Child mobility, maternal status, and household composition in rural South Africa

Local and long-distance migration among young people in rural Malawi: importance of age, sex and family

Background

In sub-Saharan Africa, migration of young people is common and occurs for a variety of reasons. Research focus is often on international or long-distance internal migration; however, shorter moves also affect people's lives and can reveal important information about cultures and societies. In rural sub-Saharan Africa, migration may be influenced by cultural norms and family considerations: these may be changing due to demographic shifts, urbanisation, and increased media access.

Methods

We used longitudinal data from a Health and Demographic Surveillance Site in rural northern Malawi to present a detailed investigation of migration in young people between 2004-2017. Our focus is on the cultural effects of gender and family, and separate migrations into short and long distance, and independent and accompanied, as these different move types are likely to represent very different events in a young person's life. We use descriptive analyses multi-level multinomial logistic regression modelling.

Results & conclusions

We found two key periods of mobility 1) in very young childhood and 2) in adolescence/young adulthood. In this traditionally patrilocal area, we found that young women move longer distances to live with their spouse, and also were more likely to return home after a marriage ends, rather than remain living independently. Young people living close to relatives tend to have lower chances of moving, and despite the local patrilineal customs, we found evidence of the importance of the maternal family. Female and male children may be treated differently from as young as age 4, with girls more likely to migrate long distances independently, and more likely to accompany their mothers in other moves.

Understanding Household Dynamics From the Ground Up: A Longitudinal Study From a Rural South African Setting

Investigations into household structure in low- and middle-income countries (LMICs) provide important insight into how families manage domestic life in response to resource allocation and caregiving needs during periods of rapid sociopolitical and health-related challenges. Recent evidence on household structure in many LMICs contrasts with long-standing viewpoints of worldwide convergence to a Western nuclearized household model. Here, we adopt a household-centered theoretical and methodological framework to investigate longitudinal patterns and dynamics of household structure in a rural South African setting during a period of high AIDS-related mortality and socioeconomic change. Data come from the Agincourt Health and Socio-Demographic Surveillance System (2003-2015). Using latent transition models, we derived six distinct household types by examining conditional interdependency between household heads' characteristics, members' age composition, and migration status. More than half of households were characterized by their complex and multigenerational profiles, with considerable within-typology variation in household size and dependency structure. Transition analyses showed stability of household types under female headship, while higher proportions of nuclearized household types dissolved over time. Household dissolution was closely linked to prior mortality experiences-particularly, following death of a male head. Our findings highlight the need to better conceptualize and contextualize household changes across populations and over time.

Child Fostering in a Changing Climate: Evidence from Sub-Saharan Africa

An extensive social science literature has examined the effects of climate change on human migration. Prior studies have focused largely on the out-migration of working-age adults or entire households, with less attention to migration and other forms of geographic mobility among other age groups, including youth. In this study, we focus on the implications of climate variability for the movement of children by examining the association between climate exposures and the in- and out-fostering of children in sub-Saharan Africa. We link high-resolution temperature and precipitation records to data from the Demographic and Health Surveys for 23 sub-Saharan African countries. We fit a series of regression models to measure the overall associations between climate exposures and each outcome, and then evaluate whether these associations are moderated by socioeconomic status, the number of children in the household, and the prevalence of fostering in each country. Precipitation is positively associated with in-fostering overall, and these effects are especially strong among households who already have at least one child and in countries where child fostering is common. We find no overall relationship between either temperature or precipitation exposures and out-fostering, but we do detect significant effects among households with many children and those with more-educated heads. In sum, our findings suggest climate variability can influence child mobility, albeit in complex and in some cases context-specific ways. Given the socioeconomic and health implications of fostering, these results underline another pathway through which climate exposures can affect children's wellbeing. More broadly, this study shows that new attention to the links between climate variability, child fostering, and other understudied forms of spatial mobility is needed to fully understand the effects of climate change on human populations.

Parenting in place: Young children's living arrangement and migrants' sleep health in South Africa

Migration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.

The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

A considerable body of research has studied the effects of siblings on child mortality through birth intervals. This research has commonly focused on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother's pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are coresident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering more than 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a birth interval of 24 months or more is advantageous for both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced than that of an older sibling and adds to the effect of an older sibling. Moreover, child mortality is particularly low during a mother's subsequent pregnancy, contrasting the shock resulting from a younger sibling's birth. Further, we find that a mother's or sibling's absence from the household results in a higher risk of mortality, and the death of either reduces child survival up to six months before the death.

Migrant health penalty: evidence of higher mortality risk among internal migrants in sub-Saharan Africa

Background: Despite the greater attention given to international migration, internal migration accounts for the majority of movements globally. However, research on the effects of internal migration on health is limited, with this relationship examined predominantly in urban settings among working-age adults, neglecting rural populations and younger and older ages.

Objectives: Using longitudinal data from 29 mostly rural sub-Saharan African Health and Demographic Surveillance Systems (HDSS), this study aims to explore life-course differences in mortality according to migration status and duration of residence.

MethodsCox proportional hazards models are employed to analyse the relationship between migration and mortality in the 29 HDSS areas. The analytical sample includes 3 836,173 people and the analysis spans 25 years, from 1990 to 2015. We examine the risk of death by sex across five broad age groups (from ages 1 to 80), and consider recent and past in- and return migrants.

Results: In-migrants have a higher risk of mortality compared to permanent rural residents, with return migrants at greater risk than in-migrants across all age-groups. Female migrants have lower survival chances than males, with greater variability by age. Risk of dying is highest among recent return migrant females aged 30–59: 1.86 (95% CI 1.69–2.06) times that of permanent residents. Only among males aged 15–29 who move to urban areas is there evidence of a ‘healthy migrant’ effect (HR = 0.62, 95% CI 0.51–0.77). There is clear evidence of an adaptation effect across all ages, with the risk of mortality reducing with duration following migration.

Conclusions: Findings suggest that adult internal migrants, particularly females, suffer greater health disadvantages associated with migration. Policy makers should focus on improving migrant’s interface with health services, and support the development of health education and promotion interventions to create awareness of localised health risks for migrants.

Exploring the unmet needs for creating an enabling environment for nurturing care to promote migrant child health in Bishkek, Kyrgyzstan: A theory-guided community-based participatory action research

Empirical evidence on community-driven child health promotion programs in disadvantaged migrant populations is limited despite various promotional strategies. Therefore, we implemented a developmental process to shape child health interventions using theory-guided community-based participatory action research (CBPAR) in a migrant community in Bishkek, Kyrgyzstan between 2015 and 2019. The collaborative and iterative CBPAR process was conducted through participatory workshops and focus group discussions with support from trusting and collegial partnerships between community members and the research team. The goal and scope of the intervention was guided by enabling environments for nurturing care, including the four domains of caregivers' capabilities, empowered communities, supportive services, and enabling policies. Diverse interests and needs identified by community members were aggregated in the theoretical model and reflected in the intervention. Community-driven intervention is perceived as a culturally acceptable, sustainable, sensitive and relevant approach to solve problems. There are several challenges in conducting the CBPAR, such as the effort and time spent on building partnerships, co-learning and mutual understanding, and the power equilibrium involved. Despite this, the success of the CBPAR process provided opportunities for community mobilization, empowerment and sustainability of the intervention. Evaluation of the process and outcomes of the intervention provided community health researchers and practitioners with evidence of the theory-guided community participatory approach.

Does Parents' Union Instability Disrupt Intergenerational Advantage? An Analysis of Sub-Saharan Africa

The long arm of childhood, with its wide-ranging influence on individuals' life chances, highlights the importance of understanding the determinants of health in early life. Research has established that parents' education is a major determinant of childhood health, but children across the globe increasingly experience their parents' divorce and subsequent remarriage, raising questions of whether union instability alters these intergenerational processes. Does divorce and remarriage interfere with parents' education benefiting their young children's health? I explore this question in sub-Saharan Africa, a world region where parents' education plays a major role in protecting children against severe health risks, and where young children commonly experience parental divorce and remarriage. Moreover, sub-Saharan Africa features distinct family lineage systems, affording an opportunity to explore this question in both majority matrilineal and patrilineal contexts. Analyses of Demographic and Health Survey data on 271,292 children in 30 sub-Saharan African countries offer no evidence that the high levels of union instability in the region will weaken the health benefits of parents' education for future generations. Following divorce, children benefit from their biological parents' education to the same degree as children with married parents-a finding that is consistent across lineage contexts. Moreover, stepfathers' education corresponds with pronounced health benefits for their coresident stepchildren, particularly in patrilineal regions where these children benefit less dramatically from their mothers' education. Together, the study results offer a renewed sense of the importance of parents'-including stepfathers'-education for early childhood health across diverse family structures.

Household composition and child health in Botswana

Background

There is a general lack of research on children’s household experiences and child health outcomes in low- and middle-income countries (LMICs). This study examines the relationship between household composition, stunting and diarrhoea prevalence among children younger than 5 years of age in Botswana.

Methods

The analysis uses data from the 2007 Botswana Family Health Survey (BFHS) and multilevel logistic regression models.

Results

The findings indicate that stunting varies by whom the child lives with. Stunting is higher among children living with no parents compared to those living with both parents. Stunting is also high among children living with unrelated household members. Similarly, children in households with a mother-only and with a grandparent present, have a higher level of stunting compared to those living with both parents. Conversely, living with an aunt and living with other relatives, protects against stunting. The findings on diarrhoea prevalence show that children living in mother-only households and those living with no parents are less likely to have diarrhoea than those living with both parents. Also, across all households, those who are more affluent have lower rates of child stunting and diarrhoea than those which are more deprived. Finally, the findings show a clustering effect at the household level for both stunting and diarrhoea prevalence.

Conclusions

These findings suggest that policies and programs aimed at reducing stunting and diarrhoea may work best if they target households and other adults co-residing in homes with children besides biological parents. Further, children who live in poorer households deserve special attention.

'When you take pills you must eat': Food (in)security and ART adherence among older people living with HIV

South Africa has increasing numbers of persons living with HIV on antiretroviral treatment (ART). There is evidence for a relationship between food, food security and HIV. Despite increasing rates of people older than 50 living with HIV coinciding with greater levels of co-morbidity, the existing research is largely limited to those aged 15-49 years. In this paper, we therefore explore how older people living with HIV (OPLWH) in two urban communities within South Africa negotiate and ensure they have sufficient access to food and how food insecurity may affect their retention in care and ART adherence. This study used exploratory qualitative semi-structured in-depth interviews with 23 OPLWH to collect data in isiXhosa. Data were analysed using thematic content analysis. Factors at the community, household and individual levels influence (a) access to sufficient and quality food, and (b) beliefs about ART and food based on (mis)understandings of messaging from health care providers. The results demonstrate the need to explore further and clarify the nutritional guidelines that OPLWH receive from providers to ensure this does not result in reduced adherence or retention in care. They also demonstrate the role that social welfare and family or kin obligations plays in ensuring the food security of OPLWH.

Internal migration and child health in Malawi

A strong and consistent association between migration and health has been found in many settings, but the overwhelming focus of this research has been on adults. In addition, identifying the effect of migration on health largely remains an unresolved challenge, due in part to the inability to distinguish between the effect of migration on health and the selection of children of differing health status into migration streams. In this research we examine the relationship between internal migration and child health in Malawi. We use longitudinal panel data with pre- and post-migration health measures for children and their mothers, which permits us to measure both migration health selection and the effect of migration on health. We also examine if child health changes over time in post-migration destinations. We do not find evidence of migration health selection: children who move have similar pre-migration health status to non-migrant children. We find that the impact of migration on child health is mediated by mothers' characteristics. Before controlling for mothers' health status, we find a strong negative impact of migration on health, particularly for children moving to rural areas or cities, and children moving due to changes in mothers' marital status. After controlling for mothers' health status, however, the negative impact of migration on child health disappears. We also find that child health is worse with longer durations spent in post-migration residence, compared to children who don't move.

Does it Take a Village? Kin Coresidence and Child Survival in Tanzania

Children in Tanzania live in a variety of family structures, many of which contain related and unrelated non-parental adults. In this article, I use data from the Rufiji Health and Demographic Surveillance System in Tanzania to examine the role of coresident non-parental adults in childrearing. First, I use quantitative demographic data to investigate the association between kin coresidence and child survival, differentiating by lineage. I also examine the role of unrelated coresident adults. Second, I test whether coresident non-parental adults moderate the association between parental absence and child survival. Finally, I draw from qualitative interview data to investigate childrearing practices and beliefs, with a particular focus on parental absence and kin coresidence. I find that, despite the institutionalization of kin caregiving, coresidence with kin is not beneficial, and kin are unable to compensate for parental absence. The two-parent living arrangement is viewed as ideal, although the reality of childrearing in the setting is complex and fluid. While absent parents try to maintain support of their children, such assistance is insufficient in times of health crisis. Kin care for children with absent parents, but their willingness to assist depends on the reason for the absence.

Does It Take a Village? Migration among Rural South African Youth

In a rural African context, the saying, "it takes a village to raise a child," suggests that community characteristics are substantially important in children's lives as they transition to adulthood. Are these contextual factors also related to youth migration? Demographers are uncertain about how community characteristics improve our understanding of an individual's propensity to migrate, beyond individual and household factors. In many low and middle-income country settings, youth become migrants for the first time in their lives to provide access to resources that their families need. We employ discrete-time event history models from the 20032011 Agincourt Health and socio-Demographic Surveillance System in rural South Africa to test whether markers of development in a village are associated with the likelihood of youth and young adults migrating, distinguishing between becoming temporary and permanent migrants during this critical life cycle phase. We find that village characteristics indeed differentially predict migration, but not nearly as substantially as might be expected.

Kin support and child health: Investigating two approaches in an African slum

Extensive research from sub-Saharan Africa shows that mothers frequently rely on help from other family members to ensure their children's health and well-being. Yet, there is considerable debate about the relative importance of support from grandmothers versus fathers. Using an innovative survey instrument to interview 462 unmarried mothers in a slum area of Nairobi, Kenya, we provide insight into this debate by showing that a status versus transfers approach to measuring kin support asks subtly different questions and yields different results. A status approach reflects an evolutionary perspective that argues that maternal grandmothers have a greater incentive than non-residential fathers to provide material and practical support for young children. In contrast, a transfers approach is consistent with social support theories whereby the social capital provided by fathers may be more beneficial to children's health than that afforded by grandmothers. Demonstrating that different approaches to measuring kin support matter highlights the need for kin research that crosses disciplinary boundaries and encourages the development of more nuanced family policies designed to protect children's health in Africa.

Households, fluidity, and HIV service delivery in Zambia and South Africa - an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial

INTRODUCTION

Population distributions, family and household compositions, and people's sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity.

METHODS

HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas.

RESULTS

Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients' transient pressures, and participants' agency in ART-related decisions.

CONCLUSIONS

Choices made to manage one's experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.

Measuring extended families over time in informal settlements in Nairobi, Kenya: Retention and data consistency in a two-round survey

BACKGROUND

Researchers have increasingly turned to longitudinal data to understand how the family environment of children changes over time and how this change affects their well-being. While the value of such efforts is clear, the inherent challenges of collecting robust data over time may limit or bias our understanding of family complexity.

OBJECTIVE

Drawing on data from an exploratory study on kinship structure and support for low income single mothers and their young children in Nairobi, Kenya, this paper aims to (1) assess the strengths and weaknesses of our approach in reflecting the complexities of kinship dynamics and (2) analyze how methodological issues such as selection and reporting inconsistency can influence our understanding of the role of kin in children's lives.

METHODS

The analysis used data from two waves of the Kinship Support Tree (KST) project. The starting sample consisted of 462 single mothers with at least one child under the age of 7, with data collected on approximately 5,000 resident and nonresident kin. Descriptive statistics and conventional tests of significance were used to analyze selection factors and inconsistencies in reporting across waves.

RESULTS

The study yielded a 91% retention rate after six months and the analysis provides some assurance that selectivity from attrition and reporting inconsistency are not entirely driven by shifts in support provision by kin. However, the selectivity of the sample underscores caution in generalizing the results.

CONCLUSIONS

While the challenges of conducting follow-up surveys such as the KST are serious, these findings suggest that it is possible to collect consistent data on kinship structure and support from the perspective of children in a mobile population. Tracking kinship structure over time using the KST is not only feasible but more importantly is unlikely to lead to incomplete or biased understanding of kinship.

CONTRIBUTION

After further testing with a wider range of women, we hope to disseminate our results for use in a wide range of contexts both in and out of Africa. We believe this data is vital to designing appropriate interventions to improve the well-being of children growing up in these communities.

Social Positioning of Older Persons in Rural South Africa: Change or Stability?

The South African context challenges the conventional categorisation of older persons as dependent after a certain age. The concurrence of old-age pensions, high unemployment, high HIV prevalence, and frailty related to ageing necessitate a more dynamic approach to understanding older persons' social positioning. We examine the extent of change in older persons' social positioning within their households and the correlates of change in a rural community in South Africa. Using data from the Agincourt Health and socio-Demographic Surveillance System and a new typology of older persons' social positioning based on living arrangements, we (1) describe older persons' living arrangements in two time periods; (2) calculate transition probabilities of older persons' changing living arrangements over time; (3) identify possible drivers of change. Results show that while older persons experience stability in living arrangements over time, this stability is more prevalent among those who start in productive roles. Moreover, those who change arrangements are likely to move into productive roles. Taken together, these findings suggest that older South Africans fulfil productive roles in households while simultaneously experiencing ageing-related frailty and diminished labour capacity. These findings underscore the importance of considering ageing as both an individual and a relational process, with implications for older persons and their families.

Beyond Orphanhood: Parental Nonresidence and Child Well-being in Tanzania

This article used data from the Rufiji Health and Demographic Surveillance System in Tanzania to examine the influence of parental non-residence on child survival and school entry. Using survival analysis methods, the article tested variations by parent and by cause, examining parental death, non-residence due to parental relationship status, and migration. In general, maternal non-residence was more consequential for child survival, while paternal non-residence influences school entry. This is consistent with gendered parenting patterns in the setting. There was important variation by cause and by outcome, particularly for paternal non-residence. Paternal non-residence due to non-marital birth was associated with increased risk of child death, while paternal migration was associated with improved survival. Paternal death and migration were associated with lower odds of school entry. This article moves beyond orphanhood to consider multiple causes of parental non-residence simultaneously, demonstrating that parental non-residence is not uniformly deleterious for children.

Household structure vs. composition: Understanding gendered effects on educational progress in rural South Africa

BACKGROUND

Demographers have long been interested in the relationship between living arrangements and gendered outcomes for children in sub-Saharan Africa. Most extant research conflates household structure with composition and has revealed little about the pathways that link these components to gendered outcomes.

OBJECTIVES

First, we offer a conceptual approach that differentiates structure from composition with a focus on gendered processes that operate in the household; and second, we demonstrate the value of this approach through an analysis of educational progress for boys and girls in rural South Africa.

METHODS

We use data from the 2002 round of the Agincourt Health and Demographic Surveillance System. Our analytical sample includes 22,997 children aged 6-18 who were neither parents themselves nor lived with a partner or partner's family. We employ ordinary least squares regression models to examine the effects of structure and composition on educational progress of girls and boys.

RESULTS

The results suggest that non-nuclear structures are associated with similar negative effects for both boys and girls compared to children growing up in nuclear households. However, the presence of other kin in the absence of one or both parents results in gendered effects favouring boys.

CONCLUSION

The absence of any gendered effects when using a household structure typology suggests that secular changes to attitudes about gender equity trump any specific gendered processes stemming from particular configurations. On the other hand, gendered effects that appear when one or both parents are absent show that traditional gender norms and/or resource constraints continue to favour boys.

CONTRIBUTION

Despite the wealth of literature on household structure and children's educational outcomes in sub-Saharan Africa, the conceptual basis of these effects has not been well articulated. We have shown the value of unpacking household structure to better understand how gender norms and gendered resource allocations impact education.

A Longitudinal Analysis of Well-Being of Ghanaian Children in Transnational Families

This study is the first to employ panel data to examine well-being outcomes-self-rated health, happiness, life satisfaction, and school enjoyment-of children in transnational families in an African context. It analyzes data collected in 2013, 2014, and 2015 from secondary schoolchildren and youth (ages 12-21) in Ghana (N = 741). Results indicate that children with fathers, mothers, or both parents away and those cared for by a parent, a family, or a nonfamily member are equally or more likely to have higher levels of well-being as children in nonmigrant families. Yet, there are certain risk factors-being a female, living in a family affected by divorce or by a change in caregiver while parents migrate-that may decrease child well-being.

Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001-2013: A Distributional Analysis Using Household Asset Indicators

Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001-2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.

Human capital on the move: Education as a determinant of internal migration in selected INDEPTH surveillance populations in Africa

BACKGROUND

Education, as a key indicator of human capital, is considered one of the major determinants of internal migration, with previous studies suggesting that human capital accumulates in urban areas at the expense of rural areas. However, there is fragmentary evidence concerning the educational correlates of internal migration in sub-Saharan Africa.

OBJECTIVES

The study questions whether more precise measures of migration in Health and Demographic Surveillance System (HDSS) populations support the hypothesis that migrants are self-selected on human capital and more educated people are more likely to leave rural areas or enter urban areas within a geographical region.

METHODS

Using unique longitudinal data representing approximately 900,000 people living in eight sub-Saharan African HDSS sites that are members of the INDEPTH Network, the paper uses Event History Analysis techniques to examine the relationship between formal educational attainment and in-and out-migration, over the period 2009 to 2011.

RESULTS

Between 7% and 27% of these local populations are moving in or out of the HDSS area over this period. Education is positively associated with both in-and out-migration in the Kenyan HDSS areas; however, the education effect has no clear pattern in the HDSS sites in Burkina Faso, Mozambique, and South Africa.

CONCLUSIONS

Empirical results presented in this paper confirm a strong age profile of migration consistent with human capital expectation, yet the results point to variability in the association of education and the propensity to migrate. In particular, the hypothesis of a shift of human capital from rural to urban areas is not universally valid.

Instability in Parent-Child Coresidence and Adolescent Development in Urban South Africa

There is widespread recognition of the importance of family stability for child development. South Africa presents an interesting context in which to study the consequences of family instability because of the traditionally fluid nature of household composition due to labor migration, child fostering, and non-marital fertility. More recently, the HIV pandemic has added another source of instability. Within South Africa, however, patterns of instability differ markedly across racial groups. We use the Cape Area Panel Study (CAPS) data to examine the implications of changes in parent-child coresidence for educational and sexual development of young South Africans. We show that changes in maternal and paternal coresidence have implications for the timing of sexual initiation for both black and coloured adolescents. Maternal and paternal transitions also lead to poorer educational outcomes for coloured adolescents, but parental disruptions are not significantly related to educational outcomes for blacks. These findings suggest that the implications of coresidential instability vary by race, reflecting racial differences with respect to cultural, social, and economic conditions.

Maternal migration and child health: An analysis of disruption and adaptation processes in Benin

Children of migrant mothers have lower vaccination rates compared to their peers with non-migrant mothers in low-income countries. Explanations for this finding are typically grounded in the disruption and adaptation perspectives of migration. Researchers argue that migration is a disruptive process that interferes with women's economic well-being and social networks, and ultimately their health-seeking behaviors. With time, however, migrant women adapt to their new settings, and their health behaviors improve. Despite prominence in the literature, no research tests the salience of these perspectives to the relationship between maternal migration and child vaccination. We innovatively leverage Demographic and Health Survey data to test the extent to which disruption and adaptation processes underlie the relationship between maternal migration and child vaccination in the context of Benin-a West African country where migration is common and child vaccination rates have declined in recent years. By disaggregating children of migrants according to whether they were born before or after their mother's migration, we confirm that migration does not lower children's vaccination rates in Benin. In fact, children born after migration enjoy a higher likelihood of vaccination, whereas their peers born in the community from which their mother eventually migrates are less likely to be vaccinated. Although we find no support for the disruption perspective of migration, we do find evidence of adaptation: children born after migration have an increased likelihood of vaccination the longer their mother resides in the destination community prior to their birth.

Dependent or Productive? A New Approach to Understanding the Social Positioning of Older South Africans Through Living Arrangements

South Africa's population is aging. Most of the older Black South Africans continue to live in extended household structures with children, grandchildren, and other kin. They also constitute a source of income through a means-tested noncontributory state-funded pension available at age 60. Using census data from the Agincourt Health and Demographic Surveillance System in 2000, 2005, and 2010, we develop a typology of living arrangements that is reflective of the social positioning of elderly persons as dependent or productive household members and analyze changes in the distribution over time. Older persons, in general, live in large, complex, and multigenerational households. Multigenerational households with "productive" older persons are increasing in proportion over the period, although there are few differences by gender or pension eligibility at any time point.

Childhood Risk of Parental Absence in Tanzania

Although parents might not live with their children for a variety of reasons, existing accounts of parental absence often examine one cause in isolation. Using detailed longitudinal demographic surveillance data from Rufiji, Tanzania, this article examines parental absence due to death, migration, child relocation, union dissolution, and union formation from 2001-2011. Employing survival analysis, the article quantifies children's risk of absence by cause and investigates sociodemographic variation in this risk. Of children born into two-parent households, 25% experience maternal absence by age 10, and 40% experience paternal absence by the same age. Roughly one-quarter of children are born into single-mother families with an absent father at birth, and nearly 70% of these children experience maternal absence as well by age 10. Despite the emphasis on orphanhood in the research and policy communities, parental death is the least common cause of absence. Furthermore, although demographic and socioeconomic characteristics are strong predictors of absence, variation in these relationships across causes underscores the distinctiveness and similarity of different reasons for absence.

CONTEXT MATTERS: FOSTERING, ORPHANHOOD AND SCHOOLING IN SUB-SAHARAN AFRICA

A growing body of research suggests that orphanhood and fostering might be (independently) associated with educational disadvantage in sub-Saharan Africa. However, literature on the impacts of orphanhood and fostering on school enrolment, attendance and progress produces equivocal, and often conflicting, results. This paper reports on quantitative and qualitative data from sixteen field-sites in Ghana and Malawi, highlighting the importance of historical and social context in shaping schooling outcomes for fostered and orphaned children. In Malawi, which has been particularly badly affected by AIDS, orphans were less likely to be enrolled in and attending school than other children. By contrast, in Ghana, with its long tradition of 'kinship fostering', orphans were not significantly educationally disadvantaged; instead, non-orphaned, purposively fostered children had lower school enrolment and attendance than their peers. Understanding the context of orphanhood and fostering in relation to schooling is crucial in achieving 'Education for All'.

Fathers' Financial Support of Children in a Low Income Community in South Africa

We used data from the Birth to Twenty Cohort study to understand children's receipt of financial support from their fathers in a low income, Black community in urban South Africa. Specifically, we (1) described fathers' financial support over the life course of children; (2) estimated survival probabilities of receiving support for all children and notreceiving support for children who experienced a parental union dissolution; and (3) identified factors that explained variation in the receipt of support after a union dissolution. Results suggest that most children received full or partial support throughout the life course. Furthermore, a high proportion of children received support after a union dissolution with much of the variation driven by pre-dissolution support, father's education and the presence of extended kin.

Family Instability and Pathways to Adulthood in Urban South Africa

Social, political, epidemiological, and economic forces have produced family instability during childhood for many young people transitioning to adulthood in South Africa. This study identifies pathways to adulthood for youth in Cape Town that capture the timing and sequencing of role transitions across the life domains of school, work, and family formation. It then uses these pathways to investigate the relationship between childhood family instability and the way young people's lives unfold during the transition to adulthood. Results indicate that changes in co-residence with parents are associated with following less advantageous pathways into adulthood, independent of particular family structure or orphan status. Overall, the findings suggest that family instability influences not only single transitions for youth, but also combinations of transitions. They also indicate the value of a multi-dimensional conceptualization of the transition to adulthood in empirical work.

Profile: Agincourt health and socio-demographic surveillance system

The Agincourt health and socio-demographic surveillance system (HDSS), located in rural northeast South Africa close to the Mozambique border, was established in 1992 to support district health systems development led by the post-apartheid ministry of health. The HDSS (90 000 people), based on an annual update of resident status and vital events, now supports multiple investigations into the causes and consequences of complex health, population and social transitions. Observational work includes cohorts focusing on different stages along the life course, evaluation of national policy at population, household and individual levels and examination of household responses to shocks and stresses and the resulting pathways influencing health and well-being. Trials target children and adolescents, including promoting psycho-social well-being, preventing HIV transmission and reducing metabolic disease risk. Efforts to enhance the research platform include using automated measurement techniques to estimate cause of death by verbal autopsy, full 'reconciliation' of in- and out-migrations, follow-up of migrants departing the study area, recording of extra-household social connections and linkage of individual HDSS records with those from sub-district clinics. Fostering effective collaborations (including INDEPTH multi-centre work in adult health and ageing and migration and urbanization), ensuring cross-site compatibility of common variables and optimizing public access to HDSS data are priorities.

Female-headed households contending with AIDS-related hardship in rural South Africa

Mainstream research and the popular media often equate female-headship with household vulnerability, crisis, and disorganization. Epidemic levels of HIV/AIDS in some parts of sub-Saharan Africa compound this portrait of hopelessness. In South Africa, the impact of HIV/AIDS on households depends on race, class, and place. As female-headed households increase in number, we need to better understand how female-heads in poor rural areas contend with AIDS related challenges. We analyze qualitative interviews with 16 female heads and the members of their households in a rural community to examine the response to AIDS-related illness, death, or caring for orphaned children. Our analysis examines female-heads' financial and social resources and how these resources buffer against hardship in households affected by AIDS. We find considerable heterogeneity among rural female-headed households and their access to resources to combat AIDS-related hardship. Our findings have important policy implications both in terms of identifying individual and household vulnerabilities as well as leveraging the potential for resilience for female-heads in rural South African communities.