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Church AC, Ibitoye M, Chettri S, Casterline JB. Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review. Reprod Health 2023; 20:86. [PMID: 37280648 DOI: 10.1186/s12978-023-01627-7] [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] [Received: 07/08/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
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.
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Affiliation(s)
- Anna C Church
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA.
| | - Mobolaji Ibitoye
- Institute for Population Research, The Ohio State University, 060 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Shibani Chettri
- College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - John B Casterline
- Institute for Population Research, The Ohio State University, 060 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
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Ernawati H, Mas’udah AF, Setiawan F, Isroin L. Health, Psychology and Economic Status: Impact of Early Marriage. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Early marriage is a global problem that harms teenagers. The occurrence of early marriage in rural areas is a common practice.
AIM: This study aims to determine the impact of early marriage on aspects of health, psychology, and economic status comprehensively based on the causes of early marriage in rural area.
METHODS: This study used a cross-sectional study design. The sampling unit of this study was early marriage families from three sub-districts in the Ponorogo district, namely Sawoo, Ngrayun, and Pulung. The number of samples used as many as 75 families. The variables in this study consisted of health, husband’s psychology, wife’s psychology, and economic status. The statistical test used polychoric Principle Component Analysis (PCA) analysis to obtain health, psychological and economic status variables derived from several indicators.
RESULTS: The results of this study indicate that in the healthcare variable, it appears that most of the respondents do not experience bleeding, do not have abdominal pain, and do not hurt on contact. Based on the emotion variable, the wife is more emotional than the husband. The results of polychoric PCA are based on scores that are divided into two categories. The results of the polychoric PCA analysis show that most of the early married couples have worse health and economic conditions, namely, 55% and 65%, respectively. Meanwhile, in the psychological condition of husband and wife, most of them have good conditions, namely, 75% and 83%.
CONCLUSION: The impact of early marriage which shows poor results is on the health and economic aspects.
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Hoffman S, Zhang A, Nguyen N, Tsong R, Chen I, Wei Y, Lutalo T, Nalugoda F, Kennedy CE, Grabowski MK, Santelli J. Incident HIV Infection Among Young Men Associated With Female Sexual Partner Types Identified Through Latent Class Analysis, Rakai, Uganda. J Acquir Immune Defic Syndr 2022; 90:124-131. [PMID: 35125472 PMCID: PMC9203866 DOI: 10.1097/qai.0000000000002928] [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] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual partner characteristics are important determinants of HIV acquisition, but little is known about partner types of young men in sub-Saharan Africa. METHODS Sexually active men aged 15-24 years from 5 rounds (2005-2013) of the Rakai Community Cohort Study in Uganda reported characteristics of up to 4 past-year female partners. Partner types were identified using latent class analysis. HIV incidence rates (IRs) were calculated by partner-type combinations, and individual-level risk adjusted IR ratios (aIRRs) relative to the lowest incidence type were estimated using the Poisson regression with generalized estimating equations. RESULTS Young men (N = 1771) reported 4539 past-year female sexual partners. Three partner types were identified: type A: noncohabiting, student, medium duration partnerships; type B: cohabiting, nonstudent, longer duration partnerships; and type C: noncohabiting, nonstudent shorter duration partnerships. Type C partners engaged in the most HIV-related risk behaviors. Many men (29%) had more than 1 partner type/round. IR overall was 9.8/1000 person-years [95% confidence interval (CI): 4.7 to 20.6]. IR was 4.0 (95% CI: 1.2 to 12.7) for men with type A partners alone (41% of men). Relative to them, IR for those with type B partners alone (25%) was not significantly different. Men with type C partners alone (5%) had higher risk (aIRR = 3.2; 95% CI: 1.0 to 9.9), as did men with >1 partner type, including men with both type A and type B partners (12%; aIRR = 6.3; 95% CI: 2.5 to 15.9) and men with type C and other partner types (17%; aIRR = 4.3; 95% CI: 1.7 to 10.8). CONCLUSIONS Partner-type combination was strongly associated with HIV incidence; type C partners and having more than 1 partner type were the riskiest patterns.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
- Department of Epidemiology Columbia University Mailman School of Public Health, New York, United States
| | - Adina Zhang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
| | - Rachel Tsong
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ivy Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - M. Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - John Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, United States
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Govindasamy D, Seeley J, Olaru ID, Wiyeh A, Mathews C, Ferrari G. Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review. Health Qual Life Outcomes 2020; 18:120. [PMID: 32370772 PMCID: PMC7201613 DOI: 10.1186/s12955-020-01352-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022] Open
Abstract
Young people living with HIV (YPLHIV) in sub-Saharan Africa (SSA) are at high risk of having a poor quality of life. Addressing wellbeing explicitly within HIV/AIDS policies could assist mitigation efforts. However, guidance on wellbeing measures to evaluate policies for YPLHIV is scarce. The aims of this mixed-methods review were to identify: i) key dimensions of wellbeing and ii) wellbeing measures that align to these dimensions among YPLHIV (15-24 years) in SSA. We searched six social science and medical databases, including grey literature. We included studies that examined correlates and lived experiences of wellbeing, among YPLHIV in SSA, from January 2000 to May 2019. Two reviewers independently screened abstracts and full texts and assessed methodological quality of included articles. We analysed quantitative and qualitative data using descriptive and meta-ethnographic approaches, respectively. Thereafter, we integrated findings using a framework approach. We identified 6527 citations. Of these, 10 quantitative and 30 qualitative studies were included. Being male, higher educational status, less stigma and more social support were likely correlates of wellbeing. Themes that shaped experiences suggestive of wellbeing were: 1) acceptance and belonging- stigma, social support; 2) coping; 3) standard of living. Our final synthesis found that the following dimensions potentially characterise wellbeing: self-acceptance, belonging, autonomy; positive relations, environmental mastery, purpose in life. Wellbeing for YPLHIV is multi-dimensional and relational. Relevant measures include the Personal Wellbeing Index, Ryff's Psychological Wellbeing Scale and Mental Health Continuum Short Form. However, psychometric evaluations of these scales among YPLHIV in SSA are needed.
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Affiliation(s)
- Darshini Govindasamy
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa.
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioana D Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alison Wiyeh
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7501, South Africa
- Adolescent Health Research Unit, Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Giulia Ferrari
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Reynolds Z, Gottert A, Luben E, Mamba B, Shabangu P, Dlamini N, Dlamini M, Mathur S, Pulerwitz J. Who are the male partners of adolescent girls and young women in Swaziland? Analysis of survey data from community venues across 19 DREAMS districts. PLoS One 2018; 13:e0203208. [PMID: 30216356 PMCID: PMC6157821 DOI: 10.1371/journal.pone.0203208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW, ages 15-24) are at high risk of HIV in Swaziland. Understanding more about their male sexual partners can inform HIV prevention efforts for both. METHODS Using the PLACE methodology across all 19 DREAMS implementation districts, 843 men ages 20-34 were surveyed between December 2016-February 2017. Surveys were conducted at 182 venues identified by community informants as places where AGYW and men meet/socialize. Descriptive and multivariate analyses examined characteristics and risk behaviors of male partners of AGYW. RESULTS Men's average age was 25.7. Sixty-three percent reported female partners ages 15-19, and 70% reported partners ages 20-24 in the last year; of those, 12% and 11% respectively had five or more such partners. Among the 568 male partners of AGYW, 36% reported consistent condom use with their current/last partner. Forty-two percent reported testing for HIV in the last year; 6% were HIV-positive, and of those, 97% were currently on treatment. One-third (37%) reported being circumcised; among uncircumcised, 81% were not considering it. In multivariate analyses, men who reported three or more AGYW partners in the last year were more likely to be HIV-positive (aOR 3.2, 95% CI 1.1,8.8). Men were also less likely to disclose their HIV status to adolescent versus older partners (aOR 0.6, 95% CI 0.4,0.9) and partners more than 5 years younger than themselves (aOR 0.6, 95% CI 0.4,0.9). Results also revealed relatively high unemployment and mobility, substantial financial responsibilities, and periodic homelessness. CONCLUSIONS Most men identified through community venues reported relationships with AGYW, and these relationships demonstrated substantial HIV risk. Challenging life circumstances suggest structural factors may underlie some risk behaviors. Engaging men in HIV prevention and targeted health services is critical, and informant-identified community venues are promising intervention sites to reach high-risk male partners of AGYW.
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Affiliation(s)
- Zahra Reynolds
- MEASURE Evaluation, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States of America
- * E-mail:
| | - Ann Gottert
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
| | - Erin Luben
- MEASURE Evaluation, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States of America
| | - Bheki Mamba
- Institute for Health Measurement, Mbabane, Swaziland
| | | | - Nsindiso Dlamini
- National Emergency Response Council on HIV and AIDS, Mbabane, Swaziland
| | - Muhle Dlamini
- Swaziland National AIDS Programme, Mbabane, Swaziland
| | - Sanyukta Mathur
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
| | - Julie Pulerwitz
- Population Council, HIV and AIDS Program, Washington, D.C., United States of America
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Gottert A, Pulerwitz J, Siu G, Katahoire A, Okal J, Ayebare F, Jani N, Keilig P, Mathur S. Male partners of young women in Uganda: Understanding their relationships and use of HIV testing. PLoS One 2018; 13:e0200920. [PMID: 30096147 PMCID: PMC6086428 DOI: 10.1371/journal.pone.0200920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Substantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15-24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW's male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda. METHODS We conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men's current and recent partnerships and HIV service use. RESULTS Most respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents' current relationship practices. CONCLUSIONS Across the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.
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Affiliation(s)
- Ann Gottert
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
- * E-mail:
| | - Julie Pulerwitz
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Godfrey Siu
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Anne Katahoire
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Jerry Okal
- Population Council, HIV and AIDS Program, Nairobi, Kenya
| | - Florence Ayebare
- Makerere University Child Health and Development Centre, Kampala, Uganda
| | - Nrupa Jani
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Pamela Keilig
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
| | - Sanyukta Mathur
- Population Council, HIV and AIDS Program, Washington D.C., United States of America
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Angotti N, Mojola SA, Schatz E, Williams JR, Gómez-Olivé FX. 'Taking care' in the age of AIDS: older rural South Africans' strategies for surviving the HIV epidemic. CULTURE, HEALTH & SEXUALITY 2018; 20:262-275. [PMID: 28741983 PMCID: PMC5985658 DOI: 10.1080/13691058.2017.1340670] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, 'taking care' in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one's HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.
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Affiliation(s)
- Nicole Angotti
- Department of Sociology, American University, Washington DC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Sanyu A. Mojola
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
- Departments of Health Sciences and Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - Jill R. Williams
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
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Thummalachetty N, Mathur S, Mullinax M, DeCosta K, Nakyanjo N, Lutalo T, Brahmbhatt H, Santelli JS. Contraceptive knowledge, perceptions, and concerns among men in Uganda. BMC Public Health 2017; 17:792. [PMID: 29017539 PMCID: PMC5633881 DOI: 10.1186/s12889-017-4815-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 10/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men. METHODS Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men. RESULTS Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge. CONCLUSIONS Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions.
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Affiliation(s)
- Nityanjali Thummalachetty
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, New York, NY 10032 USA
| | - Sanyukta Mathur
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, New York, NY 10032 USA
| | - Margo Mullinax
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Kelsea DeCosta
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, New York, NY 10032 USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Heena Brahmbhatt
- Department of Population, Family and Reproductive Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - John S. Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, New York, NY 10032 USA
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Matovu JKB, Makumbi F, Wanyenze RK, Serwadda D. Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: a cross-sectional study. Reprod Health 2017; 14:2. [PMID: 28069056 PMCID: PMC5223449 DOI: 10.1186/s12978-016-0272-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent trends in fertility rates indicate declines in total fertility rate (TFR) in some sub-Saharan African countries. However, countries such as Uganda continue to have a persistently high TFR partly attributed to strong preferences for large family sizes. We explored the factors that influence fertility desire among married or cohabiting individuals in Rakai, a rural district in southwestern Uganda. METHODS This cross-sectional study of fertility desire (desire to have another child) was nested in a cluster-randomized demand-creation intervention trial for the promotion of couples' HIV counseling and testing uptake among married or cohabiting individuals that was conducted in Rakai district between March 1 and April 30, 2015. A total of 1490 married or cohabiting individuals, resident in three study regions with differing background HIV prevalence, were enrolled into the study. Data were collected on socio-demographic, behavioral and fertility-related characteristics. We used a modified Poisson regression model to generate prevalence ratio (PR) as a measure of association for factors that were independently associated with fertility desire. We adjusted for clustering at community level and used STATA version 14.0 for all analyses. RESULTS Overall, fertility desire was high (63.1%, n = 940); higher in men (69.9%, n = 489) than women (57.1%, n = 451). More than three-quarters (78.8%, n = 1174) had 3+ biological children while slightly more than two-thirds (68.5%, n = 1020) reported an ideal family size of 5+ children. Only 30% (n = 452) reported that they had attained their desired family size. After adjusting for potential and suspected confounders, the factors that were negatively associated with fertility desire were: age 30-39 (adjusted prevalence ratio [aPR] = 0.82, 95% CI: 0.78, 0.86) and 40+ years (aPR = 0.65, 95% CI: 0.60, 0.71); having six or more biological children (aPR = 0.88, 95% CI: 0.80, 0.97); being HIV-positive (aPR = 0.86, 95% CI: 0.78, 0.95) and ever use of any family planning methods (aPR = 0.93, 95% CI: 0.87, 0.99). Being male (aPR = 1.19, 95% CI: 1.07, 1.33); having primary education (aPR = 1.21, 95% CI: 1.01, 1.44) and having not yet attained the desired family size (aPR = 4.34, 95% CI: 3.50, 5.38) were positively associated with fertility desire. CONCLUSION Having not yet attained one's desired family size, being male and having primary education were positively associated with fertility desire in this population. Targeting individuals who have not yet attained their desired family size, men and less educated individuals with fertility regulation interventions may help to reduce fertility desire in this population.
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Affiliation(s)
- Joseph K B Matovu
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda. .,Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.,Family Health Research and Development Center, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Sennott C, Angotti N. Reconsidering gendered sexualities in a generalized AIDS epidemic. GENDER & SOCIETY : OFFICIAL PUBLICATION OF SOCIOLOGISTS FOR WOMEN IN SOCIETY 2016; 30:935-957. [PMID: 35571270 PMCID: PMC9103418 DOI: 10.1177/0891243216672805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Using the threat of a severe AIDS epidemic in a collection of rural villages in South Africa, we illustrate how men and women reconsider gendered sexualities through conversations and interactions in everyday life. We draw from data collected by local ethnographers and focus on the processes through which men and women collectively respond to the threat posed by AIDS to relationships, families, and communities. Whereas previous research has shown that individuals often reaffirm hegemonic norms about gender and sexuality in response to disruptions to heteronormative gender relations, we find that the threat of AIDS provokes reconsideration of gendered sexualities at the community level. That is, our data demonstrate how men and women-through the interactions and exchanges that make up their daily lives-debate, challenge, make sense of, and attempt to come to terms with social norms circumscribing gendered sexual practices in a context where the threat of a fatal disease transmitted through sex looms large. We argue that ethnographic data are particularly useful for capturing communal responses to events that threaten heteronormative gender relations and reflect on how our findings inform theories of gender relations and processes.
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Affiliation(s)
- Christie Sennott
- Department of Sociology, Purdue University
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (South Africa)
| | - Nicole Angotti
- Department of Sociology, American University
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (South Africa)
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