Dimensions of Rural-to-Urban Migration and Premarital Pregnancy in Kenya

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

Background

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

Methods

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

Results & conclusions

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

Migration and young women's access to maternal healthcare in sub-Saharan Africa

Pregnant young women have increased risk of poor maternal health outcomes and frequently have low rates of skilled maternal healthcare utilization. Migrant youth may suffer even poorer use of maternal health services given the disruption of migration, changes in social support, and potential difficulties in obtaining care in a new community. Using a sample of 46,905 women aged 15-24 from 27 Demographic and Health Surveys collected across sub-Saharan Africa from 2003 to 2009, I examine variation in use of skilled maternal healthcare, looking at three aspects of migration: place, disruption, and adaptation. I find evidence of a significant advantage in migrating to urban versus rural areas, suggesting that there is an urban advantage in maternal healthcare regardless of migrant stream. I find no evidence of positive adaptation on maternal healthcare use, but show that rural-rural migrants experience negative adaptation after longer duration of residence. There are lingering positive effects of this urban advantage for urban-rural migrants, who, despite a dearth of healthcare facilities in rural areas, maintain high use of maternal healthcare well after migration.

Cohort profile: internal migration in sub-Saharan Africa-The Migration and Health in Malawi (MHM) study

PURPOSE

The Migration and Health in Malawi (MHM) study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. The MHM study uses a longitudinal panel premigration and postmigration study design (with a non-migrant comparison group) to measure and/or control for important characteristics that affect both migration and health outcomes.

PARTICIPANTS

Data are available for two waves. The MHM interviewed 398 of 715 migrants in 2007 (55.7%) and 722 of 1013 in 2013 (71.3%); as well as 604 of 751 (80.4%) for a non-migrant reference group in 2013. The total interviewed sample size for the MHM in both waves is 1809. These data include extensive information on lifetime migration, socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, social networks and social capital, HIV/AIDS biomarkers and other dimensions of health.

FINDINGS TO DATE

Our result for the relationship between migration and health differs by health measure and analytic approach. Migrants in Malawi have a significantly higher HIV prevalence than non-migrants, which is primarily due to the selection of HIV-positive individuals into migration. We find evidence for health selection; physically healthier men and women are more likely to move, partly because migration selects younger individuals. However, we do not find differences in physical or mental health between migrants and non-migrants after moving.

FUTURE PLANS

We are preparing a third round of data collection for these (and any new) migrants, which will take place in 2018. This cohort will be used to examine the effect of migration on various health measures and behaviours, including general mental and physical health, smoking and alcohol use, access to and use of health services and use of antiretroviral therapy.

Trends and correlates of single motherhood in Kenya: Results from the Demographic and Health Survey

Single motherhood exposes women to poorer socioeconomic and health outcomes, which may also negatively impact child outcomes. The Demographic and Health Surveys of 1989, 1993, 1998, 2003, and 2009 were used to investigate trends over time and factors associated with single motherhood in Kenya. Urban residence, older age, and poorer economic status were associated with single motherhood over time. Women with more than one child, and those with children under 15 years living at home were less likely to be single mothers. As women become single mothers at different stages, targeted and supportive strategies are required to mitigate associated risks.

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

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

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Premarital childbearing is common in sub-Saharan Africa.

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

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

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

Family Instability and Pathways to Adulthood in Urban South Africa

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