Polygynous contexts, family structure, and infant mortality in sub-saharan Africa

Men's education and intimate partner violence-Beyond the victim-oriented perspective: Evidence from demographic and health surveys in Central Africa

BACKGROUND

Intimate partner violence (IPV) has increasingly received attention in the last three decades. However, IPV-related studies in both high- and low- and middle-income countries adopted a victim-oriented perspective in which men are perpetrators and women, the victims. Using socio-cultural and resource theories as guiding frameworks, this paper assessed the associations between men's education and IPV in Central Africa, using nationally representative data of married and cohabiting women of reproductive ages.

METHODS

Data included in the analyses come from Demographic and Health Surveys (DHSs) in the Democratic Republic of the Congo (DRC), Cameroon, Gabon, and Chad. Analyzed sub-samples consisted of 3421, 5023, 3930, and 3221 married/cohabiting women of reproductive ages in Chad, DRC, Cameroon, and Gabon, respectively.

RESULTS

Findings indicated significant variations of IPV prevalence within and across countries. Previous research demonstrated that men's education is a protective factor in health-related studies. The present study, however, provide no clear evidence on the linkages between men's education and IPV. In contrast, the paper substantiated that highly educated women were at higher risks of IPV when spouses/partners were less educated.

CONCLUSION

These findings have policy and programmatic implications because they might impede progress towards SDG goals on the elimination of all forms of violence against girls and women in Central Africa, which recorded the worst development indicators in sub-Saharan Africa. On a methodological note, studies are increasingly using pooled data to increase statistical power. Those studies can be very limited to devise effective IPV-interventions since they mask geographical variations within and across countries. More effective IPV-interventions should be culturally rooted and accounting for geographical variations because some areas are more affected than others.

Factors associated with infant mortality in Nigeria: A scoping review

BACKGROUND

Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality.

OBJECTIVE

This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria.

METHODS

This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model.

RESULTS

A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level.

CONCLUSION

Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.

Systematic review of multilevel models involving contextual characteristics in African demographic research

Multilevel modelling has become a popular analytical approach for many demographic and health outcomes. The objective of this paper is to systematically review studies which used multilevel modelling in demographic research in Africa in terms of the outcomes analysed, common findings, theoretical rationale, questions addressed, methodological approaches, study design and data sources. The review was conducted by searching electronic databases such as Ebsco hosts, Science Direct, ProQuest, Scopus, PubMed and Google scholar for articles published between 2010 and 2021. Search terms such as neighbourhood, social, ecological and environmental context were used. The systematic review consisted of 35 articles, with 34 being peer-reviewed journal articles and 1 technical report. Based on the systematic review community-level factors are important in explaining various demographic outcomes. The community-level factors such as distance to the health facility, geographical region, place of residence, high illiteracy rates and the availability of maternal antenatal care services influenced several child health outcomes. The interpretation of results in the reviewed studies mainly focused on fixed effects rather than random effects. It is observed that data on cultural practices, values and beliefs, are needed to enrich the robust evidence generated from multilevel models.

Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey

BACKGROUND

Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone.

METHODS

We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities.

RESULTS

The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization.

CONCLUSION

These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.

Effects of Family Demographics and Household Economics on Sidama Children's Nutritional Status

Weight- (WAZ), height- (HAZ), and BMI-for-age (BMIZ) are frequently used to assess malnutrition among children. These measures represent different categories of risk and are usually hypothesized to be affected by distinct factors, despite their inherent relatedness. Life history theory suggests weight should be sacrificed before height, indicating a demonstrable relationship among them. Here we evaluate impact of family composition and household economics on these measures of nutritional status and explore the role of WAZ as a factor in HAZ. Anthropometrics, family demographics, and measures of household economy were collected from Sidama agropastoralist children in a peri-urban village in southwestern Ethiopia (n = 157; 79 girls). Just over half of the sample (50.9%) had z-scores of - 2SD or below on at least one measure, indicating an elevated risk of morbidity/mortality; 30% were at or below - 2SD on two or more measures. We used hierarchical linear regression with random intercept analysis to model WAZ and HAZ. Siblings and crop sales significantly decrease WAZ while electricity, agriculture, and polygyny improve z-scores; however, an interaction between polygyny and siblings indicates negative effects of siblings in polygynous families and positive effects in nonpolygynous ones (adj. R² = 66.5%). For HAZ, agriculture and electricity are positively associated with z-scores whereas siblings have a negative effect; the interaction term again indicates that effects of siblings vary in polygynous and nonpolygynous families (adj. R² = 74.2%). A mediation model exploring the role of weight in height outcomes suggests not only that WAZ has direct effects on HAZ but also that effects of electricity and agriculture on HAZ are partially mediated by WAZ. Our findings indicate that WAZ and HAZ are primarily affected by shared variables, but effects of siblings vary by polygyny status. Long-term outcomes (HAZ) among Sidama children would likely benefit from interventions focused on stabilizing WAZ across family members.

"We just do it … we are dead already": Exploring the sexual behaviors of youth living with HIV

INTRODUCTION

This study aims to describe the sexual behaviors of youth living with human immunodeficiency virus (HIV) in Malawi. As a high-risk population, understanding the contextual factors that shape their sexual behaviors is of particular interest when designing strategies to reduce HIV transmission.

METHODS

Semi-structured qualitative interviews were used to collect information about sexual behaviors from 22 youth (12 females and 10 males) living with HIV aged from 15 to 24 years. All participants were recruited from a specialized HIV clinic in Malawi. Thematic analysis was applied to identify current themes.

RESULTS

The majority of participants were sexually active. Engaging in sexual behaviors was largely related to social processes identified in three main themes: (1) Risk-taking in pursuit of confidence and maturity; (2) A lack of voice in decision making concerning practising safe sex; (3) Perceived barriers to safe sex practice such as poverty, dropping out of school, and personal perspectives about transmitting HIV to others.

CONCLUSION

Our results suggest that prevention strategies targeting youth social and economic vulnerabilities to social influences are needed to enhance their personal and social skills. We suggest nurturing cultural and religious ceremonies and involving elders to equip youth with skills and knowledge for the prevention of HIV transmission.

Women's attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role?

BACKGROUND

The risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) is related to women's sexual attitudes, beliefs, and power dynamics within marriages in developing countries. Despite the interventions towards improving women's sexual health and well-being, women are disproportionately affected by the risk of STIs transmission compared with their male counterparts in most sub-Saharan African countries including Nigeria. This study examined the roles of family structure and decision-making autonomy on women's attitudes towards negotiating safe sexual practices in Nigeria.

METHODS

The study involved analyses of data from a nationally representative and weighted sample size of 28,219 ever-married/cohabiting women aged 15-49 years from the 2018 Nigeria Demographic and Health Survey. Descriptive and statistical analyses were carried out, including frequency tables, Pearson's chi-square test, and multivariable binary logistic regression model.

RESULTS

The overall prevalence of having positive attitudes towards negotiating safe sexual practices were 76.7% and 69.6% for a wife justified in asking the husband to use a condom if he has an STI and refusing to have sex with the husband if he had sex with other women, respectively. The results further showed that polygamous unions negatively influenced urban and rural women's attitudes towards negotiating safe sexual practices, but women's decision-making autonomy on how to spend their earnings was found to be a protective factor for having positive attitudes towards negotiating safe sexual practices with partners. Surprisingly, there were significant variations in attitudes towards negotiating safe sexual practices among urban and rural women who enjoyed decision-making autonomy on their healthcare (aOR 1.70; CI 1.32-2.18 and aOR 0.52; CI 0.44-0.62, respectively). Plausibly, such women might have constrained them to compromise their sexual relationships for fear of being neglected by partners.

CONCLUSION

The outcomes of this study have some policy implications for both maternal and child health. There is the need to intensify programmes aimed at improving women's sexual health and rights towards achieving sustainable development goals of preventing deaths of newborns, ending STIs and creating gender in Nigeria.

Multilevel analysis of determinants of polygyny among married men in Ethiopia

BACKGROUND

Polygyny occurs when a man has more than one wife at the same time. It often contributes to poor health among family members, particularly young children. It encourages the spread of sexually transmitted infections (STIs) including HIV/AIDS. The determinants of polygyny have not yet been adequately explored in Ethiopia. This study adds to the body of knowledge concerning the prevalence and distribution of polygyny in the country.

METHODS

This study is a secondary analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS) data. Using a two-stage stratified cluster sampling, 7470 married men were selected. After verifying the assumptions of multilevel logistic regression analysis, Stata version 14.0 was used to analyse the data. A multilevel mixed-effects logistic regression model was used to identify predictors of polygyny. An adjusted odds ratio with a 95% confidence interval was used to measure the association. A p-value of < 0.05 was considered to indicate statistical significance.

RESULTS

Age from 30 to 44 years [AOR = 5.78, 95% CI = (3.13, 10.7)], age from 45 to 59 years [AOR = 16.5, 95% CI = (8.59, 31.8)], men with primary education or no formal education [AOR = 3.40, 95% CI = (1.50, 7.69)], being Muslim [AOR = 2.47, 95% CI = (1.28, 4.77)], sexual initiation at or above the age of 18 years [AOR = 0.46, 95% CI = (0.30, 0.68)] and being from a less developed region of Ethiopia [AOR = 3.67, 95% CI = (2.30, 5.83)] were factors associated with polygyny.

CONCLUSION

Both individual and community level factors were identified as predictors of polygyny. Improving educational attainment and delaying men's sexual debut could encourage the reduction of polygyny in Ethiopia.

Anaemia among under-five children: Is maternal marriage at 18th birthday and above protective? Evidence from 15 countries in Sub-Saharan Africa

Prevalence of child marriage has remained high in many parts of Africa despite its multisectoral adverse effect. As it is now being suggested to have intergeneration impact, we examined if marriage at or after 18th birthday is associated with the risk of anaemia among under-five children. Cross-sectional data from Demographic and Health Surveys (DHS) conducted between 2010 and 2018 in 15 African countries as of August 2020 were used. Maternal age of marriage was defined as when they started living with their husband or partner. Children with haemoglobin level below 11.0 g/dl after adjustment for altitude were categorised to be anaemic. The study involved a multivariable logistic regression analysis of 17,033 children data born by women between the childbearing ages. About 65% of under-five children in Sub-Saharan Africa (SSA) were anaemic, ranging from 40% in Rwanda to 82% in Mali. Girl child marriage ranged from 40% in South Africa to 97% in Niger with an average of about 60%. We observed a significant reduction (20%) in the risk of anaemia among under-five children when their mothers married after at or after their 18th birthday. Country-specific analysis showed that increased risk of anaemia was strongly associated with early marriage in Côte d'Ivoire and Mozambique. This study contributed to the growing evidence that maternal age of marriage might have an intergenerational impact. Maternal marriage at or after their 18th birthday reduces the risk of anaemia among under-five children in Africa. Interventions aimed at tackling anaemia in Africa should capture and affect household socioeconomic risks and children's exposures.

Educational Assortative Mating in Sub-Saharan Africa: Compositional Changes and Implications for Household Wealth Inequality

Sub-Saharan Africa (SSA) is undergoing rapid transformations in the realm of union formation in tandem with significant educational expansion and rising labor force participation rates. Concurrently, the region remains the least developed and most unequal along multiple dimensions of human and social development. In spite of this unique scenario, never has the social stratification literature examined patterns and implications of educational assortative mating for inequality in SSA. Using 126 Demographic and Health Surveys from 39 SSA countries between 1986 and 2016, this study is the first to document changing patterns of educational assortative mating by marriage cohort, subregion, and household location of residence and relate them to prevailing sociological theories on mating and development. Results show that net of shifts in educational distributions, mating has increased over marriage cohorts in all subregions except for Southern Africa, with increases driven mostly by rural areas. Trends in rural areas align with the status attainment hypothesis, whereas trends in urban areas are consistent with the inverted U-curve framework and the increasing applicability of the general openness hypothesis. The inequality analysis conducted through a combination of variance decomposition and counterfactual approaches reveals that mating accounts for a nonnegligible share (3% to 12%) of the cohort-specific inequality in household wealth, yet changes in mating over time hardly move time trends in wealth inequality, which is in line with findings from high-income societies.

He for she? Variation and exaggeration in men's support for women's empowerment in northern Tanzania

Achieving gender equality fundamentally requires a transfer of power from men to women. Yet data on men's support for women's empowerment (WE) remains scant and limited by reliance on self-report methodologies. Here, we examine men's support for WE as a sexual conflict trait, both via direct surveys (n = 590) and indirectly by asking men's wives (n = 317) to speculate on their husband's views. Data come from a semi-urban community in Mwanza, Tanzania. Consistent with reduced resource competition and increased exposure to relatively egalitarian gender norms, higher socioeconomic status predicted greater support for WE. However, potential demographic indicators of sexual conflict (high fertility, polygyny, large spousal age gap) were largely unrelated to men's support for WE. Contrasting self- and wife-reported measures suggests that men frequently exaggerate their support for women in self-reported attitudes. Discrepancies were especially pronounced among men claiming the highest support for WE, but smallest among men who held a professional occupation and whose wife participated in wage labour, indicating that these factors predict genuine support for WE. We discuss the implications of these results for our understanding of both individual variation and patriarchal gender norms, emphasising the benefits of greater exchange between the evolutionary human sciences and global health research on these themes.

Polygyny and intimate partner violence in sub-Saharan Africa: Evidence from 16 cross-sectional demographic and health surveys

In sub-Saharan Africa, where intimate partner violence has been found to be predominant, several scholars have made efforts to understand its predictors. Socio-culturally, polygyny has been considered as a key determinant of intimate partner violence. This study aimed to examine the association between polygyny and intimate partner violence in 16 sub-Saharan African countries. Binary logistic regression models were used in testing the association and the results were presented as crude and adjusted odds ratios at 95% confidence interval. The proportion of women in polygamous marriages in the 16 countries was 20.2%, ranging from as high as 40% in Chad to as low as 1.6% in South Africa. The prevalence of IPV was 30.7% in the 16 countries, ranging from as high as 44% in Uganda to as low as 12.7% in South Africa. The odds of IPV were higher among women in polygamous marriages in Angola, Burundi, Ethiopia, Uganda, Malawi, Mozambique, Zambia and Zimbabwe but was lower among women in polygamous marriages in Cameroon [COR = 0.54, 95% CI = 0.44-0.66] and Nigeria [COR = 0.61, 95% CI = 0.55-0.67], and this persisted after controlling for level of education, place of residence, wealth quintile, media exposure, and justification of violence. This study has found a significant association between polygyny and intimate partner violence. The practice of intimate partner violence in sub-Saharan Africa is fused into the socio-cultural norms and religious traditions of most countries in the sub-Saharan African region. The findings imply that family structures expose women to intimate partner violence. Therefore, global efforts in dealing with intimate partner violence through the Sustainable Development Goals should be done with attention on the socio-cultural norms and traditions around marriage and family structures.

Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries

BACKGROUND

Under-5 mortality remains a public health concern in low-income and middle-income countries. Africa contributes about one-fifth of the burden of global under-5 mortality; intimate partner violence (IPV) and polygyny, which are highly prevalent on the continent, have been linked to under-5 mortality at the individual level. This study examined the relationship between IPV and polygyny as contextual factors and the experience of under-5 mortality among women in Sub-Saharan Africa (SSA).

METHODS

We used data from the Demographic and Health Surveys (DHS) of 20 African countries with available data between 2010 and 2018 as of April 2020. We defined the experience of under-5 mortality as a woman's loss of at least one child before their fifth birthday. The DHS primary sampling unit was used to define contextual factors. The study involved a multilevel logistic regression analysis of 227 121 women of childbearing age (15-49).

RESULTS

A quarter (24.5%) of women have lost at least one child under 5 years old, more than two-thirds (40.1%) have experienced at least one form of IPV, and about two-thirds of women were in polygynous union. Our multilevel logistic regression showed that parity, polygynous union and experience of IPV were strongly associated with women's experience of under-5 mortality. The results showed that 39.9% and 19.2% of variances in odds of a woman losing a child before their fifth birthday are attributable to community-level and country-level factors, respectively. Contextual prevalence of IPV, polygynous union and gender equity attenuate the strength of associations observed at the individual level. The interaction between contextual prevalence of polygyny and IPV exacerbates the risk of under-5 mortality. Women in SSA countries with higher Human Development Index were less likely to experience under-5 mortality.

CONCLUSION

This study established that beyond individual-level effects, contextual prevalence of IPV and polygyny and their interactions shape women's experience of under-5 mortality in Africa. In designing policies and interventions to address under-5 mortality, contextual factors, especially those linked to culturally laden social norms and practices, must be considered to ensure effectiveness and sustainable impact.

Exposure to Armed Conflict and Fertility in Sub-Saharan Africa

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Data Project (ACLED) with data on fertility goals and outcomes from the Demographic and Health Surveys (n = 368,765 women aged 15-49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents' preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women's vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the second-order effects of organized violence on vulnerable populations.

Undernutrition, polygynous context and family structure: a multilevel analysis of cross-sectional surveys of 350 000 mother-child pairs from 32 countries

BACKGROUND

Contextual factors, especially where people live, has been linked to various health outcomes, therefore, there is an increasing focus on its implication for policies and implementation of health interventions. Polygyny is a widespread practice in sub-Saharan Africa that also reflects socioeconomic and sociocultural features. This study investigated the association between polygynous context and risk of undernutrition.

METHODS

Recent Demographic and Health Surveys involving 350 000 mother-child pairs from 32 sub-Saharan African countries conducted between 2010 and 2018 as of March 2020, were analysed using relevant descriptive and 3-level multilevel logistic regression modelling. Undernutrition among under-5 was defined as underweight, stunting and wasting using the WHO Multicentre Growth Reference Study. Odd Ratio (OR) at 95% credible interval was used to report the associations.

RESULTS

The prevalence of contextual polygyny varied widely across the 32 sub-Saharan African countries, the lowest (0%) found in one of the regions in South Africa and the highest (52%) in one of the regions in Uganda. Underweight, stunting and wasting were lowest in Uganda (3.5%, 9.3%-1.27%, respectively), stunting was highest in Mozambique (37.1%) while wasting was highest in Niger (7.7%). Furthermore, the results showed that the contextual prevalence of polygynous practice exacerbates the risk of underweight (1.003 (0.997-1.008)) and wasting (1.014 (1.007-1.021)) among under-5 children, even when gender inequality and sociodemographic indicators were adjusted for. Polygyny was negatively associated with stunting though not significant; multiple births had the strongest and positive association with the risk of undernutrition among under-5 children in sub-Saharan Africa.

CONCLUSIONS

This study further corroborates the strong influence of contextual factors on health outcomes-which is undernutrition in this study. In addition to specific interventions aimed at reducing the prevalence of undernutrition, broader strategies that will address contextual issues are required.

The Effects of Marital Status, Fertility, and Bereavement on Adult Mortality in Polygamous and Monogamous Households: Evidence From the Utah Population Database

Although the associations among marital status, fertility, bereavement, and adult mortality have been widely studied, much less is known about these associations in polygamous households, which remain prevalent across much of the world. We use data from the Utah Population Database on 110,890 women and 106,979 men born up to 1900, with mortality follow-up into the twentieth century. We examine how the number of wife deaths affects male mortality in polygamous marriages, how sister wife deaths affect female mortality in polygamous marriages relative to the death of a husband, and how marriage order affects the mortality of women in polygamous marriages. We also examine how the number of children ever born and child deaths affect the mortality of men and women as well as variation across monogamous and polygamous unions. Our analyses of women show that the death of a husband and the death of a sister wife have similar effects on mortality. Marriage order does not play a role in the mortality of women in polygamous marriages. For men, the death of one wife in a polygamous marriage increases mortality to a lesser extent than it does for men in monogamous marriages. For polygamous men, losing additional wives has a dose-response effect. Both child deaths and lower fertility are associated with higher mortality. We consistently find that the presence of other kin in the household—whether a second wife, a sister wife, or children—mitigates the negative effects of bereavement.

The Psychological Benefits of Marriage and Children in Rural Malawi

Despite an extensive literature on the psychological rewards of marriage and children in high-income countries, research on these relationships in low-income countries remains limited. This paper draws on data from 4,133 adult women and men interviewed in the Malawi Longitudinal Study of Families and Health to examine how marital status, categorized as never, formerly, monogamously, and polygynously married, and number of children are associated with psychological well-being. With respect to marital status, we find that women in polygynous unions fare worse than monogamously married women and this detrimental effect is stronger for women than for men. Formerly married men and women of reproductive age experience the worst psychological outcomes, although this association wanes with age. In contrast, the benefits of having children is only evident among older Malawian women. These findings offer novel insights into the patterns of nearly universal marriage and high fertility that characterize Malawi and much of sub-Saharan Africa.

Polygyny and Intimate Partner Violence in Mozambique

Polygyny has shown a positive association with intimate partner violence (IPV), yet the nature and mechanisms of this association are not well understood. This study uses data from rural Mozambique to distinguish women in polygynous unions by rank and co-residence. Findings show that senior wives report higher rates of violence than their junior-wife and monogamously married counterparts. At the same time, no difference is detected between junior wives and women in monogamous marriages. Additionally, the analysis finds that polygynously married women living away from their co-wives report higher rates of violence than both women co-residing with co-wives and women in monogamous unions, while the difference between the latter two categories is not statistically significant. However, the results also indicate that senior wives living away from their co-wives face particularly high risks of violence. These findings illustrate the social complexity of polygynous marriages and resulting differential vulnerabilities of women in them.

Community Influences on Female Genital Mutilation/Cutting: A Comparison of Four Francophone West African Countries

Despite long-term efforts to encourage abandonment of female genital mutilation/cutting (FGMC), the practice remains widespread globally. FGMC is situated in specific social and historical contexts, and both prevalence and rates of decline vary widely across practicing countries. However, cross-national comparative research on the determinants of FGMC is sparse. This paper adds to the limited body of rigorous, theoretically grounded quantitative studies of FGMC and takes a step toward advancing cross-national comparative research. We apply an integrated theoretical framework that brings together norms-based and gender-based explanations of community-level influences on FGMC. We test this framework in four francophone West African countries, drawing on comparable nationally representative data from the Demographic and Health Surveys in Burkina Faso (2010), Côte d'Ivoire (2011-2012), Guinea (2012), and Mali (2012-2013). Results show that community-level FGMC norms and community-level gendered opportunities are associated with girls' risk of FGMC, but that the direct and moderating associations vary qualitatively across countries. Our findings highlight the contribution of context-specific social and institutional processes to the decline or persistence of FGMC.

The Marital Implications of Bereavement: Child Death and Intimate Partner Violence in West and Central Africa

In high-mortality contexts, research examining the effects of child mortality has focused almost exclusively on couples' fertility responses while overlooking other potential family consequences. Using nationally representative survey data from 13 West and Central African countries, we estimate multilevel discrete-time hazard models to determine how women's risk of intimate partner violence (IPV) varies with the death of children. We assess heterogeneity in this association across two surrounding circumstances: children's age at death and regional prevalence of child bereavement. Findings indicate that the risk of IPV initiation rises with the death of children under age 5-for whom women are most intensely responsible-but not with the death of older children. The effect of young child bereavement is most pronounced in regions where it is least prevalent among mothers-a finding not explained by concomitant regional variation in gender inequality, family norms, and infrastructural development. These findings highlight the importance of child mortality for family outcomes beyond fertility in the African context and demonstrate the prominent role of the broader mortality context in shaping these implications.

Child Sex Composition, Parental Sex Preferences, and Marital Outcomes: Evidence From a Matrilineal Context

Objective

The authors study matrilineal settings in rural Malawi, a southeast African country, to assess if women experience better marital outcomes in the presence of daughters and if so whether daughter preference plays a role.

Background

A provocative finding in family sociology is that couples with sons experience better marital outcomes relative to those with daughters. Sociologists contend that these marital benefits are attributable to the gender system fostering greater closeness between fathers and sons, a preference for sons, or economic, cultural, and social incentives for fathers to invest more in unions that have produced sons. Extrapolating these arguments beyond son-inspired marital benefits in patriarchal settings suggests that the reverse process-daughter-inspired marital benefits-could prevail in matrilineal contexts.

Method

The authors analyze three rounds of the nationally representative Malawi Demographic and Health Survey. They estimate three series of parity-specific, multivariable logistic regression models to assess the associations between child sex composition and marital outcomes (two forms of relationship abuse and polygyny) and model each outcome among the full sample of women with one to four children and control for number of children, thus conveying the average effect of sex composition across parities.

Results

Women with daughters-particularly women with only daughters-in predominately matrilineal, rural communities in the central and southern regions of Malawi are more likely to be in monogamous versus polygynous unions and are less likely to have experienced emotionally abusive and controlling behaviors. We find little evidence that women and men explicitly prefer or pursue daughters.

Conclusion

The study shows that a matrilineal gender system can influence marital dynamics in the presence of daughters even without fostering an overwhelming preference for them.

Joint spatial mapping of childhood anemia and malnutrition in sub-Saharan Africa: a cross-sectional study of small-scale geographical disparities

BACKGROUND

In epidemiological studies, several diseases share common risk factors or co-exist in their spatial prevalence. Disease mapping allows the health practitioners and epidemiologists to hypothesize the disease aetiology and gain better understanding of the geographical prevalence of the disease risks.

OBJECTIVE

This paper investigates the differences in small scale geographical variations and the underlying risk factors of child's health outcomes (anemia, stunting and wasting) in Sub-Saharan Africa using spatial epidemiology.

METHOD

The study first carried out an independent univariate analysis on each malnutrition indicator to identify underlying risk factors. A multivariate conditional autoregressive prior was explored to jointly model the spatial correlation between the undernutrition indicators and the small area-geographical disparities at sub-national levels in two sub-Saharan African countries.

RESULTS

The approach was implemented on data from National cross-sectional household- based demographic and health surveys conducted in 17,307 under-five children in Burkina Faso and Mozambique in 2010-012. Out of these children, 31.8% are found to be stunted, 15.5% wasted and 30.9% had anemia among Burkina Faso children, while 42.5% of Mozambican children were stunted, 5.9% wasted and 30.9% suffered from iron-deficiency anemia. The multivariate analysis revealed that the spatial prevalence existed across regions in Burkina Faso with geographical variations in stunting estimated as: 0.7549, CI (0.4693, 1.264); wasting 0.9197; (95%CI: 0.535, 1.591)and anemia: 0.734; (0.4606, 1.214). In additin, the spatial correlation between stunting and wasting was negatively correlated: -0.998; 95% CI (-1.000, -0.984), and a perfect negative correlation;(-1) between stunting and anemia, and positive for wasting and anemia: 0.997; (0.978, 1.000). The spatial occurrence across provinces in Mozambique indicated that there was strong positive correlation between stunting and wasting; 0.986; (0.899, 1.000) and a significant negative correlation between stunting and anemia: -0.720, (-0.934, -0.308) and wasting and anemia: -0.640; (-0.903 -0.174) with individual geographical variability in child stunting: 1427, (913.6, 2268); wasting:1751, (1117, 2803) and anemia: 556, (279.5, 978.9). These extra random effect parameters computed in our multivariate approach would outperform a univariate analysis in similar studies. Our model further detected high prevalent of malnutrition and anemia in the northern Burkina Faso, but high anemia prevalent found in central Mozambique, and high stunting and wasting identified Southern Mozambique. In addition, the risk factors of malnutrition and iron deficiency anemia included household poverty, morbidity, short birth interval (less 18 months), breast feeding, antenatal attendance and maternal literacy.

CONCLUSION

The statistical relevance of the identified risk factors in this study is useful to target specific individual interventions and the maps of the geographical inequalities in sub-national region can be used for designing nutrition interventions and allocation of scarce health resources.

'You just have to grin and bear' - emotional suppression among women in polygyny in Cameroon

Polygyny is a matrimonial union in which a single man is simultaneously married to multiple wives. On a daily basis, women in polygynous unions suffer from financial, emotional and physical burdens. This study explores women's perceptions of this matrimonial regime and the factors influencing their sexual health decision-making in Cameroon. Drawing on interviews with twenty-three women aged 23 to 80 years living in polygynous unions, we explore women's daily life and perceptions on polygyny. Using content analysis, meaning units relating to respondents' experiences and perceptions were identified and condensed into codes and categories that were later grouped into themes. Five themes emerged - refusal and tolerance; heavy workload and responsibility; lack of power in sexual health decision-making; discrimination and unequal treatment of spouses; and emotional suppression. Women reported emotional suppression, limited rights, discrimination and poor living conditions as being the most significant problems that they encountered. Addressing the discrimination faced by women in polygynous unions will entail adopting and implementing laws to protect women's rights and promote their empowerment.

Rethinking and Revising Goode's Contribution to Global Family Change

This essay provides a comprehensive overview of William J. Goode's contribution to the study of global family and social change. I begin by describing Goode's theoretical perspectives and outlining his theses dating back to the 1960s. I then provide an assessment of where and why some of his predictions proved wrong and elaborate on what we have learnt on changes in families at the global level over the past half century. Lastly, I speculate on how Goode would rethink his arguments nowadays in light of fifty years of new evidence and scholarly developments - both theoretical and methodological. In so doing, I highlight shortcomings of current approaches and outline directions for future family research and theorizing.

Community Influences on Female Genital Mutilation/Cutting in Kenya: Norms, Opportunities, and Ethnic Diversity

Female genital mutilation/cutting (FGMC) is a human rights violation with adverse health consequences. Although prevalence is declining, the practice persists in many countries, and the individual and contextual risk factors associated with FGMC remain poorly understood. We propose an integrated theory about contextual factors and test it using multilevel discrete-time hazard models in a nationally representative sample of 7,535 women with daughters who participated in the 2014 Kenya Demographic and Health Survey. A daughter's adjusted hazard of FGMC was lower if she had an uncut mother who disfavored FGMC, lived in a community that was more opposed to FGMC, and lived in a more ethnically diverse community. Unexpectedly, a daughter's adjusted FGMC hazard was higher if she lived in a community with more extrafamilial opportunities for women. Other measures of women's opportunities warrant consideration, and interventions to shift FGMC norms in more ethnically diverse communities show promise to accelerate abandonment.

Socio-demographic and behavioural profile of women in polygamous relationships in South Africa: a retrospective analysis of the 2002 population-based household survey data

Background

The prevalence and effect of polygamous relationships may have serious reproductive and /or health consequences for women. In South Africa, unlike in other sub-Saharan countries, no nationwide survey has investigated polygamy except for the 2002 HIV/AIDS population-based household survey. The aim of this study was to profile socio-demographic and behavioural characteristics associated with women in polygamous relationships in South Africa using the 2002 survey data.

Methods

The survey data were collected using a multi-stage stratified cluster randomised sampling design. Bivariate and multivariate logistic regression models were used to assess the relationship between polygamy, and selected socio-demographic and behavioural factors.

Results

Of 1437 women who responded to the question on polygamy, 8.3% reported being in a polygamous marriage. Women in polygamous marriages were significantly less likely to have tertiary education [OR = 0.03(95% CI: 0.00–0.28), p = 0.003], to have money for food and clothes [OR = 0.12 (95% CI: 0.06–0.27), p < 0.001], to have a sexual partner five years younger [OR = 0.10 (95% CI: 0.01–0.94), p = 0.044] or sexual partner within 5 years older or younger [OR = 0.35 (95% CI: 0.13–0.991), p = 0.032]. They were also significantly more likely to have two or more sexual partners [OR = 20.42 (95% CI: 1.10–379.89), p = 0.043].

Conclusion

The finding that polygamy is associated with uneducated and women of low economic means, who have relationships with older men and multiple sexual partners warrants further attention. Contemporary studies on polygamy are needed in South Africa.

Modeling and mapping the burden of disease in Kenya

Precision public health approaches are crucial for targeting health policies to regions most affected by disease. We present the first sub-national and spatially explicit burden of disease study in Africa. We used a cross-sectional study design and assessed data from the Kenya population and housing census of 2009 for calculating YLLs (years of life lost) due to premature mortality at the division level (N = 612). We conducted spatial autocorrelation analysis to identify spatial clusters of YLLs and applied boosted regression trees to find statistical associations between locational risk factors and YLLs. We found statistically significant spatial clusters of high numbers of YLLs at the division level in western, northwestern, and northeastern areas of Kenya. Ethnicity and household crowding were the most important and significant risk factors for YLL. Further positive and significantly associated variables were malaria endemicity, northern geographic location, and higher YLL in neighboring divisions. In contrast, higher rates of married people and more precipitation in a division were significantly associated with less YLL. We provide an evidence base and a transferable approach that can guide health policy and intervention in sub-national regions afflicted by disease burden in Kenya and other areas of comparable settings.

Variation in the link between parental divorce and children's health disadvantage in low and high divorce settings

Like in other world regions, children with divorced parents in sub-Saharan Africa experience significant heath disadvantages relative to their peers with married parents. Preliminary evidence suggests this disadvantage may not be uniform across the subcontinent's diverse settings. Research from other world regions shows that the childhood health consequences of divorce vary across different contexts. Specifically, we hypothesize that the childhood disadvantages associated with divorce are more severe in regions of sub-Saharan Africa where divorce is rare, and less so where divorce is a more common family experience. Using Demographic and Health Survey data from 290 subnational regions within 31 sub-Saharan African countries, multilevel models document the previously shown link between having a divorced mother and child morbidity and mortality. The study results further demonstrate that the childhood health disadvantage is accentuated in subnational African regions where fewer women are divorced and muted in areas where more women are divorced. The findings demonstrate that the broader context can powerfully moderate childhood health inequalities traditionally thought of as operating at the family or individual level.

Maternal union instability and childhood mortality risk in the Global South, 2010-14

Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children's mortality risk in Africa, Latin America and the Caribbean, and Asia using children's actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability-regardless of current union status-may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.

Women's narratives of living in polygamous marriages: Rural Malawian experience distilled and preserved in poetic constructions

Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.

Premarital childbearing in sub-Saharan Africa: Can investing in women's education offset disadvantages for children?

Premarital childbearing is common in many parts of sub-Saharan Africa, and may become increasingly so with the rise in women’s age at first marriage. These trends are concerning given the severe childhood health consequences associated with being born premaritally. However, women’s could condition the experience of having a premarital birth in a way that lessens its consequences for children. Extending the large literature on the child health benefits of mothers’ education—including her educational attainment and acquisition of key educational skills – I analyze whether the consequences of being born premaritally are lessened among children whose mothers are more highly-educated. The study focuses on Malawi, a southeast African country where child mortality rates remain high. I use Demographic and Health Survey data to estimate discrete-time logistic regression models (N=30,411 children younger than age five) of the relationships between premarital childbearing, mothers’ educational background, and child mortality. The findings confirm that though being born premaritally is associated with higher child mortality, this is only true for children whose mothers have never been to school or discontinued at the primary level and/or never learned how to read. There is no evidence that being born premaritally is associated with elevated mortality among children whose mothers have been to secondary school and/or know how to read. The results demonstrate that analyzing how premarital childbearing intersects with other sources of health inequality enhances our understanding of the circumstances under which it poses the greatest risk to child well-being in sub-Saharan Africa.

•

Premarital childbearing is common in sub-Saharan Africa.

•

Being born premaritally is known to increase children’s risk of mortality.

•

In Malawi, the consequences of being born premaritally differs by mothers’ education.

•

Mothers’ educational attainment and literacy offsets the elevated mortality risk associated with being born premaritally.

No evidence that polygynous marriage is a harmful cultural practice in northern Tanzania

Polygyny is cross-culturally common and a topic of considerable academic and policy interest, often deemed a harmful cultural practice serving the interests of men contrary to those of women and children. Supporting this view, large-scale studies of national African demographic surveys consistently demonstrate that poor child health outcomes are concentrated in polygynous households. Negative population-level associations between polygyny and well-being have also been reported, consistent with the hypothesis that modern transitions to socially imposed monogamy are driven by cultural group selection. We challenge the consensus view that polygyny is harmful, drawing on multilevel data from 56 ethnically diverse Tanzanian villages. We first demonstrate the vulnerability of aggregated data to confounding between ecological and individual determinants of health; while across villages polygyny is associated with poor child health and low food security, such relationships are absent or reversed within villages, particularly when children and fathers are coresident. We then provide data indicating that the costs of sharing a husband are offset by greater wealth (land and livestock) of polygynous households. These results are consistent with models of polygyny based on female choice. Finally, we show that village-level negative associations between polygyny prevalence, food security, and child health are fully accounted for by underlying differences in ecological vulnerability (rainfall) and socioeconomic marginalization (access to education). We highlight the need for improved, culturally sensitive measurement tools and appropriate scales of analysis in studies of polygyny and other purportedly harmful practices and discuss the relevance of our results to theoretical accounts of marriage and contemporary population policy.