Exposure to Armed Conflict and Fertility in Sub-Saharan Africa

Obstetric violence in the context of community violence: The case of Mexico

This study examines the relationship between community violence and obstetric violence in Mexico, where the so-called "War on Drugs" has led to sustained high levels of homicides and one-third of pregnant people report experiencing abusive treatment from healthcare providers during childbirth. We combine unique nationally representative survey data on experiences of obstetric violence for births that occurred between 2016 and 2021 with administrative homicide data at the month-municipality level. Using fixed effects models, we investigate how different manifestations of obstetric violence relate to community violence in the short-, medium-, and long-term. Results suggest that the intensity of community violence matters for obstetric violence. Specifically, we find that sustained high-intensity homicidal violence is associated with an increased risk of mistreatment at childbirth, particularly in the form of physical abuse and non-consensual care. Associations are stronger among adolescent, low-educated, and urban respondents. Addressing obstetric violence requires recognising the structural role of sustained high-intensity community violence and the normalisation of violent behaviour that exposure to such environmental stressors may create.

Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review

RATIONALE

The desired number of children is markedly higher in Sub-Saharan Africa (SSA) than in other major regions. Efforts to understand how and why these desires are generated and maintained have yielded a broad research literature. Yet there is no full picture of the range of contextual, cultural, and economic factors that support and disrupt high fertility desires.

OBJECTIVE

This scoping review synthesizes thirty years of research on the determinants of fertility desires in SSA to better understand what factors underlie men and women's stated fertility desires and how they weigh the costs and benefits of having (more) children.

METHOD

We identified and screened 9863 studies published from 1990 to 2021 from 18 social science, demographic, and health databases. We appraised determinants of fertility desires from 258 studies that met inclusion criteria according to their roles as traditional supports or contemporary disrupters of high fertility desires.

RESULTS

We identified 31 determinants of high fertility desires, which we organized into six overarching themes: economy and costs; marriage; the influence of others; education and status; health and mortality; and demographic predictors. For each theme, we summarize ways in which the determinants both support and disrupt high fertility desires. We find that high fertility remains desirable in many regions of sub-Saharan Africa but contemporary disrupters, such as the economic situations and increases to family planning and education, cause individuals to decrease their desired fertility with such decreases often viewed as a temporary adjustment to temporary conditions. Most included studies were quantitative, cross-sectional, and based on survey data.

CONCLUSION

This review demonstrates how traditionally supportive and contemporary disruptive forces simultaneously influence fertility desires in sub-Saharan Africa. Future studies analyzing fertility desires in sub-Saharan Africa should be informed by the lived experiences of men and women in this region, with qualitative and longitudinal studies prioritized.

Human fertility after a disaster: a systematic literature review

Fertility is a key demographic parameter influenced by disaster. With the growing risk of disasters, interest in the fertility response to a disaster is increasing among the public, policy makers and researchers alike. However, a systematic literature review on how disaster affects live birth counts does not yet exist. We reviewed 50 studies retrieved from a systematic search based on a pre-registered protocol. We found an overall negative impact of disasters on fertility. If any, increases in fertility were mostly linked with weather-related physical disasters. We also identified 13 distinct mechanisms which researchers have considered as underlying the fertility effects of disaster. By contrast to the common belief that disasters are more likely to increase fertility in contexts with already high fertility, we found little evidence to suggest that the total fertility rate of the studied populations was an important predictor of the direction, timing or size of fertility impacts. While this may be because no relationship exists, it may also be due to biases we observed in the literature towards studying high-income countries or high-cost disasters. We summarize the methodological limitations identified from the reviewed studies into six practical recommendations for future research. Our findings inform both the theories behind the fertility effects of disasters and the methods for studying them.

Is the mortality-fertility nexus gendered? A research note on sex differences in the impact of sibling mortality on fertility preferences

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.

Wedding Amidst War? Armed Conflict and Female Teen Marriage in Azerbaijan

Does armed conflict influence female teen marriage? Despite increasing attention to early marriage, its drivers and consequences, quantitative research on whether teen unions are affected by situations of armed violence is minimal. This paper addresses this gap by examining the relationship between exposure to the conflict in Nagorno-Karabakh over 1992-1996 and teen marriage outcomes in Azerbaijan. Using data from the 2006 Demographic and Health Survey and the Uppsala Conflict Data Program, I compare cohorts at risk of teen union before and during the conflict climax years with a modelling strategy that exploits information on forced displacement and spatial variation in conflict violence. Results show that experiencing war violence in adolescent ages, its intensity and frequency are associated with a lower risk of teen marriage. Reductions are largest for the cohorts who spent most of their adolescent ages under conflict and who were displaced as a result. For never-migrant conflict-affected girls, declines extend to the youngest cohorts. The combination of age at conflict occurrence and the experience of disruptive events like forced migration matters for teen marriage outcomes.

Conflict and Climate Factors and the Risk of Child Acute Malnutrition Among Children Aged 24-59 Months: A Comparative Analysis of Kenya, Nigeria, and Uganda

Acute malnutrition affects a sizeable number of young children around the world, with serious repercussions for mortality and morbidity. Among the top priorities in addressing this problem are to anticipate which children tend to be susceptible and where and when crises of high prevalence rates would be likely to arise. In this article, we highlight the potential role of conflict and climate conditions as risk factors for acute malnutrition, while also assessing other vulnerabilities at the individual- and household-levels. Existing research reflects these features selectively, whereas we incorporate all the features into the same study. The empirical analysis relies on integration of health, conflict, and environmental data at multiple scales of observation to focuses on how local conflict and climate factors relate to an individual child's health. The centerpiece of the analysis is data from the Demographic and Health Surveys conducted in several different cross-sectional waves covering 2003-2016 in Kenya, Nigeria, and Uganda. The results obtained from multi-level statistical models indicate that in Kenya and Nigeria, conflict is associated with lower weight-for-height scores among children, even after accounting for individual-level and climate factors. In Nigeria and Kenya, conflict lagged 1-3 months and occurring within the growing season tends to reduce WHZ scores. In Uganda, however, weight-for-height scores are primarily associated with individual-level and household-level conditions and demonstrate little association with conflict or climate factors. The findings are valuable to guide humanitarian policymakers and practitioners in effective and efficient targeting of attention, interventions, and resources that lessen burdens of acute malnutrition in countries prone to conflict and climate shocks.

Life After Loss: A Prospective Analysis of Mortality Exposure and Unintended Fertility

The relationship between mortality and fertility is a key component of demographic transition theory, placing it at the center of extensive inquiry. Among other linkages, mortality in women's communities and social networks influences their subsequent fertility. Existing demographic research assumes this is principally due to volitional mechanisms, implying that exposure to mortality consolidates women's desire to become pregnant, leading to intended fertility. Yet, insights from other disciplines suggest that mortality exposure could also increase women's unintended fertility through psychological, relational, and behavioral mechanisms. This study examines the relationships between network mortality exposure and women's hazard of pregnancy, and of unintended pregnancy specifically. We analyze two years (2009-2011) of closely spaced panel data on young Malawian women (N=1,272) enrolled in the Tsogolo la Thanzi study. Our data include information on funeral attendance and fertility desires measured weeks before conception, which is confirmed through frequent pregnancy testing. Hazard models show that the number of funerals women attend corresponds with a higher hazard of pregnancy and of unintended pregnancy specifically. These findings make clear that mortality exposure can influence fertility not by shaping women's desires but by disrupting the realization of those desires.