.848), 1.9 (95% CI: 1.784-2.025), and 1.6 (95% CI: 1.521-1.681), respectively, holding all
other factors constant.

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 On the other hand, coefficients of wealth variables support the notion that women from poorer
households are at greater risk of early childbearing, while the opposite is true for richer households. At
any fixed point in time, the risks of childbearing for women from the poorest, poorer, middle, and richer
households compared to women from the richest households are 1.78 (95% CI: 1.660 - 1.914), 1.58 (95%
CI: 1.471-1.687), 1.37 (95% CI: 1.285-1.469), and 1.17 (95% CI: 1.096-1.250), respectively, holding all
other factors constant.

S238, or the woman’s age at first menstrual occurence, yielded a coefficient of 0.02944. This
means that the relative risk for a woman who had her menarche at 15 years old, compared to another
who had it at 10 years old, is equal to exp[(15-10)*0.02944] = 1.15. A year increase in age of menarche
increases the risk of first childbearing by 2.3 percent, holding all other factors constant (95% CI: 1.017 -
1.043).

Lastly, the first childbearing risk of those who experienced being forced into sex is 1.283 relative
to those who experienced none (95% CI: 1.186-1.388). The final model for the hazard of first childbearing
is given by:

where E0, E1, and E2 are binary indicators of having none, primary, and secondary school as
highest educational attainment, respectively; W1, W2, W3 and W4 are indicators of belonging to wealth
level 1, 2, 3 and 4, respectively; M is the age at first menarche, and F is whether or not one has ever
experienced forced sex. The survival and hazard curves of time to first birth are presented as follows:

Figures 2, 3. Survival Function and Cumulative Hazard

Functions of Time to First Birth

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4.4. Model Fit Diagnostics

The model is checked for three requirements. First, the covariates must be correctly specified.
The Martingale residuals allow us to find the best functional form of the covariates. Second, the
proportional hazards assumption of the Cox model must be satisfied. For categorical variables, a quick
way to check for this is to inspect whether the survival curves for each category are parallel. For
continuous variables, this is checked through the Schoenfeld residuals. Lastly, we check for any survival
time outliers or influential points. The cox-snell residuals plot allows us to check for the outliers and the
overall fit of the model, while the deviance residual plot could help identify influential observations.

The plot of Cox-Snell residuals indicates a good fit because it follows the 45-degree line, despite
large deviations on the latter end. It is in fact Figure 4. Cox-Snell Residual Plot

common for survival data to exhibit the

latter characteristic.

Figures 5 and 6. Schoenfeld Residuals for forcedsex and age at menarche

To satisfy the proportionality assumption, the slope of the residuals must be equal to zero.
Graphical inspection tells us that variables forcedsex and age at menarche satisfy the proportional
hazard assumption since their respective slopes are about y=0.

Figure 7. Deviance Residual Plot

Lastly, the deviance residual plot is fairly

symmetric around 0, but there is presence of
some influential observations.

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 Figures 8 to 11. Martingale Residuals Plots

The martingale residuals can be interpreted as a measure of excess observed events, or the
difference between the observed number of events and the expected number of events under the model.

Each of the martingale residual plots showed that the variables educational level, wealth index,
experience of forced sex and age at first menarche follow the linearity assumption. The residuals for
each variable also have means close to zero. Only the age at first menarche showed slight deviation
from the assumptions of having a zero mean and following linearity.

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 Figures 12 and 13. Survival Curves for Education Level and Wealth Index

The survival curves classified per category are approximately parallel, demonstrating that the
proportional odds assumption is satisfied by educ_level and wealth_index. Notice that the survival
curves for educ_level = 3 (higher education) and wealth_index = 5 (richest) are the highest for the
respective variables, consistent with earlier findings that women who received higher education and
who belong to the richest households are at a lesser of risk of first childbearing.

4.5. The Case of Teenage Pregnancy

For the purpose of this research, Figure 14. Cumulative Hazard Functions of Time to First Birth
teenage childbearers are defined as Among Women Aged <20
respondents aged less than 20 at the time of
the interview, and who have already given
their first birth at age less than 20, following
the technical definition used by the Philippine
Statistics Authority (2014) in its report. Of the
3,252 respondents aged less than 20, 7.6% or
248 reported to have had given birth already.
The mean survival time to first childbearing
among teenage women is 18.75. Using the
Kaplan-Meier estimation, the cumulative
survival and hazard functions are presented.

There is a sudden increase in the

cumulative hazard of teenage childbearing at
around 17 to 19 years old. Figure 14 shows
that the hazard of teenage childbearing
clearly increases for lower educational attainment. This supports the notion that teenage pregnancy is,
to an extent, accounted for by an adolescent’s level of education.

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 Figures 15 and 16. Survival Curves for Education level and Wealth index (Age < 20)

A teenage Filipino woman’s “survival” until first childbearing increases as her highest
educational attainment. This means that teenage women who failed to complete any level of education
have the greatest risk of first childbearing.

While there are overlaps in middle values, what is clearly seen in survival curves for wealth index
is that teenage women from the poorest households have the greatest risk of early motherhood, and the
opposite is true among women from the richest households.

5. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

The mean age at first birth by Filipino women is about 22 years old, a bit lower than the
Philippines’ neighboring countries such as Indonesia (22.8) and Thailand (23.3). Meanwhile, the
country’s teenage pregnancy rate based on the data is 7.6%. The UN Population Fund has already noted
that the Philippines is the only country in the Asia-Pacific Region where teenage pregnancy has been on
the rise in the last ten years. This has consequences especially on an economy that depends on more
working-age people than younger dependencies.

The Kaplan-Meier estimate showed that the mean survival time to first childbearing among
women aged 10-19 is 18.75 years. One primary advantage of choosing survival analysis over other
techniques is that it treats the response as a function of both time and event status, and hence,
censored observations are taken into account. Univariate analysis through the log-rank test showed that
educational level, wealth index, age at first menstrual period, and experience of forced sex individually
have significant effects on the time to first childbearing. These were the same variables that later on
comprised the cox proportional hazards model.

Estimates revealed that the risk of childbearing is greatest among women whose highest
educational attainment is primary, relative to college graduates. This highlights the importance of
education in shaping the values and vision of young women who may prove to be vulnerable to sexual
risks. On the basis of this finding, basic sex education must be introduced to primary school students.

10
 On the other hand, the risk of childbearing is inversely related to wealth level, with women from
the poorest households at a risk of first motherhood 1.8 times that of women from the richest
households. Among the poorest households, majority of the women gave birth within 15-19 years old,
while most women from the richest households had their first childbearing within 20-29 years. Note that
the wealth index was computed using household economic factors, and the findings reveal that access
to resources significantly impacts the risk of motherhood.

Age at first menstrual period is also shown to have a significant effect on first childbearing. A
year increase in the age of menarche increases the risk of childbearing by 3%. This seem to support the
claim of Udry and Cliquet (1982) that puberty, signalled by menstruation, “determines the timing of the
social perceptions of the pubescent girl as an appropriate participant in heterosexual relationships
suitable to her age (as defined by the culture).”

Lastly, there is sufficient evidence as well that experience of forced sex impacts the risk of first
childbearing. The risk of first motherhood among those who experienced rape is 1.3 relative to those
who did not. This result is further supported by a study by Noll, Trickett and Putnam (2010), which
stipulated that abused women were more preoccupied with sex, younger at first voluntary intercourse
and more likely to have been teen mothers.

Results of this study can aid the Philippine government to prevent the increasing cases of
teenage pregnancy in the country. Basic sex education should be more comprehensive and should be
brought down to the primary level of education with proper implementation. The government can also
empower the youth and women through different educational services and livelihood programs. Proper
information dissemination on how to prevent and report sexual abuse is another avenue on lowering the
number of teenage pregnancy in the country. Hence, collective efforts both by the government and local
communities are vital in preventing early childbearing among women.

REFERENCES

Bratti, M., & Cavalli, L. (2014). Delayed first birth and new mothers’ labor market outcomes: Evidence
from biological fertility shocks. European Journal of Population, 30(1), 35-63.

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world-factbook/fields/2256.html

Cox Proportional-Hazards Model. (1972). Retrieved from http://www.sthda.com/english/wiki/cox-

proportional-hazards-model

Freedman, D. S., Thornton, A., & Wallisch, L. (1981). Age at first birth and family size: Evidence from a
longitudinal study. Social biology, 28(3-4), 217-227.

Fiscella, K., Kitzman, H. J., Cole, R. E., Sidora, K. J., & Olds, D. (1998). Does Child Abuse Predict
Adolescent Pregnancy? Pediatrics, 101(4), 620-624. doi:10.1542/peds.101.4.620

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Introduction to Survival Analysis in SAS. (n.d.). Retrieved May 28, 2018, from
https://stats.idre.ucla.edu/sas/seminars/sas-survival/

Jolley, M. (2018, January 24). Young, poor and pregnant: Teen mums in the Philippines. Al Jazeera.
Retrieved from https://www.aljazeera.com/indepth/features/young-poor-pregnant-teen-mums-
philippines-180123080457459.html

Klein, J. P., & Moeschberger, M. L. (2010). Survival analysis: Techniques for censored and truncated data.
New York: Springer.

Glick, P., Handy, C., & Sahn, D. E. (2015). Schooling, marriage, and age at first birth in Madagascar.
Population Studies, 69(2), 219-236. doi:10.1080/00324728.2015.1053513

Grant, M. J. (2015). The Demographic Promise of Expanded Female Education: Trends in the Age at First
Birth in Malawi. Population and Development Review, 41(3), 409-438. doi:10.1111/j.1728-
4457.2015.00066.x

Mirowsky, J. (2005). Age at first birth, health, and mortality. Journal of Health and Social Behavior, 46(1),
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National Research Council, & Committee on Population. (2005). Growing up global: The changing
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News, A. T. (2016, February 04). UNFPA report raises alarm over teen pregnancy, adolescent sex in PHL.
Retrieved May 28, 2018, from
http://www.gmanetwork.com/news/lifestyle/healthandwellness/554035/unfpa-report-raises-alarm-
over-teen-pregnancy-adolescent-sex-in-phl/story/

Noll, J. G., Trickett, P. K., & Putnam, F. W. (2003). A prospective investigation of the impact of childhood
sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71(3), 575-
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Packham, A. (2016, March 09). This Is The Average Age Women Get Pregnant Around The World.
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mums_n_9416064.html?guccounter=2

Philippine Statistics Authority. (2013). Teenage pregnancy. Retrieved May 28, 2018, from
https://psa.gov.ph/sites/default/files/TRIVIA_teenagemothers_rev.pdf

Rindfuss, R. R., & St. John, C. (1983). Social determinants of age at first birth. Journal of Marriage and
the Family, 553-565.

The World Factbook. (n.d.). Retrieved May 28, 2018, from https://www.cia.gov/library/publications/the-
world-factbook/fields/2256.html

Udry, J. R., & Cliquet, R. L. (1982). A Cross-Cultural Examination of the Relationship Between Ages at
Menarche, Marriage, and First Birth. Demography, 19(1), 53. doi:10.2307/2061128

APPENDIX

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 Model Fit Statistics
Criterion Without Covariates With Covariates
-2LOG L 174271.42 172594.99
AIC 174271.42 172612.99
SBC 174271.42 172677.84

Testing Global Null Hypothesis: BETA = 0

Test Chi-square DF Pr > ChiSq
Likelihood Ratio 1676.4243 9 <0.0001
Score 1712.3445 9 <0.0001
Wald 1626.0362 9 <0.0001

Type 3 Tests
Effect DF Wald Chi-Square Pr > ChiSq
Education Level 3 465.6085 <0.0001
Wealth Index 4 305.9153 <0.0001
Age at first menstruation 1 21.9248 <0.0001
Experience forced sex 1 38.3435 <0.0001

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