DEMOGRAPHIC

AND

HEALTH

RESEARCH

DHS WORKING PAPERS

2010 No. 75

Sutay Yavuz

October 2010

This document was produced for review by the United States Agency for 

International Development.

Changes in Adolescent Childbearing in 

Morocco, Egypt and Turkey
The DHS Working Papers series is a prepublication series of papers reporting on research in progress that 

is based on Demographic and Health Surveys (DHS) data. This research is carried out with support 

provided by the United States Agency for International Development (USAID) through the MEASURE 

DHS project (#GPO-C-00-08-00008-00). The views expressed are those of the authors and do not 

necessarily reflect the views of USAID or the United States Government. 

MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about the MEASURE DHS project can 

be obtained by contacting MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, 

MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@measuredhs.com; internet: 

www.measuredhs.com).
Changes in Adolescent Childbearing in Morocco, Egypt and Turkey 

Sutay Yavuz 

ICF Macro

Calverton, Maryland, USA

October 2010 

Corresponding author: Sutay Yavuz, Ankara University, Faculty of Health Sciences, Social Work Department, 

Şükriye Mahallesi Plevne Caddesi No:5, Aktaş Kavşağı 06340 Cebeci-Altındağ, Turkey; E-mail: 

sutayy@gmail.com
ACKNOWLEDGEMENT 

The author would like to thank Macro International and the U.S. Agency for International 

Development (USAID) for financial and analytical support to complete this study. The analysis 

benefited from the comments of Astou Coly, Monica Kothari, Simona Bignami, Shane Khan and 

Amir Erfani. 

Suggested citation: 

Yavuz, Sutay. 2010. Changes in Adolescent Childbearing in Morocco, Egypt and Turkey. DHS 

Working Papers No. 75. Calverton, Maryland, USA: ICF Macro.
ABSTRACT

The present study aims to gain insights into trends and determinants of adolescent 

childbearing in three countries of the South and East Shores of the Mediterranean Basin: 

Morocco, Egypt and Turkey. The study uses data from recent Demographic and Health Surveys 

(DHS)—Morocco 2003/04, Egypt 2005 and Turkey 2003—to estimate the timing and 

determinants of first births among adolescent women (under age 20) after controlling for the 

effects of various socioeconomic and cultural characteristics. The study focuses on married 

adolescents, who have significantly different experiences than their unmarried counterparts. 

The results suggest that the probability of having a first birth before age 20 has 

substantially declined since the mid-1990s in Morocco and in Turkey, but has declined only 

moderately in Egypt. In Morocco and Turkey the decline in adolescent childbearing has been 

driven by all socioeconomic segments, while in Egypt the decline has been driven by women 

with the lowest educational attainment. Early marriage, low educational attainment of women, 

poor welfare status and high spousal age difference constitute the major socioeconomic and 

socio-cultural factors facilitating adolescent childbearing in all three countries. The findings 

suggest that policies and programs toward decreasing fertility during adolescence should be 

directed to promoting female education beyond the primary level. Also all types of reproductive 

assistance programs should have a husband dimension. 

1

INTRODUCTION 

Over the last three decades, countries of the South and East shores of the Mediterranean 

basin have undergone significant social, economic and political changes that have had a 

profound impact on individuals‘ lives. These changes include urbanization, rising income levels, 

increases in women‘s educational attainment, improvement of health conditions and 

globalization, with its new social and cultural dimensions (D‘Addato et al., 2008). 

Although countries in the South and East Mediterranean region currently display 

different magnitudes of fertility decline, the last decades have been critical in terms of 

convergence toward smaller family size. Some recent studies have shown that in the three 

emblematic countries of the region—Morocco, Egypt and Turkey—the propensity to establish 

smaller family size has spread across different segments of society (D‘Addato et al., 2008).

Although recent general fertility trends in these countries have been well documented through 

analysis of demographic sample surveys (Courbage, 1999; Eltigani, 2000 and 2003; D‘Addato, 

2006; Vignoli, 2006; Yavuz, 2006), adolescent reproductive behavior has not been examined 

extensively.

Adolescence is a period with special importance in the life course of an individual. As the 

period of childhood is disappearing, adolescents are presented with various choices for their 

future lives. Many important life events and health-damaging behaviors start during adolescence 

(Khan and Mishra, 2008). Today, the effect of rapid social change on adolescents is more visible 

than ever. The enormous impact of globalization, the spread of information and communication 

technologies, the influence of HIV/AIDS, profound changes in family structures and conflict and 

change in intergenerational relations are becoming part of life for adolescents everywhere 

(United Nations, 2007). 

In relation to these social changes, young people have increasingly been the focus of 

international attention, especially since the adoption in 1995 of the World Programme of Action 

for Youth by the United Nations General Assembly (United Nations, 1996). This program and 

the subsequently adopted Millennium Development Goals (MDG) in 2000 encompass the 

principal set of guidelines and target areas for youth policies (United Nations, 2004; United 

Nations, 2005; United Nations, 2007). As these plans have served as the reference point for 
2

many governments around the world in policies and programs focused on young people, 

important changes have taken place since the mid-1990s. Considering the demographic effect of 

such policies, the age at first marriage has risen to the mid-to-late twenties in many areas due to 

extended school attendance and delayed entry into the labor market, particularly for young 

women. There has also been a trend among adolescents toward delaying childbearing and having 

fewer children (United Nations, 2005). 

Despite the process of social change toward modernization in Morocco, Egypt and 

Turkey, social norms in the three countries still strongly prescribe marriage and having at least 

one child. When marriage and childbearing occur in adolescence, they have far-reaching 

individual and social consequences. Early marriage and subsequent early childbearing have 

adverse social and health consequences particularly for females—including dropping out of 

school, marginalization in the job market, ongoing dependence on males and greater risk of 

maternal death and loss of their children. Regarding its long-term adverse impact on the quality 

of life of women and children, adolescent reproductive behavior prevails as one of the major 

youth policy concerns in Morocco, Egypt and Turkey (UNDP, 2006). 

Married adolescent women in these countries face several challenges that make it difficult 

to protect their health and well-being. They often have low educational attainment and no further 

schooling options, limited control over resources, highly restricted mobility, shrinking social 

networks and limited power in their new households (Population Council, 2009a). For these 

reasons married adolescent girls are the most vulnerable group of adolescents and thus deserve 

special attention in policies and programs. The present study aims to gain further insights into the 

specifics of adolescent reproductive behavior in the three countries by looking at trends and 

determinants of adolescent childbearing. The study focuses upon married adolescent girls, who 

have significantly different experiences than their unmarried counterparts. 

Analysis focuses upon two research questions: First, the study explores how the entry 

into motherhood among women who married in adolesence has changed in the last decades in 

Morocco, Egypt and Turkey. Second, we analyze the factors that influence first birth before age 

20 for women who married during adolesence. 

The study is organized into several sections: Background describes changes in the social 

conditions of the adolescent population in Morocco, Egypt and Turkey from the mid-1990s 
3

onwards and provides an overview of selected social and economic determinants of adolescent 

fertility. Methodology explains the data, methods and variables used in the empirical part of the 

study. The Results section presents the adolescent childbearing trends and patterns of the three 

countries, through hazard models. Discussion explores these findings further and offers 

conclusions. 
4

BACKGROUND

Changes in the Social Conditions of the Adolescent Population since the Mid-1990s 

Morocco, Egypt and Turkey are three predominantly Muslim countries in the South and 

East Mediterranean region. According to the World Population Prospects: The 2008 Revision

(United Nations, 2009), the population of Morocco in 2010 is estimated at 32.4 million, Egypt at

84.5 million, and Turkey at 75.7 million. Adolescents age 10-19 comprise almost one-fifth of the 

total population in Morocco, Egypt and Turkey, as of 2010 (Table 1).

Table 1: Total population and adolescent population (age 10-19) in Morocco, Egypt and Turkey, 

1995 and 2010

Morocco Egypt Turkey

Age 1995 2010 1995 2010 1995 2010

Total population (thousands) 26,951 32,381 63,858 84,474 61,206 75,705

Adolescent population (000) 10-14 3,386 3,032 8,052 8,464 6,930 6,886

15-19 2,947 3,178 6,934 8,079 6,642 6,812

Total adolescent population (000) 10-19 6,333 6,210 14,986 16,543 13,572 13,698

Adolescents as percentage of total 

population (%)

10-14 12.6 9.4 12.6 10.0 11.3 9.1

15-19 10.9 9.8 10.9 9.6 10.9 9.0

Percentage change in adolescent

population 1995-2010 (%)

10-14 -10.5 5.1 -0.6

15-19 7.8 16.5 2.6

10-19 -1.9 10.4 0.9

Source: United Nations, 2009

Turkey scores in the high range of the Human Development Index1 (HDI at 0.806) as per 

the Human Development Report 2009 (UNDP, 2009). Egypt and Morocco exhibit similar levels 

of development and are classified in the middle range of the HDI (Egypt 0.703, Morocco 0.654). 

Among the three countries, the HDI has grown fastest in Morocco since the 1990s. The per 

 

1

 The Human Development Index (HDI) is a composite index measuring average achievement by three basic 

dimensions of human development: a long and healthy life (life expectancy index); knowledge (education index); 

and a decent standard of living (GDP development). For the change in HDI over time and in selected social and 

economic development indicators, see Appendix Table A1.
5

capita gross domestic product (GDP), which has constantly increased in the three countries in 

recent decades, is substantially higher in Turkey (US$12,955) than in Egypt (US$5,349) or 

Morocco (US$4,108). 

Socioeconomic developments have played a significant role in driving both rising age at 

marriage and desire for smaller families in Morocco, Egypt and Turkey, which in turn have 

resulted in fertility declines. In the mid-1990s the Total Fertility Rate (TFR) was 3.6 children per 

woman in Morocco, 3.9 children per woman in Egypt and 2.9 children per woman in Turkey. 

Following a decade of rapid fertility decline in Morocco and Turkey, the TFR now is 

approaching the replacement level (TFR 2.4 in Morocco and 2.1 in Turkey in 2007). In Egypt the 

fertility decline has been slower over the same period (TFR 2.9 in 2007) (see Appendix Table 

A1). 

As empirical studies have shown, urbanization has a potentially important influence on 

the societal environments of adolescents. Changes in socioeconomic structural factors have a 

stronger impact in urban areas than rural areas. Urbanization usually is associated with rising 

income levels, growing opportunities for education and employment, cultural diversity, openness 

to change, and family planning program efforts (Rodriguez and Cleland, 1981). Nevertheless, in 

urban areas poor adolescents may not be able to easily take advantage of available key 

development resources. For example, studies have shown that urban poor adolescents have lower 

school enrollment rates than their wealthier counterparts (Population Council, 2009a). 

In Turkey nearly 70 percent of the population lives in urban areas, compared with 55 

percent of Morocco‘s population and 43 percent of Egypt‘s population (see Appendix Table A1). 

According to Eltigani (2000), over the last several decades the pace of urban growth has slowed 

in Egypt as rural-to-urban migration has been replaced by the daily flow of people between rural 

and urban areas. In Morocco and Turkey, however, migration from regions that are relatively 

socially and economically less developed to urban areas that are more developed has constituted 

one of the major population trends (Eltigani, 2000; Kocaman, 2008). 

Educational attainment reflects human capital, which plays an important role in the social 

and economic outcomes of individuals and societies. Education is also one of the most critical 

components of a healthy transition to adulthood for adolescents. In terms of demographic 
6

outcomes, schooling of adolescents has been associated with delays in the age at first sex, 

marriage, and childbearing (Population Council, 2009a). 

Rates of school attendance by adolescents in the three countries show substantial 

increases between the mid-1990s and mid-2000s. As Table 2 shows, the percentage of 

adolescents, especially age 10-14, attending school at any level has increased considerably. 

Among girls age 15-19, however, attendance at secondary school or higher levels is only 35 

percent in Morocco and 33 percent in Turkey, compared with almost 80 percent in Egypt, as of 

2005. In all three countries gender differentials in school attendance favor boys. The gap in 

school attendance between girls and boys is smaller at age 10-14 but becomes more evident at 

age 15-19. 
7

Table 2: School attendance among adolescents age 10-14 and 15-19 in Morocco (1992 and 

2003/04), Egypt (1992 and 2005), and Turkey (1993 and 2003/04)

School attendance* among girls and boys age 10-14 (in percent)

Girls Boys

Not in 

school

Attending 

primary

Attending 

secondary

Not in 

school

Attending 

primary

Attending 

secondary

Morocco 1992 58.9 31.8 9.3 39.8 47.5 12.6

2003 25.4 54.7 19.9 17.3 62.9 19.8

Egypt 1995 27.1 27.9 45.0 17.4 31.2 51.4

2005 7.2 52.7 40.2 2.1 56.9 41.0

Turkey 1993 36.8 36.6 26.6 20.8 44.0 35.2

2003 13.5 29.8 56.8 4.5 33.8 61.7

School attendance* among girls and boys age 15-19 (in percent)

Girls Boys

Not in 

school or 

attending 

primary

Attending 

secondary

Attending 

higher

Not in 

school or 

attending 

primary

Attending 

secondary

Attending 

higher

Morocco 1992 78.1 21.7 0.3 68.3 31.4 0.3

2003 65.1 33.1 1.7 59.5 38.8 1.7

Egypt 1995 56.9 37.1 6.1 45.4 47.6 7.1

2005 18.9 64.6 16.5 7.0 76.9 16.0

Turkey 1993 76.3 21.5 2.3 61.0 36.5 2.5

2003 64.0 29.5 6.5 50.7 41.9 7.4

Note: Figures presented on the table are based on analysis of DHS data of each country

* Attendance at any time during school year

Sources: Population Council 2001a, 2001b, 2002, 2009a, 2009b, and 2009c
8

In Morocco, Egypt and Turkey marriage is a principal indicator of women‘s exposure to 

the risk of childbearing. Early marriage often leads to a higher total number of lifetime births due 

to a longer period of exposure to the risk of pregnancy. According to recent DHS surveys in all 

three countries, slightly more than 10 percent of adolescent women age 15-19 are ever-married 

(Table 3). 

Making decisions on contraceptive use and method selection based on adequate 

information is a crucial factor in family planning. In order to gain access to and use the right 

contraceptive method women must first be familiar with contraceptive methods. Knowledge of at 

least one family planning method is almost universal among adolescent women in the three 

countries, and almost all adolescent women know at least one modern contraception method. 

Changes in contraceptive prevalence and method use among adolescent women vary by 

country (Table 3). The percentage of married adolescent women using contraception declined 

between 1993 and 2003 in Morocco but rose substantially in Egypt and Turkey. In Morocco and 

Egypt married adolescent women mainly use modern methods, whereas in Turkey married 

adolescent women rely heavily on traditional or folk methods. 

The proportion of ever-married adolescent women who have began childbearing (or are 

pregnant with a first child) is 6.4 percent in Morocco, 9.4 percent in Egypt and 7.5 percent in 

Turkey, according to DHS surveys conducted in the mid-2000s. Compared with findings from 

surveys in the early 1990s, some decline in the proportion of adolescents who have begun 

childbearing is seen in Morocco and Turkey, but little decline in Egypt. In all three countries the 

proportion of adolescent women starting to have children increases rapidly after age 17. 
9

Table 3: Marital status, contraceptive knowledge and use, and childbearing among adolescent 

women age 15-19 in Morocco (1992 and 2003/04), Egypt (1992 and 2005), and Turkey (1993 and 

2003/04)

Morocco Egypt Turkey

MDHS 

1992

MDHS 

2003/04

EDHS 

1992

EDHS 

2005

TDHS

1993

TDHS

2003/04

Marital Status (%)

Never married 89.5 89.0 86.1 87.5 86.5 88.1

Ever married 10.5 11.0 13.9 12.5 13.5 11.9

Knowledge of contraception (%)

Any method 98.8 99.7 98.2 99.9*98.5 98.4

Modern method 98.8 99.7 97.9 99.9*98.3 98.0

Current Use of contraception (%)**

Any method 43.1 38.4 13.3 26.3 24.1 44.3

Any modern method 39.9 35.9 12.7 24.1 9.3 16.9

Any traditional or folk method 4.3 2.5 0.6 2.2 14.8 27.5

Adolescents who have began 

childbearing by age (%)

15 0.7 1.4 1.2 0.5 1.0 0.2

16 4.2 1.7 3.9 2.2 3.4 1.3

17 6.3 5.8 6.1 6.5 8.1 5.3

18 9.3 8.9 12.8 15.0 14.5 11.4

19 16.0 15.3 20.8 22.7 23.1 20.7

Total 7.1 6.4 9.9 9.4 9.3 7.5

Source: Morocco: Azelmat et al., 1993, Ministère de la Santé et al., 2005: Egypt: EI-Zanaty et al., 1994, EI-Zanaty 

and Way, 2006; Turkey: Ministry of Health, 1994; HUIPS, 2005

* Ever-married women age 15-49

** Married adolescent women at survey date

Adolescents who have began childbearing (%) is the percentage of ever-married women age 15-19 who had 

children or were pregnant with their first child at survey date
10 

Effects of Woman’s Characteristics on Progression to First-Time Motherhood 

Individual and household-level explanatory factors that affect fertility in general and 

adolescent fertility in particular in Morocco, Egypt and Turkey can be grouped under two broad 

headings: socioeconomic and cultural factors. 

Among socioeconomic factors, findings on adolescent reproductive behavior in 

developing countries have consistently shown that an increase in educational attainment is one of 

the strongest factors associated with decreasing adolescent fertility (Gupta and Leite, 1999; Koç 

and Ünalan, 2001; Cesar and Vignoli, 2006; Nahar and Min, 2008; Khan and Mishra, 2008). 

Fertility decline in fact is mostly initiated and maintained by women who are relatively more 

educated and urbanized and from more affluent households. But analyses of fertility 

determinants also have shown that the influence of women's education on fertility is not 

independent from her husband's education (Martin and Juarez, 1995). In Morocco, Egypt and 

Turkey men on average are more educated than women and, at all educational levels, are more 

actively participating in the labor force. Because more education typically brings more income, 

the husband‘s educational attainment can be seen as an appropriate proxy for the socioeconomic 

level of families. Thus the effect of women‘s education on fertility behavior can be better 

examined when the independent effects of men‘s education are considered as well (Kravdal, 

2000). 

Adolescent women‘s place of residence is another socioeconomic factor associated with 

childbearing behavior. In most developing countries, levels of teenage pregnancy are higher in 

rural areas than urban areas (United Nations, 2005; Khan and Mishra, 2008). Explanations of this 

discrepancy are related to differential opportunities in education and employment between rural 

and urban areas. 

Social and cultural factors are also important. Fertility behavior is an eminently social 

behavior and, as such, is influenced both by the decisions of individuals and couples and also by 

the social context. That is, the socioeconomic factors that affect fertility, such as women‘s 

education, cannot be regarded as independent of the cultural setting that conditions them. In 

patriarchal settings as in Morocco, Egypt and Turkey, marriage has broad implications for 

women‘s changing roles and status. A newly married woman may bear a child—and preferably a 

son—as soon as possible in order to strengthen the bond with her husband and to establish her 
11 

status in the family and society in general. From the perspective of a couple, the transition to 

motherhood/fatherhood can change the interpersonal relationships with relatives and other 

members of the society. Entry into parenthood can improve a young couple‘s social status and 

can simplify access to supportive resources that help to reduce the cost of having children, thus 

stabilizing the economic situation of a household (Bühler, 2006). 

Prevailing gender norms in a society affect individual perceptions about women‘s own 

control over decision-making. Unequal gender relations, internalized by individuals often very 

early in life, may create significant barriers to the empowerment of women and women‘s 

autonomy in all social spheres of life. This kind of gender norm may prevent women from using 

contraception and other means to achieve their desired timing and spacing of children. As 

documented in the literature, for example, women who agree that there are circumstances under 

which it is acceptable for a husband to beat his wife are more likely than other women to report 

unintended pregnancies (Population Council, 2009a). 

Cultural variables are difficult to measure with comparable indicators over different 

countries. In order to examine this dimension in the empirical analysis, a researcher should find 

relevant proxy variables. In the context of Morocco, Egypt and Turkey, the social environment 

of women can be categorized as more or less ―traditional‖ regarding certain characteristics of 

their marriages. Women‘s status is assumed to be relatively lower for more traditionalistic 

marriage types than in more egalitarian marriage types. Spousal age difference can be a relevant 

proxy in this sense, because the young age of a woman combined with the older age of her 

partner intensifies power differentials in the relationship. A large age difference between 

husband and wife may worsen a young bride‘s disadvantage in negotiating with her husband on 

matters such as her own health care needs or contraceptive use (Rahsad et al., 2005) 

Consanguineous marriage (marriage between relatives), a common characteristic of the 

South and East shores of the Mediterranean basin, can be another proxy for the cultural 

dimension. These unions tend to occur at earlier ages and are more prevalent among poor, less 

educated and traditional families (Koç, 2008). In relation to these characteristics, fertility is 

higher among women in consanguineous marriages than in non-consanguineous marriages 

(Bittles, 2001). 
12 

METHODOLOGY 

Data 

The study is based on retrospective survey data from the Morocco DHS (MDHS) 

2003/04, Egypt DHS (EDHS) 2005 and Turkey DHS (TDHS) 2003. All three surveys were 

based on nationally representative samples that were selected with a weighted, stratified cluster 

sampling approach. The MDHS-2003/04 interviewed 7,074 never-married women and 9,724 

ever-married women age 15-49 (Ministère de la Santé et al., 2005). The EDHS 2005 covered 

19,474 ever-married women age 15-49 (EI-Zanaty and Way, 2006), while the TDHS 2003 

conducted interviews with 8,075 ever-married women age 15-49. Also, in the TDHS household 

questionnaire a short module provided further information on never-married women age 15-49 

(HUIPS, 2005). 

Methodology and Variables 

The method used in this analysis should be able to ascertain how and to what extent the 

entry into motherhood is systematically related to an adolescent woman‘s individual and 

household-level characteristics. One appropriate way of analyzing such data is to apply 

proportional-hazard models that deal with rates of transition from one social status to another, 

combining aspects of the life table and regression techniques (Blossfeld and Rohwer, 2002). By 

using hazard models it will be possible to evaluate how married adolescent women‘s first-birth 

transition rates are dependent on their demographic, socioeconomic and socio-cultural 

characteristics. Transition rates of first births are estimated with a piecewise constant intensity 

regression model where an adolescent woman‘s first-birth rate is defined as the probability of her 

experiencing a first birth within the next month based on her individual-level characteristics and 

given that she has not given birth by the beginning of the month. The basic process time variable 

of the hazard regression is the number of months elapsed since an adolescent woman turns age 

10. The baseline duration of hazard is categorized into several time intervals where the hazard 

rates are assumed to be constant within each time interval but may vary across such intervals. 
13 

Even though the DHS included a wide range of retrospective questions on birth histories 

of women, most background characteristics were not collected with individual life histories. That 

is, many useful attributes of women, such as type of place of residence and contraceptive use, are 

difficult to examine in conjunction with first births. Besides this limitation, selection of the 

variables was conditioned by the availability of comparable data for the three countries under 

study. 

Two different data sets and two different hazard regression models were obtained to 

address two research questions in this study. The samples are analyzed separately for the three 

countries. The first dataset includes both never-married and ever-married women. Because the 

Egypt and Turkey surveys are based on the ever-married women sample, a different procedure 

was followed in order to include never-married women in the analysis. All variables pertaining 

to never-married women age 10-49 are taken from the household member data set of these 

countries. In the household member data file the completed age of never-married women in the 

survey year was recorded. This  ̳age of the household member‘ variable is used to estimate yearof-birth information for each never-married woman. A random variable was generated to assign 

a month of birth to each never-married woman. Using  ̳year of birth‘ and  ̳month of birth‘ 

variables, we calculated a Century Month Code (CMC)2

 variable, which is used in estimation of 

the basic process time variable of the hazard regressions. 

Because having a birth outside marriage is very rare in the three countries, in the dataset 

that we constructed we assumed that never-married women have not given birth. 

Model 1- Trends for the entry into motherhood: 

The first model is used to examine the trend of the entry into motherhood before age 20 

among women who had married during adolesence. We included two independent variables in 

this model: calendar period and educational attainment of woman. In each variable the level 

selected as the reference category is given in bold italics below: 

 

2

In order to form Century Month Codes (CMC) variable we followed standard DHS procedure (see Rutstein and 

Rojas, 2006).
14 

1. Calendar period (time-varying): This variable intends to capture the influence of 

the overall social milieu on the first birth intensities. There are six levels: ‘Before 1990’,

 ̳1990-1992‘,  ̳1993-1995‘,  ̳1996-1998‘,  ̳1999-00‘, and  ̳2001-2003/04‘. 

2. Educational attainment of woman: This variable is recorded as years of schooling 

completed. There are two levels:  ̳No education (0 years of schooling)‘ and  ̳Primary 

incomplete or higher (at least 1 year of schooling)‘. As for other covariates, educational 

attainment refers to the level obtained by the date of the survey. It is assumed that 

educational characteristics obtained before first birth are not prone to significant change 

subsequently. Women who marry early, and especially in adolescence, typically leave 

school at a younger age than women who marry later. 

The second model and dataset are used to explore determinants of first birth before age 

20. The fertility experience of the cohort age 15-19 was not completed at the survey date, as the 

women were still in adolescence. In order to better examine timing of childbearing before age 

20, we also included those respondents age 20-24 in the analysis. As marriage remains the 

predominant social norm in Morocco, Egypt and Turkey and nearly all births occur within 

marital unions, the study focused on women in (first) marital union who had married during 

adolescence. We assumed that the individual and household-level characteristics of married 

adolescent women before the first birth at the time of survey were not radically different. 
15 

Model 2- Hazards of having first birth during adolescence by background characteristics: 

In the second hazard regression model we employed seven independent variables. As 

before, in each variable the level selected as reference category is given below in bold italics: 

Demographic variable:

1. Age at marriage: There are two levels:  ̳Less than 18‘ and ‘18 or higher’. 

Socioeconomic variables: 

2. Educational attainment of woman: There are three levels:  ̳0-4 years‘,  ̳5-7 years‘, 

and ‘8 or more years’. 

3. Educational attainment of husband: There are four levels:  ̳0-4 years‘,  ̳5-7 years‘, 

‘8 or more years’, and  ̳Missing‘. 

4. Wealth status of household: This index, available in original datasets, is created 

by using information on household ownership of a number of consumer items and on 

dwelling characteristics (Rutstein, 2006). Although the original variable is presented in 

quintiles, we introduced this variable in hazard regression with two levels:  ̳Below 

middle‘ (poorest and poorer) and ‘Middle or over’ (middle, rich and richest). 

Socio-cultural variables:

5. Consanquinity: There are three levels:  ̳Not related’,  ̳Related‘, and  ̳Missing‘. 

6. Spousal age difference: There are three levels:  ̳0 to 4 years‘,  ̳5 years or more‘, 

and  ̳Missing‘. 

7. Women’s attitudes toward wife beating: All respondents in the three surveys were 

asked whether they thought a husband would be justified in beating his wife in each of 

the following five situations: if she burns the food, if she argues with him, if she goes out 

without telling him, if she neglects the children, and if she refuses to have sexual 

relations. Using information collected from these five variables, we formed a new 

variable: women‘s attitudes toward wife beating. There are three levels: ‘Not accepting’ 

(if a woman answered no to all five questions),  ̳Accepted at least one of the reasons‘ (if a 

woman answered yes to at least one of the five questions), and  ̳Missing‘. 
16 

RESULTS 

 Table 4 provides a description of the study population used for Model 1, where we 

estimated the hazard of a having a first birth before age 20 for all women age 15-49 over the 

calendar period. As the table shows, among women age 15-49 one-third in Morocco and nearly 

one-fourth in Egypt and Turkey were married during adolescence. In all three countries, among 

women who married before age 20 almost 35 percent gave birth before age 20. The table also 

shows that among women age 15-49 in the study group 50 percent in Morocco have no education 

(0 years of schooling), as do 27 percent in Egypt and 20 percent in Turkey. 

The results of the first hazard model (Table 5) seem to be generally robust in illustrating 

the effect of calendar period and educational characteristics of women on the hazard of having a 

first birth during adolescence. The hazard of experiencing childbearing during adolescence 

decreases over time in all three countries, while the extent of the decrease varies by country. 

Table 4: Descriptive statistics of Model 1, women age 15-49 in Morocco (2003/04), Egypt (2005), 

and Turkey (2003/04) 

Morocco Egypt Turkey

Number % Number % Number %

Marital Status

Never married 7,074 42.1 9,544 32,9 3,824 32.4

Married before age 20 5,548 33.0 10,804 37.3 4,570 38.7

Married after age 20 4,175 24.9 8,622 29.8 3,419 28.9

Birth Status1

Has given birth before age 20 3,436 35.3 6,812 35.1 2,955 37.0

Has given birth after age 20 5,194 53.4 10,775 55.4 4,340 54.3

Has not given birth 1,094 11.3 1,839 9.5 694 8.7

Educational Attainment of Woman

No education (0 years) 8,406 50.1 7,760 26.8 2,383 20.2

Primary incomplete or more (at least 

1 year) 8,391 49.9 21,194 73.1 9,430 79.7

Missing - - * 0.1 * 0.1

Total2

16,797 100.0 28,970 100.0 11,813 100.0

1

Among ever-married women 15-49

2 Data shown is weighted using sample weight

* Indicates a figure is based on fewer than 25 unweighted cases and has been suppressed
17 

Among women age 15-49 in Morocco, Table 5 shows a faster decline in the hazard ratio 

of having a first birth by age 20 until the mid-1990s than the decline from the mid-1990s to 

2003/04. In Egypt and Morocco the hazard ratio declined swiftly until the mid-1990s compared 

to its level before 1990. Since then, however, the hazard of progression to first birth during 

adolescence shows only a minor change. Overall, compared to its level before 1990, in Egypt the 

hazard ratio is 22 percent lower in the period 2001-2003/04. In Turkey, unlike Morocco and 

Egypt, the hazard ratio declined with an almost constant pace until the beginning of the 2000s. 

The pace of decline seems to be particularly faster since then. In the last period, 2001-2003/04, 

the hazard ratio is almost 80 percent lower than in the period before 1990. 

Table 5: Model 1: Hazard ratios and 95% confidence intervals (CI) showing the effect of calendar 

period and education on first birth by age 20 among women age 15-49 in Morocco (2003/04), 

Egypt (2005), and Turkey (2003/04) 

Morocco Egypt Turkey

Hazard 

ratio 95% CI

Hazard 

ratio 95% CI

Hazard 

ratio 95% CI

Duration (exposure time) 

since she turns age 10

4 years 0.05*** 0.05 0.06 0.05*** 0.05 0.06 0.03*** 0.02 0.03

5 years 0.19*** 0.17 0.22 0.19*** 0.18 0.21 0.13*** 0.11 0.15

6 years 0.35*** 0.31 0.39 0.37*** 0.34 0.40 0.30*** 0.26 0.34

7 years 0.61*** 0.55 0.67 0.56*** 0.52 0.60 0.51*** 0.45 0.57

8 years 0.82*** 0.75 0.90 0.79*** 0.74 0.84 0.69*** 0.61 0.77

9 years 1.00 1.00 1.00

Calendar Period 

Before 1990 1.00 1.00 1.00

1990-1992 0.73*** 0.65 0.82 0.93* 0.86 1.00 0.87*** 0.77 0.99

1993-1995 0.64*** 0.56 0.72 0.76*** 0.70 0.83 0.77*** 0.67 0.88

1996-1998 0.62*** 0.55 0.70 0.81*** 0.75 0.88 0.59*** 0.51 0.68

1999-2000 0.57*** 0.49 0.67 0.75*** 0.68 0.82 0.52*** 0.44 0.63

2001--2003/04 0.50*** 0.44 0.57 0.78*** 0.72 0.85 0.24*** 0.19 0.30

Educational Attainment 

of Woman

No education (0 year) 2.71*** 2.49 2.94 2.77*** 2.64 2.91 1.87*** 1.71 2.05

Primary incomplete or 

more (at least 1 year) 1.00 1.00 1.00

Log pseudo-likelihood -7806.27 -13078.173 -5698.45

*** p < 0.01, ** p < 0.05, * p < 0.1
18 

In all three countries the hazard of having a first birth during adolescence declines 

considerably as women‘s educational attainment increases. The difference between hazard ratios 

of women with no education and women with some educational attainment is more pronounced 

in Morocco and Egypt than in Turkey. 

The process of decline in childbearing during adolescence can be better examined with an 

interaction model fitted between the calendar period and educational attainment of women 

(Table 6). In Morocco the likelihood of giving birth during adolescence was reduced nearly by 

half from the beginning of the 1990s to 2001-2003/04, regardless of women‘s educational 

attainment. The results show that the hazard ratios decreased with a highly similar pace over time 

for the two educational groups of women. 

In Egypt trends for women with and without educational attainment followed different 

paths. The hazard of childbearing during adolescence for the group with no education declined 

constantly from the beginning of 1990s to the most recent period. For women with some 

educational attainment, at first the hazard declined until the mid-1990s, but since then this trend 

loses its momentum. Overall, the hazard ratio declined only 16 percent for women with some 

educational attainment from the first to the last period. 

In Turkey, for both women with and without educational attainment, the results show 

considerable decline in the likelihood of experiencing adolescent childbearing over the study 

period. As shown in Table 6, in Turkey the relative decline in hazard for women with no 

educational attainment was moderately stronger than the relative decline in hazard for women 

with some educational attainment. In the last calendar period (2001-2003/04) the hazard ratio is 

lower by 90 percent for women with no education, and 70 percent for women with some 

educational attainment, than for the corresponding hazard ratio up to 1990. 
19 

Table 6: Hazard ratios of first birth by age 20 among women age 15-49, by interaction between 

calendar period and educational attainment of woman. Hazard relative to calendar period ‘-1990’ 

and ‘Primary incomplete or more’ categories, in Morocco (2003/04), Egypt (2005), and Turkey 

(2003/04)

Morocco Egypt Turkey

Calendar 

period

No 

education

Primary 

incomplete 

or more

No 

education

Primary 

incomplete 

or more

No 

educ./Primary 

incomplete

Primary 

complete or 

more

Before 1990 3.02***

(2.66-3.43) 1.00

2.76***

(2.57-2.96) 1.00

1.98***

(1.77-2.23) 1.00

1990-1992 2.03*** 

(1.72-2.40)

0.96

(0.77-1.19)

2.77*** 

(2.49-3.09)

0.86** 

(0.77-0.99)

1.98*** 

(1.58-2.47)

0.86* 

(0.75-1.00)

1993-1995 1.88*** 

(1.56-2.26)

0.77**

(0.61-0.98)

2.32*** 

(2.04-2.63)

0.70*** 

(0.62-0.80)

1.60*** 

(1.24-2.06)

0.79** 

(0.67-0.93)

1996-1998 1.85*** 

(1.55-2.22)

0.70*** 

(0.55-0.89)

2.06*** 

(1.81-2.34)

0.85***

(0.77-0.95)

1.04

(0.78-1.38)

0.64*** 

(0.54-0.76)

1999-2000 1.57*** 

(1.26-1.96)

0.74** 

(0.57-0.97)

2.15*** 

(1.85-2.49)

0.73*** 

(0.64-0.82)

0.69*

(0.47-1.01)

0.61*** 

(0.50-0.74)

2001-2003/04 1.62*** 

(1.33-1.97)

0.51*** 

(0.41-0.65)

1.87*** 

(1.63-2.15)

0.84*** 

(0.75-0.93)

0.21*** 

(0.13-0.36)

0.30*** 

(0.23-0.38)

*** p < 0.01, ** p < 0.05, * p < 0.1

Table 7 shows determinants of first birth before age 20 examined with a separate hazard 

regression model. The study population of Model 2 is composed of currently married women age 

15-24 who married before age 20. Distributions of these women by age at marriage in Morocco, 

Egypt and Turkey indicate that in all three countries nearly three of every our women were 

married before age 20. 

Table 7: Currently married women age 15-24 by whether they married before age 20 and have 

given a birth by the survey date, in Morocco (2003/04), Egypt (2005), and Turkey (2003/04)

Morocco Egypt Turkey

Number % Number % Number %

Married before age 20 1,074 76.2 2,685 73.5 899 72.5

Married after age 20 336 23.8 969 26.5 341 27.5

Total* 1,409 100.0 3,655 100.0 1,240 100.0

* Data shown is weighted using sample weight
20 

Table 8 presents descriptive statistics for samples included in the determinant analysis of 

adolescent childbearing. Among currently married adolescents age 15-24 who married before 

age 20, the proportion giving birth during adolescence is almost identical in the three countries. 

The distribution of the study population by women‘s educational characteristics, however, shows 

very divergent results. In Morocco a relatively small proportion of the study population has more 

than five years of schooling compared to other two countries. This distribution may be related to 

stricter selection into adolescent marriage by virtue of higher educational attainment. In Egypt 

the general structure of the study population implies high polarization: 40 percent have 0-4 years 

of schooling and nearly half have eight or more years of school attendance. In Turkey the study 

population is composed predominantly of women with middle-level educational attainment (5-7 

years of schooling). Overall, in Morocco husbands also show a significantly low profile in 

educational attainment. Morocco and Egypt show similar characteristics with respect to sociocultural characteristics. Consanguineous marriages, high spousal age difference (five or more 

years), and justification of wife beating are more common in Morocco and Egypt than in Turkey 

among currently married women age 15-24 who married before age 20. 

Table 9 presents the effects of demographic, socioeconomic and socio-cultural 

characteristics on the hazard of childbearing before age 20 among currently married women age 

15-24. As expected, marriage before age 18 notably increases the chance of having a first birth 

during adolescence. In all three countries women‘s educational attainment, especially eight or 

more years of schooling, appears to be an important determining factor of adolescent 

childbearing, whereas husband‘s educational attainment does not have a similar influence. In 

Morocco and Egypt, middle-or-higher level household wealth status has a reducing impact on 

adolescent childbearing. Among the covariates that control for the socio-cultural dimension, only 

spousal age difference is found to have an impact on progression to first birth during 

adolescence. Hazard ratios of experiencing adolescent births for women who have five or more 

years age difference with their husbands are almost 20 percent higher compared to women the 

same age or who have less than five years age difference with their husbands, in all three 

countries. 
21 

Table 8: Descriptive statistics of Model 2, number and percentage of currently married women 

age 15-24 who married before age 20, in Morocco (2003/04), Egypt (2005), and Turkey (2003/04) 

Morocco Egypt Turkey

Number % Number % Number %

Has not given birth 279 26.0 610 22.7 191 21.3

Has given birth before age 20 610 56.8 1,536 57.2 538 59.8

Has given birth after age 20 185 17.2 539 20.1 170 18.9

Total 1,074 100.0 2,685 100.0 899 100.0

Age at Marriage

Less than 18 699 65.1 1,475 54.9 531 59.1

18 or higher 374 34.9 1,211 45.1 368 40.9

Educational Attainment of Woman

0-4 years 786 73.2 1,087 40.5 169 18.9

5-7 years 150 14.0 362 13.5 519 57.8

8 or more years 137 12.8 1,237 46.1 210 23.4

Educational Attainment of Husband

0-4 years 659 61.4 674 25.1 63 7.1

5-7 years 142 13.2 432 16.1 442 49.2

8 or more years 258 24.0 1,569 58.4 390 43.4

Missing/DK * 1.4 * 0.4 * 0.4

Wealth Status of Household

Below middle 568 52.9 1,303 48.5 409 45.5

Middle and over 505 47.1 1,382 51.5 490 54.5

Consanguinity

Not related 724 67.4 1,604 59.7 665 74.0

Related 350 32.6 1,077 40.1 233 25.9

Missing - - * 0.2 * 0.1

Spousal Age Difference

0 to 4 years 208 19.4 625 23.3 297 33.0

5 years or more 865 80.6 2,060 76.7 602 67.0

Missing - -

Women’s Attitudes Toward Wife 

Beating

Not accepting 249 23.2 1,118 41.6 415 46.2

Accepted at least one of the reasons 820 76.4 1,538 57.3 467 51.9

Missing * 0.4 (29) 1.1 17 1.9

Total* 1,074 100.0 2,685 100.0 899 100.0
22 

Table 9: Model 2: Hazard ratios and 95% confidence intervals (CI) of first birth in adolescence 

among currently married women age 15-24 who married before age 20, in Morocco (2003/04), 

Egypt (2005), and Turkey (2003/04)

Morocco Egypt Turkey

Hazard 

ratio 95% CI

Hazard 

ratio 95% CI

Hazard 

ratio 95% CI

Duration (exposure time) 

since she turns to age 10

0-5 years 0.01*** 0.01 0.02 0.01*** 0.01 0.01 0.01*** 0.01 0.01

6-8 years 0.26*** 0.21 0.31 0.17*** 0.15 0.19 0.21*** 0.17 0.26

9 years 1.00 1.00 1.00

Age at Marriage

Less than 18 (<18) 5.92*** 4.86 7.20 3.64*** 3.20 4.14 6.57*** 5.31 8.12

18 or higher (18≤) 1.00 1.00 1.00

Educational Attainment of 

Woman

0-4 years 1.52** 1.13 2.04 1.17* 0.99 1.39 1.23 0.89 1.70

5-7 years 1.21 0.84 1.71 1.24** 1.00 1.55 1.19 0.94 1.50

8 or more years 1.00 1.00 1.00

Educational Attainment of 

Husband

0-4 years 1.03 0.82 1.29 0.99 0.84 1.18 1.28 0.88 1.86

5-7 years 0.96 0.74 1.25 1.02 0.84 1.24 1.04 0.85 1.27

8 or more years 1.00 1.00 1.00

Wealth Status of Household

Below middle 1.22* 1.02 1.45 1.20* 1.04 1.39 1.11 0.91 1.35

Middle or over 1.00 1.00 1.00

Consanguinity

Not related 1.00 1.00 1.00

Related 0.95 0.81 1.12 0.99 0.87 1.13 1.05 0.85 1.28

Spousal Age Difference

0 to 4 years 1.00 1.00 1.00

5 years or more 1.21* 1.00 1.47 1.16** 0.99 1.35 1.22* 1.00 1.49

Women’s Attitudes Toward 

Wife Beating

Not accepting 1.00 1.00 1.00

Accepted at least one of the 

reasons 1.02 0.84 1.23 0.99 0.87 1.15 0.99 0.82 1.20

Log pseudo-likelihood -287.62 -801.29 -172.19

*** p < 0.01, ** p < 0.05, * p < 0.1
23

DISCUSSION 

Young people constitute the largest component of the total population in Morocco, Egypt 

and Turkey. Integration of youth, especially adolescents ages 10-19, into the general 

development is one of the major challenges of these countries (UNDP, 2006). Early marriage and 

subsequent early childbearing constitute another predicament that especially concerns adolescent 

girls. When these demographic events occur in adolescence, they can have far-reaching adverse 

social and health consequences for females. Additionally, in terms of its demographic outcomes, 

continued prevalence of adolescent childbearing is of particular concern to Morocco, Egypt and 

Turkey because shorter spans between generations are a key factor in rapid population 

momentum and growth. 

This study sought to gain insights into the characteristics of adolescent childbearing in 

Morocco, Egypt and Turkey, countries that have reached the advance stages of their fertility 

transition. The study is focused on trends and determinants of adolescent childbearing among 

married adolescent girls, whose life course varies significantly from that of their unmarried 

counterparts. We applied hazard regression models separately to the data sets for MDHS2003/04, EDHS-2005 and TDHS-2003. 

We first explored changes in the progression to first birth among women who married in 

adolescence over the past two decades. The probability of having a first birth before age 20 has 

declined substantially since the mid-1990s in Morocco and in Turkey but only moderately in 

Egypt. Further exploration of the observed trends in each country using an interaction variable 

between calendar period and educational attainment of women suggests that the decline in 

adolescent childbearing has been a general trend in Morocco and Turkey, as the processes were 

driven by women from all socioeconomic segments. In Egypt, however, the decline in adolescent 

childbearing over the last decade has been driven mainly by women with the lowest educational 

attainment, that is, women from lower socioeconomic segments of the society. 

Second, we examined the influence of selected demographic, socioeconomic and sociocultural factors on progression to first birth before age 20 among currently married women age 

15-24 who married during adolescence. The results show that age at first marriage, as defining 

the beginning of exposure to the risk of giving birth, appears to be the strongest determinant of 
24

adolescent childbearing in the social context of Morocco, Egypt and Turkey. Lower age at first 

marriage (below age 18) obviously increases the probability of becoming an adolescent mother. 

Besides early marriage, low educational attainment of women, poor welfare status and high 

spousal age difference constitute major socioeconomic and socio-cultural factors associated with 

adolescent childbearing in all three countries. 

Opinion leaders in Morocco, Egypt and Turkey have been singling out adolescent 

marriage and childbearing as an independent issue and increasingly have begun to deal with it.

Findings of this study point out that policies and programs designed to delay marriage can 

accelerate a decline in adolescent childbearing. In fact, in the last decade changes in this 

direction have occurred in the juridical sphere of these countries. Despite the criticism of 

conservatives, as a result of ongoing efforts to improve the status of women the minimum 

marriageable age for girls has risen from 15 to 18 in all three countries3

. These new legal 

arrangements, however helpful they will be, may not alone satisfyingly settle the matter. Behind 

adolescent marriage are several societal factors that could keep women from enjoying these new 

rights4

. It is worth mentioning that adolescent marriages are more widespread in the rural and 

socioeconomically less developed parts of these countries, where societal changes may lag 

behind the juridical modernization. 

As several previous studies have shown, the more education an adolescent in these 

countries receives, the less likely she is to marry during adolescence (Population Council 2001a, 

2001b and 2002). Our study additionally shows that the educational attainment of an adolescent 

girl at marriage has an impact on her subsequent childbearing. The higher the educational 

attainment of an adolescent before marriage, the less likely she is to give birth before age 20. In 

this respect, along with juridical reforms the three countries should adhere to policies that 

improve access to education for adolescents, and especially for girls. 

Our study also suggests that programming efforts should be directed to education beyond 

the primary level. Increasing the proportion of the adolescent population attaining a secondary-

 

3

 The minimum age at marriage for both sexes is set at 18 years with a new Family Code, adopted at the beginning 

of 2004 in Morocco (Bordat and Kouzzi, 2004), with amendments to the Child Law that were adopted in June 2008 

in Egypt (Samaan, 2008), and with reformation of the Civil Code at the beginning of 2002 in Turkey (Ilkkaracan and 

Bertay, 2002). 

4

 For the challenges of implementing legal arrangements in these countries, see Bordat and Kouzzi, 2004; Kulu, 

2009.
25

level education (eight or more years of schooling) will further raise age at marriage and thereby 

will reduce the likelihood of giving a birth during adolescence. Of course, for Morocco a focus 

upon making progress in primary school attendance should have more priority due to fact that in 

Morocco primary-level attendance lags behind that in Egypt and Turkey. The experience of 

Turkey could set a good example, where compulsory schooling was raised from five to eight 

years at the beginning of the 1997-1998 school years. The fact that we found accelerated decline 

in adolescent childbearing in Turkey in 2001 onwards appears related to this policy change. 

For married adolescents, improving access to effective contraceptive methods can be an 

additional policy option. Hence, the programming efforts of reproductive health programs should 

be reconsidered especially in Egypt and Turkey, where modern contraceptive method use among 

married adolescents is at lower levels than in Morocco. Moreover, as in all three countries our 

analysis shows that the large age difference between husbands and wives brings elevated risk of 

adolescent childbearing, all types of programs aimed at decreasing childbearing during 

adolescence should have a husband dimension. 
26

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31

APPENDIX 

Table A1: Comparison of selected socioeconomic development indicators and demographic 

indicators of Morocco, Egypt and Turkey, 1995 - 2007

Annual average 

growth rate (%)

1995 2000 2005 2007

1990-

2007

2000-

2007

Morocco

Human Development Index Value (HDI) 0.562 0.583 0.640 0.654 1.37 1.63

Gender Related Development Index (GDI) 0.625

Adult Literacy Rate: Female (% age 15 and above) 31.00 36.10 39.60 31.00

Adult Literacy Rate: Male (% age 15 and above) 56.60 61.80 65.70 56.60

GDP per Capita, PPP (constant 2007 international $) 2,817 3,156 3,800 4,108 2.00

Urban Population (%) 51.70 53.30 55.00

Total Fertility Rate (TFR) (births per woman) 3.66 2.97 2.52 2.38

Infant Mortality Rate (per 1,000 live births) 58.00 47.00 37.50 30.60

Egypt

Human Development Index Value (HDI) 0.631 0.665 0.696 0.703 1.13 0.81

Gender Related Development Index (GDI) --

Adult Literacy Rate: Female (% age 15 and above) 38.80 43.80 59.40 57.80

Adult Literacy Rate: Male (% age 15 and above) 63.60 66.60 83.00 74.60

GDP per Capita, PPP (constant 2007 international $) 3,797 4,459 4,844 5,349 2.50

Urban Population (%) 42.80 42.60 42.60

Total Fertility Rate (TFR) (births per woman) 3.91 3.50 3.16 2.89

Infant Mortality Rate (per 1,000 live births) 63.70 48.00 39.50 34.80

Turkey

Human Development Index Value (HDI) 0.730 0.758 0.796 0.806 0.79 0.87

Gender Related Development Index (GDI) 0.788

Adult Literacy Rate: Female (% age 15 and above) 72.40 76.50 79.60 81.30

Adult Literacy Rate: Male (% age 15 and above) 91.70 93.50 95.30 96.20

GDP per Capita, PPP (constant 2007 international $) 9,100 10,161 11,877 12,955

Urban Population (%) 62.10 64.70 67.30

Total Fertility Rate (TFR) (births per woman) 2.90 2.57 2.23 2.13

Infant Mortality Rate (per 1,000 live births) 53.60 40.40 31.40 27.50

Sources: UNDP, 1998, 2007, 2009 and United Nations, 2009 and 2010