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De PK, Tümay M. Education and reproductive health: evidence from schooling expansion in Turkey. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:301-331. [PMID: 38182808 DOI: 10.1007/s10754-023-09364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/19/2023] [Indexed: 01/07/2024]
Abstract
We investigate the role of additional years of schooling mandated by a compulsory schooling expansion law in affecting reproductive preferences and safe reproductive health behaviors in Turkey-a middle-to-high-income country with gender inequity in education but overall high levels of safe reproductive health practices at the time of passing the law. Using a fuzzy regression discontinuity design, we find that the additional schooling improved several health behaviors. However, the effects on some outcomes commonly analyzed in the existing literature, such as contraceptive use or fertility, were either weak or insignificant. Overall, our findings complement the current literature on the marginal health benefits of schooling expansion and suggest that policymakers consider the institutional and cultural factors while evaluating the scope and potential non-educational benefits of such expansions.
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Affiliation(s)
- Prabal K De
- Department of Economics and Business, Colin Powell School, CUNY City College and Graduate Center, 160 Convent Ave, New York, NY, 10031, USA.
| | - Muhammed Tümay
- Department of Economics, Faculty of Economics and Administrative Sciences, Gumushane University, Baglarbasi Mahallesi, Gumushane, 29100, Turkey
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2
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Smith-Greenaway E, Lin Y, Weitzman A. The Intergenerational Transmission of Health Disadvantage: Can Education Disrupt It? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241246250. [PMID: 38682591 DOI: 10.1177/00221465241246250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In low-income countries, intergenerational processes can culminate in the replication of extreme forms of health disadvantage between mothers and adult daughters, including experiencing a young child's death. The preventable nature of most child deaths raises questions of whether social resources can protect women from enduring this adversity like their mothers. This study examined whether education-widely touted as a vehicle for social mobility in resource-poor countries-disrupts the intergenerational cycle of maternal bereavement. We estimated multilevel discrete-time survival models of women's hazard of child loss using Demographic and Health Survey Program data (N = 195,744 women in 345 subnational regions in 32 African countries). Women's educational attainment minimizes the salience of their mothers' bereavement history for their own probability of child loss; however, mothers' background becomes irrelevant only among women with ≥10 years of schooling. Education's neutralizing influence is most prominent in the highest mortality-burdened communities.
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Affiliation(s)
| | - Yingyi Lin
- Bill & Melinda Gates Foundation, Seattle, WA, USA
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Guzzo KB, Hayford SR. Educational experiences and American young adults' childbearing goals: A research note. JOURNAL OF MARRIAGE AND THE FAMILY 2024; 86:513-525. [PMID: 38828209 PMCID: PMC11142460 DOI: 10.1111/jomf.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/15/2023] [Indexed: 06/05/2024]
Abstract
Objective This research note describes the relationship between young adults' educational experiences and childbearing goals in the U.S. Background In the U.S., education is associated with later childbearing and fewer children, but the relationship between education and fertility desires and intentions is less well-understood. This article contributes to the research literature by illustrating variation in prospective fertility goals by education, focusing on the early life course in order to understand young adults' goals before they have been shaped by parenting and extensive workforce experiences. Method This analysis uses data from the National Surveys of Family Growth (1995-2019), a nationally representative survey, to study fertility desires and intentions among childless U.S. men and women ages 19-24. Predicted probabilities demonstrating differences in fertility goals by educational experiences, from three sets of multivariable analyses (logistic regression predicting fertility desires and intentions, separately, and negative binomial regression predicting intended parity), are shown. Results Men and women with a bachelor's degree and those enrolled in college do not have lower fertility goals than those without a degree and not enrolled; if anything, more educated individuals are slightly more likely to desire (for men only) and intend children and to have slightly larger intended family size. Conclusions Education gaps in fertility in the United States are not attributable to differences in early-life fertility goals.
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Affiliation(s)
- Karen Benjamin Guzzo
- Department of Sociology, 155 Hamilton Hall, CB #3210, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3210
| | - Sarah R Hayford
- Department of Sociology, Townshend Hall 205, 1885 Neil Ave., The Ohio State University, Columbus, OH 43210
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Martin A, Sprague A, Raub A, Bose B, Bhuwania P, Kidman R, Nandi A, Behrman J, Heymann J. The intergenerational effect of tuition-free lower-secondary education on children's nutritional outcomes in Africa. Glob Public Health 2024; 19:2291703. [PMID: 38118117 DOI: 10.1080/17441692.2023.2291703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children's nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.
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Affiliation(s)
- Alfredo Martin
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Aleta Sprague
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Amy Raub
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Bijetri Bose
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Pragya Bhuwania
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada
| | - Jere Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
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Agyen VA, Annim SK, Asmah EE. Neighbourhood mothers' education and its differential impact on stunting: Evidence from 30 Sub-Saharan African countries. Soc Sci Med 2024; 340:116462. [PMID: 38048737 DOI: 10.1016/j.socscimed.2023.116462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023]
Abstract
The study used data from Demographic and Health Surveys for 30 Sub-Saharan African countries to investigate differences in the residential effects of mothers' education on stunting. Multilevel logistic regressions were employed to examine the neighbourhood effects of mothers' education on stunting. The study found that although a higher proportion of mothers with secondary education in a neighbourhood, irrespective of the residence type (rural or urban), reduces a child's probability of being stunted, this effect is stronger for children residing in rural areas than those in the urban. Achieving a target of at least 75 per cent of mothers obtaining secondary education and higher will bridge the rural-urban gap in stunting in Sub-Saharan Africa.
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Smith-Greenaway E, Lin Y. Is the mortality-fertility nexus gendered? A research note on sex differences in the impact of sibling mortality on fertility preferences. POPULATION STUDIES 2023; 77:141-151. [PMID: 36748425 DOI: 10.1080/00324728.2023.2168036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Research guided by demographic transition theory has shown that exposure to mortality influences women's fertility preferences and behaviours. Despite the myriad contexts, methodological approaches, and linkages featured in past studies, they have shared a focus on women, leaving questions on the gendered salience of mortality exposures for adults' fertility-related outcomes unanswered. In this research note, we analyse data from three African countries with distinct fertility profiles (Nigeria, Zambia, and Zimbabwe) to examine associations between sibling mortality exposure and ideal family size among women, men, and couples. We also investigate the stability of these associations over time. The associations between adults' sibling mortality exposure and their own and their spouses' ideal family sizes vary across countries. However, the gendered nature of the results in every country and evidence of cross-spousal effects uniformly demonstrate the need to incorporate sex differences into the study of the mortality-fertility link.
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Behrman JA, Weitzman A. Point of Reference: A Multisited Exploration of African Migration and Fertility in France. INTERNATIONAL MIGRATION REVIEW 2022; 56:911-940. [PMID: 37461403 PMCID: PMC10351488 DOI: 10.1177/01979183211046571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
A considerable literature explores whether the fertility of migrants from high-fertility contexts converges with that of women in lower fertility destinations. Nonetheless, much of this research compares migrants' reproductive outcomes to those of native-born women in destination countries. Drawing on research emphasizing the importance of transnational perspectives, we standardize and integrate data collected in France (the destination) and in six high-fertility African countries (the senders). We show that African migrants in our sample had higher children ever born (CEB) than native French women but lower CEB than women in corresponding origin countries. These findings suggest that socialization into pronatalist norms is an incomplete explanation for migrant fertility in the first generation, an insight that is overlooked when analyzing destination settings only. Next, we conduct multivariate analyses that weight migrants' background characteristics to resemble women in both origin and destination countries. Findings indicate that observed differences between African migrants in France and women in African origin countries help explain differences in CEB between the two groups, which supports selection. We also demonstrate that African migrants in France had delayed transitions into first, second, and third births and lower completed fertility compared to women in origin countries, thus disputing the disruption hypothesis. Finally, we show that observed differences between African migrants in France and native French women explain differences in CEB between the two groups, which supports adaptation. These multifaceted findings on selection, disruption, and adaptation would be obscured by analyzing destination settings only, thus validating a multisited approach to migrant fertility.
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Affiliation(s)
- Julia A Behrman
- Faculty Fellow Institute for Policy Research, Northwestern University, Evanstown, IL, USA
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Shorette K, Burroway R. Consistencies and contradictions: Revisiting the relationship between women's education and infant mortality from a distributional perspective. SOCIAL SCIENCE RESEARCH 2022; 105:102697. [PMID: 35659052 DOI: 10.1016/j.ssresearch.2022.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/24/2021] [Accepted: 01/14/2022] [Indexed: 06/15/2023]
Abstract
The connection between women's education and infant mortality is one of the most consistent and powerful relationships established in public health. A large body of cross-national research highlights the benefits of women's access to education, especially for improving population health in developing countries. However, most of this literature assumes the relationship is uniform across cases. In this study, we revisit the education-health link using a distributional approach. To do so, we conduct a series of unconditional quantile regression analyses that estimate the impact of female secondary school enrollment on infant mortality rates across 153 countries from 1970 to 2016. This technique allows for the possibility that the relationship between education and health may vary across the distribution of mortality. Indeed, results show that the education advantage is distribution-specific. We find that the expected benefits of women's education are limited to the middle of the distribution where infant mortality rates range from about 11 to 55 deaths per 1000 live births. However, we find no significant effect where mortality is comparatively low or high. Both consistent with and contradictory to prior research, these findings provide a more nuanced picture of how women's access to education relates to global health inequalities.
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Zahra F, Haberland N, Psaki S. PROTOCOL: Causal mechanisms linking education with fertility, HIV, and child mortality: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1250. [PMID: 36911344 PMCID: PMC9187904 DOI: 10.1002/cl2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In this review, we will investigate the pathways linking education and health to understand why education appears to improve health in some settings or among certain populations, and not in others, as well as to inform recommendations about how best to target investments in education to maximize the benefits to health. We will seek to answer the following key research questions, focusing specifically on the mechanisms that affect fertility, HIV, and infant and child mortality. If feasible, these answers will include meta-analyses of comparable education and mediator outcomes: (1) Do changes in education affect the primary theorized mediators (e.g., knowledge, attitudes, resources, and agency; health behaviors and harmful practices) of the relationship between education and fertility, HIV and child mortality? (2) How does the relationship between these mediators and education vary across different aspects of education (e.g., grade attainment vs. literacy/numeracy vs. attendance)?
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Urbina DR. Mass Education and Women's Autonomy: Evidence From Latin America. Demography 2022; 59:1195-1220. [PMID: 35579996 DOI: 10.1215/00703370-9983381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Most low- and middle-income countries have implemented mass education reforms in the last few decades. Demographers and policymakers have posited that mass schooling would enhance women's autonomy and, therefore, accelerate population transformations in the Global South. However, gains in women's schooling may have unexpected implications for female autonomy in contexts where hypergamy norms-the ideal that men should marry down and women should marry up in education and other markers of status-are still dominant. This study addresses difficulties in evaluating the causal impact of additional education on women's autonomy by leveraging the timing of compulsory schooling reforms in three Latin American countries: Bolivia, Colombia, and Peru. Using Demographic and Health Surveys, I implement an instrumental variable design using random exposure to compulsory schooling laws as an instrument for years of education. Results show that for women who entered the school system as a result of compulsory reforms, further schooling decreased their level of autonomy in all countries-especially among women from rural Bolivia and Peru. Additional analyses suggest these results are explained by changes in the selection into schooling and the formation of unions defying hypergamy norms. Together, these findings highlight the importance of examining the returns to mass schooling considering population heterogeneity and the contextual meaning of women's education.
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Affiliation(s)
- Daniela R Urbina
- Leverhulme Centre for Demographic Science, Department of Sociology, Nuffield College, University of Oxford, Oxford, UK
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Bhuwania P, Heymann J. Tuition-free secondary education and women's attitudes toward intimate partner violence: Evidence from Sub-Saharan Africa. SSM Popul Health 2022; 17:101046. [PMID: 35242994 PMCID: PMC8866889 DOI: 10.1016/j.ssmph.2022.101046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Intimate partner violence against women (IPVAW) is devastatingly common around the world. It rose further during the pandemic, increasing the urgency of finding interventions to prevent IPVAW and supporting women's ability to exit violent situations. Interventions that prevent violence and eliminate views among perpetrators that violence is acceptable should be top priority. It is also critical to study women's attitudes toward IPVAW as these shape women's responses to the abuse and their exit options. Moreover, research shows that these attitudes have a direct impact on women's health outcomes. We examine the effect of tuition-free secondary education on women's attitudes toward IPVAW across 29 Sub-Saharan African countries using data from the Demographic and Health Surveys conducted between 2000 and 2019. Using the difference-in-difference-in-differences strategy, we estimate the change in women's attitudes toward IPVAW in countries that implement tuition-free secondary policy compared with countries with tuition-free primary alone and those without any tuition-free policy during the study period. We find that while tuition-free primary education policy alone did not reduce the probability of IPVAW being perceived as justified, tuition-free secondary reduced it significantly. The probability that IPVAW was perceived as justified under at least one circumstance declined by 5.3 percentage points more on average in countries that adopted tuition-free policy up to the secondary level relative to those that adopted only up to the primary level. Tuition-free secondary affects four of the five circumstances under which IPVAW was perceived as justified — if she goes out without telling the husband, argues with him, neglects children or refuses sex. We observed no declines for when she burns food, suggesting different factors affecting this outcome. Our findings underscore the importance of making a stronger commitment toward policies that make secondary education more accessible to not only benefit education outcomes but also advance population health. Intimate Partner Violence against women (IPVAW) is on the rise globally. We examine tuition-free education policy's effect on women's attitudes toward IPVAW. Our study exploits variation in the timing of policy rollout in Sub-Saharan Africa. Tuition-free primary policy alone did not affect women's attitudes toward IPVAW. Tuition-free secondary reduced the probability of IPVAW being perceived as justified.
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Alcaraz M, Hayford SR, Glick JE. Desired Fertility and Educational Aspirations: Adolescent Goals in Rapidly Changing Social Contexts. JOURNAL OF MARRIAGE AND THE FAMILY 2022; 84:7-31. [PMID: 35935276 PMCID: PMC9355342 DOI: 10.1111/jomf.12815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
Objective This article analyzes the relationship between educational aspirations and fertility aspirations early in the life course in three different settings. Background The negative relationship between women's educational attainment and childbearing is one of the most consistent associations in social science. Family scholars have a more limited understanding of the relationship between educational aspirations and fertility aspirations before childbearing or union formation. Method The authors use data collected in Jalisco, Mexico; Gaza, Mozambique; and Chitwan Valley, Nepal as part of the Family Migration and Early Life Outcomes project. They estimate nested Poisson regressions to model the relationship between adolescent educational aspirations and desired family size, controlling for individual- and household-level sociodemographic variables as well as adolescent beliefs and values. Results On average, adolescents who desire more education want fewer children in unadjusted models. In Mozambique and Nepal, this association is attenuated in models accounting for household characteristics. In Mexico, the association persists after incorporating these factors, but the inclusion of individual aspirations attenuates the relationship between educational aspirations and desired family size. In Mozambique, the association of educational aspirations with desired family size is moderated by gender. Conclusion As young people enter adolescence, their desires for education and childbearing are inversely related, but the mechanisms driving this association vary across contexts. This variation may be related to linkages between education, social status, and family values.
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Niragire F, Ndikumana C, Nyirahabimana MG, Uwizeye D. Prevalence and factors associated with fertility desire among HIV-positive women in Rwanda in the context of improved life expectancy. Arch Public Health 2021; 79:209. [PMID: 34819164 PMCID: PMC8613943 DOI: 10.1186/s13690-021-00742-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap. Methods Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors. Results The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age of 35–49 years (AOR = 0.051, 95% CI: 0.013–0.204), woman’s parity of 3 children or above (AOR = 0.177, 95% CI: 0.037–0.837), being employed (AOR = 0.298, 95% CI: 0.113–0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057–0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203–11.702) of desire for more children than women who desire the same as their partners. Conclusion Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda’s health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs.
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Affiliation(s)
- François Niragire
- Department of Applied Statistics, University of Rwanda, Kigali, Rwanda.
| | - Celestin Ndikumana
- Department of Governance and Public Administration, University of Rwanda, Kigali, Rwanda
| | | | - Dieudonne Uwizeye
- Department of Development Studies, University of Rwanda, Kigali, Rwanda
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Pattnaik A, Mohan D, Tsui A, Chipokosa S, Katengeza H, Ndawala J, Marx MA. The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi. PLoS One 2021; 16:e0232504. [PMID: 34780507 PMCID: PMC8592450 DOI: 10.1371/journal.pone.0232504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/29/2021] [Indexed: 11/20/2022] Open
Abstract
To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.
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Affiliation(s)
- Anooj Pattnaik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Hans Katengeza
- Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
| | | | - Melissa A. Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Yeboah I, Kwankye SO, Frempong-Ainguah F. Predictors of underachieved and overachieved fertility among women with completed fertility in Ghana. PLoS One 2021; 16:e0250881. [PMID: 34115779 PMCID: PMC8195416 DOI: 10.1371/journal.pone.0250881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A woman's ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women's preferred fertility by the end of their reproductive years. DATA AND METHODS The study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45-49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility. RESULTS The results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman's education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception. CONCLUSION Partner's fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman's inability to achieve her fertility preference. Policies to regulate men's fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana.
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Affiliation(s)
- Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Ahinkorah BO, Seidu AA, Budu E, Agbaglo E, Adu C, Dickson KS, Ameyaw EK, Hagan JE, Schack T. Which factors predict fertility intentions of married men and women? Results from the 2012 Niger Demographic and Health Survey. PLoS One 2021; 16:e0252281. [PMID: 34106940 PMCID: PMC8189508 DOI: 10.1371/journal.pone.0252281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Niger is the country with the highest total fertility rate in the world. In the present study, we investigated factors associated with the desire for more children among married men and women in Niger. MATERIALS AND METHODS We utilised data from the 2012 Niger Demographic and Health Survey. The outcome variable for the study was fertility intentions. The data were analysed with Stata version 14.0. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. RESULTS Desire for more children was 97.2% and 87.2% among men and women respectively. Women aged 45-49 were less likely to desire more children, compared to those aged 25-39 [aOR = 0.13, CI = 0.11-0.16]. The odds of desire for more children were high in rural areas, compared to urban areas [aOR = 1.61, CI = 1.20-2.17]. Childbearing women with seven or more births were less likely to desire more children, compared to those with 1-3 births [aOR = 0.09, CI = 0.06-0.14]. Men aged 50-59 were less likely to desire more children, compared to those aged 25-39 [aOR = 0.13, CI = 0.05-0.35]. Men with secondary/higher level of education were less likely to desire more children, compared to those with no formal education [aOR = 0.24, CI = 0.11-0.52]. Childbearing men with seven or more births were less likely to desire more children, compared to those with 1-3 births [aOR = 0.06, CI = 0.01-0.30]. CONCLUSION This study shows high fertility desire among men and women in Niger. However, the prevalence of fertility desire among men is higher than that of women. A number of socio-economic and demographic factors were found to be associated with desire for more children among men and women in Niger. This calls for a collective effort to educate women and men in Niger on the negative consequences of rapid population growth and large family sizes.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
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Kebede E, Striessnig E, Goujon A. The relative importance of women’s education on fertility desires in sub-Saharan Africa: A multilevel analysis. Population Studies 2021; 76:137-156. [DOI: 10.1080/00324728.2021.1892170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Endale Kebede
- University of Vienna
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)
| | - Erich Striessnig
- University of Vienna
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)
- European Commission Joint Research Centre
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Alvergne A, Stevens R. Cultural change beyond adoption dynamics: Evolutionary approaches to the discontinuation of contraception. EVOLUTIONARY HUMAN SCIENCES 2021; 3:e13. [PMID: 37588536 PMCID: PMC10427300 DOI: 10.1017/ehs.2021.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Numerous evolutionary mechanisms have been proposed for the origins, spread and maintenance of low fertility. Such scholarship has focused on explaining the adoption of fertility-reducing behaviour, especially the use of contraceptive methods. However, this work has yet to engage fully with the dynamics of contraceptive behaviour at the individual level. Here we highlight the importance of considering not just adoption but also discontinuation for understanding contraceptive dynamics and their impact on fertility. We start by introducing contemporary evolutionary approaches to understanding fertility regulation behaviours, discussing the potential for integrating behavioural ecology and cultural evolution frameworks. Second, we draw on family planning studies to highlight the importance of contraceptive discontinuation owing to side-effects for understanding fertility rates and suggest evolutionary hypotheses for explaining patterns of variation in discontinuation rates. Third, we sketch a framework for considering how individual flexibility in contraceptive behaviour might impact the evolution of contraceptive strategies and the demographic transition. We argue that integrating public health and evolutionary approaches to reproductive behaviour might advance both fields by providing (a) a predictive framework for comparing the effectiveness of various public health strategies and (b) a more realistic picture of behaviour by considering contraceptive dynamics at the individual level more explicitly when modelling the cultural evolution of low fertility.
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Affiliation(s)
- Alexandra Alvergne
- ISEM, Université de Montpellier, CNRS, IRD, EPHE, Montpellier, France
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
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Abstract
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.
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Affiliation(s)
- Brian C Thiede
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, 111A Armsby Building, University Park, PA, 16802, USA.
| | - Matthew Hancock
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, 111A Armsby Building, University Park, PA, 16802, USA
| | | | - James Piazza
- Department of Political Science, The Pennsylvania State University, 321 Pond Lab, University Park, PA, 16802, USA
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Cardona C, Rusatira JC, Cheng X, Silberg C, Salas I, Li Q, Bishai D, Rimon JG. Generating and capitalizing on the demographic dividend potential in sub-Saharan Africa: a conceptual framework from a systematic literature review. Gates Open Res 2020; 4:145. [PMID: 33870102 PMCID: PMC8028847 DOI: 10.12688/gatesopenres.13176.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries' understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: The final review consisted of 78 peer-reviewed articles, ten reports from the gray literature, and one book. Data were categorized according to relevant demographic dividend typology: pre-dividend and early-dividend. The results from the literature review were synthesized into a framework consisting of five sectors for pre-dividend countries, namely 1) Governance and Economic Institutions, 2) Family Planning, 3) Maternal and Child Health, 4) Education, and 5) Women's Empowerment. An additional sector, 6) Labor Market, is added for early-dividend countries. These sectors must work together to attain a demographic dividend. Conclusions: A country's demographic transition stage must guide policy and programs. Most sub-Saharan African countries have prioritized job creation and employment for youth, yet their efforts to secure a productive labor market require preliminary and complementary investments in governance, family planning, maternal and child health, education, and women's empowerment. Creating a favorable policy environment for generating and capitalizing on a demographic dividend can support their stated goals for development.
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Affiliation(s)
- Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jean Christophe Rusatira
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Xiaomeng Cheng
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ian Salas
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Qingfeng Li
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jose G. Rimon
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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21
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Liu DH, Raftery AE. How Do Education and Family Planning Accelerate Fertility Decline? POPULATION AND DEVELOPMENT REVIEW 2020; 46:409-441. [PMID: 33132461 PMCID: PMC7590131 DOI: 10.1111/padr.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Education and family planning can both be influenced by policy and are thought to accelerate fertility decline. However, questions remain about the nature of these effects. Does the effect of education operate through increasing educational attainment of women or educational enrollment of children? At which educational level is the effect strongest? Does the effect of family planning operate through increasing contraceptive prevalence or reducing unmet need? Is education or family planning more important? We assessed the quantitative impact of education and family planning in high-fertility settings using a regression framework inspired by Granger causality. We found that women's attainment of lower secondary education is key to accelerating fertility decline and found an accelerating effect of contraceptive prevalence for modern methods. We found the impact of contraceptive prevalence to be substantially larger than that of education. These accelerating effects hold in sub-Saharan Africa, but with smaller effect sizes there than elsewhere.
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22
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Odusina EK, Ayotunde T, Kunnuji M, Ononokpono DN, Bishwajit G, Yaya S. Fertility preferences among couples in Nigeria: a cross sectional study. Reprod Health 2020; 17:92. [PMID: 32527271 PMCID: PMC7291488 DOI: 10.1186/s12978-020-00940-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background The persistently high and stalled total fertility in Sub-Saharan Africa, including in Nigeria, calls for new efforts towards fertility reduction. Most efforts on fertility desire in sub-Saharan Africa have focused either on individual men or women with little focus on couples as a unit of analysis. Moreover, the influences of different types of marriages in which couples reproduce have not been adequately explored. Therefore, this study examined fertility desires among couples in Nigeria. Methods This paper used data from the Nigeria Demographic and Health Survey (NDHS) of 2018 to assess fertility desire by marriage type among couples in Nigeria. In addition, the association between fertility desire and disparity in couples’ educational attainment, place of residence, region, religion, occupation, wealth status, children ever born and contraceptive use were considered. The participants consisted of 6813 couples aged between 15–49 years. Couples’ characteristics were reported using frequency and percentage distribution tables. Descriptive and logistic regression analyses were conducted. Results Overall, the study revealed that 73.8% of couples were in monogamous relationships while 26.2% were in polygynous relationships. The mean ideal number of children for men and women were 7.2 and 6.1, respectively. Also, 49.3% of the couples reported husbands desired more children, 43.9% claimed wives desired more children, while 6.8% indicated equal number of desired children among wives and husbands. The results of binary logistic regression showed that couples in polygynous relationships were 4.3 times as likely to desire more children, compared to couples in monogamous relationships (OR = 4.3; 95% CI: 3.5, 5.3). Couples in polygynous relationships wanted as many as four times the number of children desired by couples in monogamous relationships. Fertility desire was significantly higher among couples who indicated the following: either was using contraceptives (OR = 2.3; 95% CI: 1.6–3.4), both were not using contraceptives (OR = 2.8; 95% CI: 1.9, 4.1), lived in North East (OR = 2.0; 95% CI: 1.5, 2.6) and North West (OR = 1.7; 95% CI: 1.3, 2.3), both were not working (OR = 1.33, 95% CI; 1.1, 1.6) and were adherents of Islam (OR = 1.8; 95% CI; 1.5, 2.4). Conclusion These findings reflect the role of region, use of contraceptives, work status and religion in the fertility desire of couples. Implementing programmes and policies on sexual education and reproductive rights of couples and individuals may reduce high fertility desire and its adverse consequences, such as child and maternal morbidity and mortality in Nigeria.
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Affiliation(s)
| | - Titilayo Ayotunde
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Dorothy N Ononokpono
- Department of Sociology and Anthropology, Faculty of Social Sciences, University of Uyo, Uyo, Nigeria
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. .,The George Institute for Global Health, The University of Oxford, Oxford, UK.
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23
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Garver S, Trinitapoli J, Yeatman S. Changing Childbearing Norms During an Era of ART Expansion in Malawi, 2009 to 2015. AIDS Behav 2020; 24:1676-1686. [PMID: 31612333 PMCID: PMC7153966 DOI: 10.1007/s10461-019-02685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Community norms shape the childbearing goals and behaviors of persons living with HIV/AIDS (PLWHA) but little is known about how norms around HIV-positive childbearing have changed with expanded access to antiretroviral treatment (ART). We analyze data collected in 2009 and 2015 by the Tsogolo la Thanzi (TLT) project-a longitudinal, population-based study of young adults in southern Malawi. Respondents were asked about the acceptability of childbearing using vignettes that varied a hypothetical couple's HIV status and number of children. We assess mean differences in support for childbearing over time and by respondent gender and serostatus. The acceptability of childbearing for PLWHA increased dramatically over the 6-year period; however, support levels varied based on a couple's current number of children and whether they were seropositive concordant or discordant. Differences in attitudes by gender and HIV status diminished over time, pointing to a population-level convergence in norms about acceptable childbearing.
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Affiliation(s)
- Sarah Garver
- Sociology Department, University of Chicago, Chicago, USA.
- Social Science Research Center, 1155 E 60th St, Chicago, IL, 60615, United States.
| | | | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, USA
- University of Colorado Population Center (CUPC), Boulder, USA
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24
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Psaki SR, Soler-Hampejsek E, Saha J, Mensch BS, Amin S. The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia. Demography 2020; 56:1899-1929. [PMID: 31502232 PMCID: PMC6797635 DOI: 10.1007/s13524-019-00816-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Global investments in girls’ education have been motivated, in part, by an expectation that more-educated women will have smaller and healthier families. However, in many low- and middle-income countries, the timing of school dropout and first birth coincide, resulting in a rapid transition from the role of student to the role of mother for adolescent girls. Despite growing interest in the effects of pregnancy on levels of school dropout, researchers have largely overlooked the potential effect of adolescent childbearing on literacy and numeracy. We hypothesize that becoming a mother soon after leaving school may cause the deterioration of skills gained in school. Using longitudinal data from Bangladesh, Malawi, and Zambia, we test our hypothesis by estimating fixed-effects linear regression models to address the endogeneity in the relationship between childbearing and academic skills. To our knowledge, this is the first study to examine the effects of adolescent childbearing on academic skills in low- and middle-income countries. Our results indicate that among those with low levels of grade attainment, first birth has a negative effect on English literacy and numeracy. Among those with higher levels of grade attainment, we find little evidence of effects of childbearing on academic skills. Childbearing also has little effect on local language literacy. Beyond the immediate loss of English literacy and numeracy, if these skills lead to better health and more economic productivity, then adolescent childbearing may have longer-term repercussions than previously understood. In addition to ongoing efforts to increase educational attainment and school quality in low- and middle-income countries, investments are needed to strengthen the academic skills of adolescent mothers to secure the demographic and economic promise of expanded education for girls and women.
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Affiliation(s)
- Stephanie R Psaki
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | | | | | - Barbara S Mensch
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Sajeda Amin
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Samari G. Education and fertility in Egypt: Mediation by women's empowerment. SSM Popul Health 2019; 9:100488. [PMID: 31993483 PMCID: PMC6978478 DOI: 10.1016/j.ssmph.2019.100488] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/18/2019] [Accepted: 09/19/2019] [Indexed: 11/02/2022] Open
Abstract
In 2006, fertility in Egypt reached a two-decade low of 3 births per woman; however, by 2008, the demographic transition reversed, and fertility has remained higher at 3.5 births per woman. Low educational achievement is linked to high fertility. Education is also important in the process of women's empowerment, suggesting that educational achievement lowers fertility through gains in women's agency. However, no studies test this pathway, and evidence on the relationship between education and fertility in Middle Eastern settings is limited. Using longitudinal data from the 2006 and 2012 Egyptian Labor Market Panel Survey (ELMPS), a nationally representative sample of households in Egypt, for 4336 married women aged 15-49 years, this study estimates several linear and mediation regression models of number of births and considers whether women's empowerment explains the relationship between education and number of births. Women's empowerment is operationalized through three measures of instrumental agency: individual household decision making, joint household decision making, and mobility and one measure of intrinsic agency-gender beliefs and attitudes. Higher educational achievement has significant adjusted associations with lower fertility. However, measures of women's agency have mixed mediation associations for education and fertility. Greater individual household decision making and belief in egalitarian gender norms partially mediate the relationship between education and fertility, while greater joint decision making suppresses the relationship. Contrary to expectation, women who have more instrumental agency through more individual and joint household decisions have higher fertility than those who make fewer household decisions. However, women who demonstrate intrinsic agency through greater egalitarian gender beliefs have lower fertility than those who believe in inequitable gender norms. Empowerment programs should focus on improvements in women's education and changing women's intrinsic agency in Egypt, to lower fertility.
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Andriano L, Monden CWS. The Causal Effect of Maternal Education on Child Mortality: Evidence From a Quasi-Experiment in Malawi and Uganda. Demography 2019; 56:1765-1790. [PMID: 31591685 PMCID: PMC6797651 DOI: 10.1007/s13524-019-00812-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since the 1980s, the demographic literature has suggested that maternal schooling plays a key role in determining children's chances of survival in low- and middle-income countries; however, few studies have successfully identified a causal relationship between maternal education and under-5 mortality. To identify such a causal effect, we exploited exogenous variation in maternal education induced by schooling reforms introducing universal primary education in the second half of the 1990s in Malawi and Uganda. Using a two-stage residual inclusion approach and combining individual-level data from Demographic and Health Surveys with district-level data on the intensity of the reform, we tested whether increased maternal schooling reduced children's probability of dying before age 5. In Malawi, for each additional year of maternal education, children have a 10 % lower probability of dying; in Uganda, the odds of dying for children of women with one additional year of education are 16.6 % lower. We also explored which pathways might explain this effect of maternal education. The estimates suggest that financial barriers to medical care, attitudes toward modern health services, and rejection of domestic violence may play a role. Moreover, being more educated seems to confer enhanced proximity to a health facility and knowledge about the transmission of AIDS in Malawi, and wealth and improved personal illness control in Uganda.
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Affiliation(s)
- Liliana Andriano
- Department of Sociology and Nuffield College, University of Oxford, Oxford, UK.
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The 21st Century Coal Question: China, India, Development, and Climate Change. ATMOSPHERE 2019. [DOI: 10.3390/atmos10080476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
China and India are not only the two most populous nations on Earth, they are also two of the most rapidly growing economies. Historically, economic and social development have been subsidized by cheap and abundant fossil-fuels. Climate change from fossil-fuel emissions has resulted in the need to reduce fossil-fuel emissions in order to avoid catastrophic warming. If climate goals are achieved, China and India will have been the first major economies to develop via renewable energy sources. In this article, we examine the factors of projected population growth, available fossil-fuel reserves, and renewable energy installations required to develop scenarios in which both China and India may increase per capita energy consumption while remaining on trach to meet ambitious climate goals. Here, we show that China and India will have to expand their renewable energy infrastructure at unprecedented rates in order to support both population growth and development goals. In the larger scope of the literature, we recommend community-based approaches to microgrid and cookstove development in both China and India.
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Frye M, Lopus S. From Privilege to Prevalence: Contextual Effects of Women's Schooling on African Marital Timing. Demography 2019; 55:2371-2394. [PMID: 30334139 DOI: 10.1007/s13524-018-0722-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Africa and elsewhere, educated women tend to marry later than their less-educated peers. Beyond being an attribute of individual women, education is also an aggregate phenomenon: the social meaning of a woman's educational attainment depends on the educational attainments of her age-mates. Using data from 30 countries and 246 birth cohorts across sub-Saharan Africa, we investigate the impact of educational context (the percentage of women in a country cohort who ever attended school) on the relationship between a woman's educational attainment and her marital timing. In contexts where access to education is prevalent, the marital timing of uneducated and highly educated women is more similar than in contexts where attending school is limited to a privileged minority. This across-country convergence is driven by uneducated women marrying later in high-education contexts, especially through lower rates of very early marriages. However, within countries over time, the marital ages of women from different educational groups tend to diverge as educational access expands. This within-country divergence is most often driven by later marriage among highly educated women, although divergence in some countries is driven by earlier marriage among women who never attended school.
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Affiliation(s)
- Margaret Frye
- Department of Sociology, University of Michigan, 500 State St., Ann Arbor, Michigan, 48109, USA.
| | - Sara Lopus
- Department of Social Sciences, California Polytechnic State University, San Luis Obispo, CA, 93407, USA
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Channon MD, Harper S. Educational differentials in the realisation of fertility intentions: Is sub-Saharan Africa different? PLoS One 2019; 14:e0219736. [PMID: 31318943 PMCID: PMC6638943 DOI: 10.1371/journal.pone.0219736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background The gap between fertility outcomes and fertility ideals is notably higher in sub-Saharan Africa (SSA) than elsewhere, relating to both under- and overachievement of fertility ideals. We consider the extent to which the relationship between fertility ideals and fertility outcomes is related to educational achievement. Further, we consider if these educational differentials are the same or different in SSA, and thereby consider the extent to which increasing levels of education in SSA may decrease fertility. Data and methods We use 227 Demographic and Health Surveys (DHSs) from 58 countries worldwide to look at population- level measures of the mismatch between fertility ideals and fertility outcomes. Population level measures are used to assess whether the correspondence between fertility intentions and achievements differ by level of education. We then look at the individual-level determinants of both under- and overachieving fertility intentions. Data from the most recent DHS in 54 of the original countries is used for the individual level analysis, with five countries excluded due to the most recent available survey being out of date. Results An average of 40% of women in SSA underachieve their stated fertility intentions compared to 26% in non-SSA countries. Furthermore, compared to other LMICs, higher levels of education are not related to better correspondence between fertility intentions and outcomes in SSA. In Middle/Western Africa countries, on average, 48% of women with secondary or higher education have fewer children than their ideal, compared to just 24% who have more children than their ideal. Conclusion We argue that the phenomenon of underachieving fertility ideals (or unrealized fertility) may be of particular importance for the ongoing fertility transition throughout SSA, especially as more highly educated groups do not appear to be following the patterns observed elsewhere.
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Affiliation(s)
- Melanie Dawn Channon
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
- * E-mail:
| | - Sarah Harper
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
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Eissler S, Thiede B, Strube J. Climatic Variability and Changing Reproductive Goals in Sub-Saharan Africa. GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2019; 57:101912. [PMID: 32818011 PMCID: PMC7430718 DOI: 10.1016/j.gloenvcha.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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31
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Abstract
Purpose
The purpose of this paper is to examine the relationship between education and health amongst Australian women.
Design/methodology/approach
This study uses the Household, Income and Labour Dynamics in Australia data set. Spouse’s education is employed as an instrument to solve the potential endogeneity of educational attainment.
Findings
The results indicate that an additional year of schooling can lead to an increase in self-reported health, physical health, mental health and a reduced likelihood of having long-term health conditions. Women who are not in the labour force are likely to enjoy higher benefits of education compared to their employed counterparts. The findings also suggest that the relationship between education and health can be explained by the extent of positive health behaviours and social capital as mediators.
Research limitations/implications
The conclusion from the results might be different in the case of men, reducing the generalisability of the results. Several objective health variables should be used to provide further aspects of health on which education has an impact.
Practical implications
As the positive effect of education on women’s health is empirically found, investment in women’s education should be seriously considered and reevaluated.
Originality/value
This paper focuses on Australian women which not only reduces the heterogeneity between genders but also adds to the rare number of studies on this topic in Australia. This paper also employs a formal mediation analysis to examine what are the mechanisms explaining the relationship between education and health.
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Solanke BL. Maternal socio-demographic factors associated with low parity and grand multiparity in Nigeria. Women Health 2019; 59:730-747. [PMID: 30615577 DOI: 10.1080/03630242.2018.1553815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parity may be categorized as low parity (one or two births), multiparity (three or four births), and grand multiparity (five or more births). In Nigeria, studies have examined factors associated with parity among women. However, these studies have focused on the associated factors of grand multiparity with near exclusion of associated factors of low parity. This study addressed this knowledge gap by examining maternal socio-demographic factors associated with both low parity and grand multiparity in Nigeria. The study analyzed secondary data from 2013 Nigeria Demographic and Health Survey (NDHS). The weighted sample size was 25,852 women. With the use of Stata (version 14), analyses were performed at three levels. Multinomial logistic regression was applied at the multivariate level. Results showed that many of the studied maternal characteristics were significantly associated with either low parity or grand multiparity. Results further showed that while late age at first marriage, improved education, never experiencing child mortality, and polygyny increased the likelihood of low parity, improved education, polygyny, never experiencing child mortality, late age at first marriage, and higher household wealth reduced the likelihood of grand multiparity. These factors should be given prominence in population and women-centered programs in the country.
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Affiliation(s)
- Bola Lukman Solanke
- a Department of Demography and Social Statistics , Obafemi Awolowo University , Ile-Ife , Nigeria
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Maternal Education, Fertility, and Child Survival in Comoros. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122814. [PMID: 30544762 PMCID: PMC6313670 DOI: 10.3390/ijerph15122814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/21/2018] [Accepted: 12/08/2018] [Indexed: 12/05/2022]
Abstract
Reduction in child mortality is a demographic progress of significant socioeconomic development relevance in Africa. This paper analyzed the effect of maternal education and fertility on child survival in the Islands of Comoros. The 2012 Demographic and Health Survey (DHS) data were used. A two-stage probit regression method was used for data analysis. The results showed that about 75% of the children’s mothers had given birth to between one and five children, while more than half did not have any form of formal education. The results of the two-stage probit regression showed that while child survival reduced significantly (p < 0.05) with the age of the heads of households, residence in the Ngazidja region, being born as twins, mother’s number of business trips, and number of marital unions, it increased with maternal education, fertility, male household headship, and the child being breastfed immediately after birth. It was concluded that efforts to enhance maternal education would reduce child mortality. It is also critical to promote child breastfeeding among women, while regional characteristics promoting differences in child mortality in Comoros Islands should be properly addressed with keen focus on the Ngazidja region.
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Costa ME, Trumble B, Kaplan H, Gurven MD. Child nutritional status among births exceeding ideal family size in a high fertility population. MATERNAL & CHILD NUTRITION 2018; 14:e12625. [PMID: 29888858 PMCID: PMC6865964 DOI: 10.1111/mcn.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 04/10/2018] [Accepted: 04/19/2018] [Indexed: 11/27/2022]
Abstract
Ideal family size (IFS) is measured in social surveys to indicate unmet need for contraception and impending shifts in fertility behaviour. Whether exceeding IFS affects parental behaviour in ways that result in lower investments in child nutrition, well-being, and educational attainment is not known. This study examines parental IFS and the association between exceeding stated ideals and child nutritional status in a high-fertility, high-mortality population in the Bolivian Amazon. Height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, stunting, haemoglobin, and anaemia status in 638 children aged 0-5 years are predicted as a function of birth order in relation to parental IFS, adjusting for household characteristics and mother and child random effects. Children of birth orders above paternal IFS experience higher weight-for-age z-scores when living further away from the market town of San Borja, consistent with underlying motivations for higher IFS and lower human capital investment in children in more remote areas (β = .009, p = .027). Overall, we find no statistical evidence that birth orders in excess of parental ideals are associated with compromised child nutrition below age 2, a period of intensive breastfeeding in this population. Despite a vulnerability to nutritional deficiencies postweaning for children age 2-5, there was no association between birth order in excess of parental ideals and lower nutritional status. Further studies examining this association at various stages of the fertility transition will elucidate whether reported ideal or optimal family sizes are flexible as trade-offs between quality and quantity of children shift during the transition to lower fertility.
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Affiliation(s)
- Megan E. Costa
- T. Denny Sanford School of Social and Family DynamicsArizona State UniversityTempeArizonaUSA
| | - Benjamin Trumble
- School of Human Evolution and Social Change and Center for Evolution and MedicineArizona State UniversityTempeArizonaUSA
| | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science InstituteArgyros School of Business and Economics Chapman UniversityOrangeCaliforniaUSA
| | - Michael D. Gurven
- Department of AnthropologyUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
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Abstract
Sub-Saharan Africa is home to several of the world’s least developed economies. Additionally, forty percent of the nearly one billion people in this region lack access to basic electricity. There are several initiatives and programs aimed at increasing electricity access, clean cooking fuel, and renewable energy around the world. Economic development efforts have traditionally relied on increasing an economy’s use of fossil fuels. However, global climate change agreements and mitigation efforts are in direct contrast with this approach. As such, future development efforts must fit into the larger energy–population–climate nexus of global sustainability. Here we utilise a quantitative approach to examine three scenarios for development in sub-Saharan Africa and compare the results to nine historical examples of economic development. While no perfect development analogue was found, there are several lessons that can be learned from the last half century of efforts. We find that UN projected population growth in the region is expected to outpace non-renewable energy availability. The population of sub-Saharan Africa, and subsequent projected growth (4 billion by 2100), will represent a significant energy and climate strain on the 21st century world. In a larger sense, the social and economic development of sub-Saharan Africa is likely to be tied to an increase in per capita energy consumption. This increase is not going to come from traditional fossil fuels and will therefore require significant investment in a renewable energy infrastructure.
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Weitzman A. Does Increasing Women's Education Reduce Their Risk of Intimate Partner Violence? Evidence from an Education Policy Reform. CRIMINOLOGY : AN INTERDISCIPLINARY JOURNAL 2018; 56:574-607. [PMID: 31592177 PMCID: PMC6779421 DOI: 10.1111/1745-9125.12181] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although scholars have employed rigorous causal methods to examine the relationship between education and crime, few studies have taken a causal approach to the study of education and intimate partner violence (IPV) specifically. From a social causation perspective, improving women's education should protect them from violence, yet from a social selection perspective, education could proxy for unobserved factors that explain negative associations between education and IPV. This study adjudicates between the two possibilities using an exogenous source of variation in education-a 1990s compulsory schooling reform in Peru. Specifically, the author conducts an instrumented regression discontinuity that implicitly controls for women's unobserved endowments by comparing women who were aged just above (N=8,195) and below (N=6,645) the school-age cutoff at the time of the reform. Consistent with the social causation perspective, increasing women's schooling reduced both their recent and longer-term probabilities of psychological, physical, and sexual IPV, and their recent and longer-term probabilities of experiencing any IPV and poly-victimization. Supplemental mediation analyses provide support for three interrelated causal pathways-improvements in women's personal resources, delayed family formation, and changes in partner selection. These findings confirm the protective effects of women's education and further illuminate mechanistic processes by which this occurs.
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Brauner-Otto SR, Axinn WG. Natural resource collection and desired family size: a longitudinal test of environment-population theories. POPULATION AND ENVIRONMENT 2017; 38:381-406. [PMID: 28943691 PMCID: PMC5608093 DOI: 10.1007/s11111-016-0267-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Theories relating the changing environment to human fertility predict declining natural resources may actually increase the demand for children. Unfortunately most previous empirical studies have been limited to cross-sectional designs that limit our ability to understand links between processes that change over time. We take advantage of longitudinal measurement spanning more than a decade of change in the natural environment, household agricultural behaviors, and individual fertility preferences to reexamine this question. Using fixed-effects models, we find that women experiencing increasing time required to collect firewood to heat and cook or fodder to feed animals (the dominant needs for natural resources in this setting) increased their desired family size, even as many other macro-level changes have reduced desired family size. In contrast to previous, cross-sectional studies we find no evidence of such a relationship for men. Our findings regarding time spent collecting firewood are also new. These results support the "vicious circle" perspective and economic theories of fertility pointing to the value of children for household labor. This feedback from natural resource constraint to increased fertility is an important mechanism for understanding long term environmental change.
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Affiliation(s)
| | - William G Axinn
- University of Michigan, University of Michigan, 426 Thompson Street, P.O. Box 1248, Ann Arbor, MI 48104-1248
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Bongaarts J, Mensch BS, Blanc AK. Trends in the age at reproductive transitions in the developing world: The role of education. Population Studies 2017; 71:139-154. [DOI: 10.1080/00324728.2017.1291986] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weitzman A. The effects of women's education on maternal health: Evidence from Peru. Soc Sci Med 2017; 180:1-9. [PMID: 28301806 DOI: 10.1016/j.socscimed.2017.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 01/26/2023]
Abstract
This article examines the causal effect of women's education on maternal health in Peru, a country where maternal mortality has declined by more than 70% in the last two and a half decades. To isolate the effects of education, the author employs an instrumented regression discontinuity that takes advantage of an exogenous source of variation-an amendment to compulsory schooling laws in 1993. The results indicate that extending women's years of schooling reduced the probability of several maternal health complications at last pregnancy/birth, sometimes by as much as 29%. Underlying these effects, increasing women's education is found to decrease the probability of short birth intervals and unwanted pregnancies (which may result in unsafe abortions) and to increase antenatal healthcare use, potentially owing to changes in women's cognitive skills, economic resources, and autonomy. These findings underscore the influential role of education in reducing maternal morbidity and highlight the contributions of women's education to population health and health transitions.
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Affiliation(s)
- Abigail Weitzman
- Population Studies Center, University of Michigan, United States; Sociology Department and Population Research Center, University of Texas at Austin, United States
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Behrman JA, Peterman A, Palermo T. Does Keeping Adolescent Girls in School Protect Against Sexual Violence? Quasi-Experimental Evidence From East and Southern Africa. J Adolesc Health 2017; 60:184-190. [PMID: 27916327 DOI: 10.1016/j.jadohealth.2016.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/04/2016] [Accepted: 09/12/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We examine the relationship between educational attainment in adolescence on young women's lifetime experience of sexual violence in Malawi and Uganda. METHODS Exposure to Universal Primary Education policies in the mid-1990s serves as a natural experiment to estimate the causal effect of schooling on women's subsequent experience of sexual violence using an instrumented regression discontinuity design and Demographic and Health Survey data. RESULTS We find a one-year increase in grade attainment leads to a nine-percentage point reduction (p < .05) in the probability of ever experiencing sexual violence in a sample of 1,028 Ugandan women (aged 18-29 years), an estimate which is considerably larger than observational estimates. We find no effect of grade attainment on ever experiencing sexual violence among a sample of 4,413 Malawian women (aged 19-31 years). In addition, we find no relationship between grade attainment and 12-month sexual violence in either country. Analysis of pathways indicates increased grade attainment increases literacy and experience of premarital sex in Malawi and reduces the probability of ever being married in both countries. CONCLUSIONS Keeping girls in school results in a number of benefits for young women; however, protects against lifetime experience of sexual violence only in Uganda. It is possible that overall higher grade attainment, particularly at secondary school levels is driving this effect in Uganda. More research on this relationship is needed, as well as on effective interventions, particularly those which can be taken to scale related to enhancing the quality and quantity of education.
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Affiliation(s)
| | - Amber Peterman
- Social and Economic Policy Unit, UNICEF Office of Research-Innocenti, Florence, Italy
| | - Tia Palermo
- Social and Economic Policy Unit, UNICEF Office of Research-Innocenti, Florence, Italy; Program in Public Health, Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, New York
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Digitale J, Psaki S, Soler-Hampejsek E, Mensch BS. Correlates of Contraceptive Use and Health Facility Choice among Young Women in Malawi. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2017; 669:93-124. [PMID: 30369615 PMCID: PMC6202030 DOI: 10.1177/0002716216678591] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We explore whether differential access to family planning services and the quality of those services explain variability in uptake of contraception among young women in Malawi. We accomplish this by linking the Malawi Schooling and Adolescent Study, a longitudinal survey of young people, with the Malawi Service Provision Assessment collected in 2013-2014. We also identify factors that determine choice of facility among those who use contraception. We find that the presence and characteristics of nearby facilities with contraception available did not appear to affect use. Rather, characteristics such as facility type and whether contraception was provided free of charge determined where women deciding to use contraception obtained their contraception. We argue that in a context where almost all respondents resided within 10 kilometers of a health facility, improving access to and quality of family planning services may not markedly increase contraceptive use among young women without broader shifts in norms regarding childbearing in the early years of marriage.
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Affiliation(s)
- Jean Digitale
- Population Council, One Dag Hammarskjold Plaza, New York, New York 10017
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Verguet S, Nandi A, Filippi V, Bundy DAP. Maternal-related deaths and impoverishment among adolescent girls in India and Niger: findings from a modelling study. BMJ Open 2016; 6:e011586. [PMID: 27670517 PMCID: PMC5051405 DOI: 10.1136/bmjopen-2016-011586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/27/2016] [Accepted: 08/24/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND High levels of maternal mortality and large associated inequalities exist in low-income and middle-income countries. Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty. We examined the distribution across socioeconomic groups of maternal deaths and impoverishment among adolescent girls (15-19 years old) in Niger, which has the highest total fertility rate globally, and India, which has the largest number of maternal deaths. METHODS In Niger and India, among adolescent girls, we estimated the distribution per income quintile of: the number of maternal deaths; and the impoverishment, measured by calculating the number of cases of catastrophic health expenditure incurred, caused by complicated pregnancies. We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year. We used epidemiological and cost inputs sourced from surveys and the literature. RESULTS The number of maternal deaths would be larger among the poorer adolescents than among the richer adolescents in Niger and India. Impoverishment would largely incur among the richer adolescents in Niger and among the poorer adolescents in India. Increasing educational attainment of adolescent girls might avert both a large number of maternal deaths and a significant number of cases of catastrophic health expenditure in the 2 countries. CONCLUSIONS Adolescent pregnancies can lead to large equity gaps and substantial impoverishment in low-income and middle-income countries. Increasing female education can reduce such inequalities and provide financial risk protection and poverty alleviation to adolescent girls.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Arindam Nandi
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
- Tata Centre for Development, Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Makate M, Makate C. The causal effect of increased primary schooling on child mortality in Malawi: Universal primary education as a natural experiment. Soc Sci Med 2016; 168:72-83. [PMID: 27639483 DOI: 10.1016/j.socscimed.2016.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
The primary objective of this analysis is to investigate the causal effect of mother's schooling on under-five health - and the passageways through which schooling propagates - by exploiting the exogenous variability in schooling prompted by the 1994 universal primary schooling program in Malawi. This education policy, which saw the elimination of tuition fees across all primary schooling grades, creates an ideal setting for observing the causal influence of improved primary school enrollment on the under-five fatality rates of the subsequent generation. Our analysis uses data from three waves of the nationally representative Malawi Demographic and Health Surveys conducted in 2000, 2004/05, and 2010. To address the potential endogeneity of schooling, we employ the mother's age at implementation of the tuition-free primary school policy in 1994 as an instrumental variable for the prospect of finishing primary level instruction. The results suggest that spending one year in school translated to a 3.22 percentage point reduction in mortality for infants and a 6.48 percent reduction for children under age five years. For mothers younger than 19 years, mortality was reduced by 5.95 percentage points. These figures remained approximately the same even after adjusting for potential confounders. However, we failed to find any statistically meaningful effect of the mother's education on neonatal survival. The juvenile fatality estimates we find are weakly robust to several robustness checks. We also explored the potential mechanisms by which increased maternal schooling might help enhance child survival. The findings indicated that an added year of motherly learning considerably improves the prospect of prenatal care use, literacy levels, father's educational level, and alters fertility behavior. Our results suggest that increasing the primary schooling prospects for young women might help reduce under-five mortality in less-industrialized regions experiencing high under-five fatalities such as in sub-Saharan Africa.
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Affiliation(s)
- Marshall Makate
- Department of Economics, State University of New York at Albany (SUNY Albany), 1400 Washington Avenue, Albany, NY 12222, USA.
| | - Clifton Makate
- UNEP Tongji Institute of Environment for Sustainable Development Tongji University, 903 Zonghe Building, 1239 Siping Road, Shanghai, 200092, China.
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Grant MJ. The Demographic Promise of Expanded Female Education: Trends in the Age at First Birth in Malawi. POPULATION AND DEVELOPMENT REVIEW 2015; 41:409-438. [PMID: 27158172 PMCID: PMC4857891 DOI: 10.1111/j.1728-4457.2015.00066.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The expansion of female education has been promoted as a way to postpone the age of first birth. In sub-Saharan Africa, the first cohorts to benefit from policies that expanded access to education are now reaching adulthood and beginning childbearing. I investigate whether the expansion of education in Malawi, which implemented a free primary education policy in 1994 and subsequently expanded secondary schooling, has led to a later age at first birth and whether the education gradient in fertility timing has remained stable over time. Despite increases in female grade attainment over the past twenty years, the age at first birth has not changed. Using instrumental variables analysis, I find a significant negative association between grade attainment and age at first birth, suggesting that the deterioration of school quality and shift in the age pattern of enrollment that accompanied educational expansion may have compromised the transformative potential of education.
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Handa S, Peterman A, Huang C, Halpern C, Pettifor A, Thirumurthy H. Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on early pregnancy and marriage of adolescent girls. Soc Sci Med 2015; 141:36-45. [PMID: 26246032 PMCID: PMC4659857 DOI: 10.1016/j.socscimed.2015.07.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022]
Abstract
There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on adolescent transitions to adulthood in resource poor settings, however existing research is typically from small scale programs in diverse geographic and cultural settings. We provide estimates of the impact of a national unconditional cash transfer program, the Kenya Cash Transfer for Orphans and Vulnerable Children, on pregnancy and early marriage among females aged 12 to 24, four years after program initiation. The evaluation was designed as a clustered randomized controlled trial and ran from 2007 to 2011, capitalizing on the existence of a control group, which was delayed entry to the program due to budget constraints. Findings indicate that, among 1549 females included in the study, while the program reduced the likelihood of pregnancy by five percentage points, there was no significant impact on likelihood of early marriage. Program impacts on pregnancy appear to work through increasing the enrollment of young women in school, financial stability of the household and delayed age at first sex. The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa, suggesting a degree of generalizability of the results reported here. Although the objective of the program is primarily poverty alleviation, it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood.
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Affiliation(s)
- Sudhanshu Handa
- Department of Public Policy, University of North Carolina, Chapel Hill, USA; UNICEF Office of Research Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy
| | - Amber Peterman
- UNICEF Office of Research Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy.
| | - Carolyn Huang
- Department of Public Policy, University of North Carolina, Chapel Hill, USA
| | - Carolyn Halpern
- Department of Materal and Child Health, UNC Gillings School of Global Public Health, USA
| | - Audrey Pettifor
- Department of Epidemiology, UNC Gillings School of Global Public Health, USA
| | - Harsha Thirumurthy
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA
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