Education and fertility in sub-Saharan Africa: individual and community effects

The Intergenerational Transmission of Health Disadvantage: Can Education Disrupt It?

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.

Cameroon's slow fertility transition: A gender perspective

We interrogate the proposition that men's attitudes have constrained the fertility transition in Cameroon, where fertility remains high and contraceptive use low despite much socio-economic progress. We use five Demographic and Health Surveys to compare trends in desired family size among young women and men and analyse matched monogamous couple data from the two most recent surveys to examine wives' and husbands' desires to stop childbearing and their relative influence on current contraceptive use. In 2018, average desired family size was 5.6 and 5.1, for young men and women respectively, and this difference (half a child) has not changed since 1998. Among matched couples, the proportions wanting to stop childbearing were similar in wives and their husbands, but wives perceived husbands to be much more pronatalist than themselves. Surprisingly, men's own reported preferences were more closely associated with contraceptive use than wives' perceptions of husbands' preferences. We discerned little evidence that men's attitudes have impeded reproductive change.

Community characteristics and the risk of non-communicable diseases in Ghana

Non-communicable Diseases (NCDs) are rising quickly in low- and middle- income countries. In Ghana, chronic diseases are major causes of morbidity and mortality, yet data and the evidence- base for awareness, detection, and management of NCDs are lacking. Using data from the 2014 Ghana Demographic and Health Survey (GDHS), the first national study with information on hypertension and other risk factors, we examine the correlates and community characteristics associated with the risk of hypertension, obesity, and anemia among women. We find that hypertension prevalence in Ghana was 16 percent and 17 percent were overweight/obese, while 41 percent had anemia of any form. On community characteristics, the level of poverty in a community was significantly associated with lower risks of all three NCDs, while the aggregate level of employment had higher risks. On individual characteristics, the wealth of a household, women's educational level and urban residence were significant predictors of NCDs. We interpret the findings within the literature on neighborhood characteristics, the social gradient of health and in the context of speeding up the attainment of the Sustainable Development Goals (SGDS) to reduce premature deaths by one-third by 2030.

Intra-cluster correlations in socio-demographic variables and their implications: An analysis based on large-scale surveys in India

Individuals who share similar socio-economic and cultural characteristics also share similar health outcomes. Consequently, they have a propensity to cluster together, which results in positive intra-class correlation coefficients (ICCs) in their socio-demographic and behavioural characteristics. In this study, using data from four rounds of the National Family Health Survey (NFHS), we estimated the ICC for selected socio-demographic and behavioural characteristics in rural and urban areas of six states namely Assam, Gujarat, Kerala, Punjab, Uttar Pradesh, and West Bengal. The socio-demographic and behavioural characteristics included religion & caste of the household head, use of contraception & prevalence of anaemia among currently married women and coverage of full immunization services among children aged 12-23 months. ICC was computed at the level ofPrimary Sampling Units (PSUs), that is, villages in rural areas and census enumeration blocks in urban areas. Our research highlights high clustering in terms of religion and caste within PSUs in India. In NFHS-4, the ICCs for religion ranged from the lowest of 0.19 in rural areas of Kerala to the highest of 0.67 in urban areas of West Bengal. For the caste of the household head, the ICCs ranged from the lowest of 0.12 in the urban areas of Punjab to the highest of 0.46 in the rural areas of Assam. In most of the states selected for the study, the values of ICC were higher for the use of family planning methods than for full immunization. The value of ICC for use of contraception was highest for rural areas of Assam (0.15) followed by rural areas of Gujarat (0.13). A higher value of ICC has considerable implications for determining an effective sample size for large-scale surveys. Our findings agree with the fact that for a given cluster size, the higher the value of ICC, the higher is the loss in precision of the estimate. Knowing and taking into account ICCs can be extremely helpful in determining an effective sample size when designing a large-scale demographic and health survey to arrive at estimates of parameters with the desired precision.

Social norms and fertility intentions: Evidence from China

China’s low fertility rates are a major concern across all sectors of society. Fertility is a major issue related to economy, society and family development. Based on social norms theory, this paper explores the influence of social norms on individuals’ fertility intentions from two perspectives: spatial proximity and social proximity. Using data from the China Family Panel Studies, we found that individual’s fertility intentions were influenced by social norms; both neighborhood social norms and group social norms had significant effects. The role of social norms in shaping individual fertility intentions varied by gender, hukou, and life course; specifically, men, rural residents, and married individuals were more significantly influenced by social norms. This study improves the theoretical framework of fertility decision making by arguing that in addition to macro and individual factors, social norms have a very important influence on fertility intentions. Our findings suggest that reshaping social norms regarding fertility is essential to enhance fertility rates in China.

The trends of female sterilization in India: an age period cohort analysis approach

In India, sterilisation is the most frequent method of modern contraception, and is primarily used by women. The contemporaneous assessment of sterilisation literature focuses only on trends and patterns that are limited to socioeconomic considerations, ignoring the cohort and period issues. No study has employed Age Period Cohort (APC) analysis to highlight the effect of APC on a particular outcome to yet. We have used maximum entropy method modelling to analyse the individual influence of APC on female sterilisation in India using the four rounds of the National Family Health Survey (NFHS). While the older group had higher sterilisation rates than the younger cohort, the age effects were found to have a standard inverted U-shaped curve, with women sterilising in their mid-30s as the might have completed their desire family size. The analysis found high rural-urban differentials in utilising female sterilisation, highlighting the relevance of education and empowerment in contraceptive decision-making among the educated one. Female sterilisation has become less common among Muslims in India over time, and among uneducated women, and it has shifted to later ages with each succeeding period. This was determined to be concerning in terms of India's future fertility. Since 1947, the government has implemented numerous policies to provide women with a variety of contraceptive options; however, the dominance of female sterilisation throughout all periods demonstrates that the government's efforts to provide temporary methods were futile.

Mass Education and Women's Autonomy: Evidence From Latin America

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.

Effect of Women's and Partners' Education on Maternal Health-care Services Utilization in Five Empowered Action Group States of India: An analysis of 13,443 Women of Reproductive Age

Background

Suboptimal utilization of maternal health-care services is a perennial problem in Empowered Action Group (EAG) states. This study examines role of women's and partners' education on usage of antenatal, postnatal care (PNC), and skilled birth attendance in these states.

Methodology

National Family Health Survey-4 (2015-2016) data for 13,443 women in reproductive age group of 15-49 years in Bihar, Madhya Pradesh (MP), Odisha, Rajasthan, and Uttar Pradesh (UP) were analyzed using logistic regression.

Results

Increasing level of education had a significant impact on utilization of antenatal services in all states, highest and lowest odds being observed with higher and primary level of partner's education, respectively. Skilled birth attendance universally showed rising trend with increasing women education, while it remained substantially low even at higher level of partner's education. For PNC, utilization increased with increasing level of maternal education. While significantly lower odds of PNC were seen with primary level of partner education in Rajasthan and UP, partner's secondary education showed positive and significant association in Bihar, Rajasthan, and UP. At higher level of partner education, positive and significant effects on PNC were observed only in Bihar, MP, and UP.

Conclusions

Universal education is vital to attain sustainable development goals at the grassroot level, which is happening relatively slowly in the EAG states.

How the internet increases modern contraception uptake: evidence from eight sub-Saharan African countries

Background

Sub-Saharan African (SSA) countries have the highest worldwide levels of unmet need for modern contraception. This has led to persistently high fertility rates in the region, rates which have had major adverse repercussions on the development potential there. Family planning programmes play a key role in improving the uptake of modern contraception, both by fostering women’s health and by lowering their fertility. Increasing awareness of contraception benefits is a major component of such programmes. Here, we ask whether internet access can bridge the gap between women’s need for modern contraception and women’s uptake of the same.

Methods

We use a compendium of data for 125 242 women, aged 15–49, from the Demographic Health Survey, Akamai and International Communication Union data, covering eight SSA countries, for the period 2014–2019. We apply a Two-Stage Least Square model, using as instruments for individual internet exposure the distance to the main server in the country and whether the backbone network in the country has been connected to at least one submarine cable.

Results

Internet exposure, measured as women access the internet at least monthly (almost daily), is associated with a positive, 11.4% (95% CI 10.6% to 12.2%) (53.8% (95% CI 13.4% to 94.1%)), increase in modern contraception uptake. Education is an important moderator. Poorly educated women benefit the most from internet exposure.

Discussion

Internet exposure appears to have significantly increased the uptake of modern contraception among sub-Saharan women. The poorly educated appear particularly to benefit. There are two mechanisms at play: the internet increases women’s knowledge of contraception; and, in parallel, fosters their empowerment.

Predictors of underachieved and overachieved fertility among women with completed fertility in Ghana

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.

Family planning perspectives and practices of married adolescent girls in rural Upper Egypt

OBJECTIVES

The aims of the study were to explore the contraceptive practices of married adolescent girls in rural Upper Egypt and identify the determinants of their ever use of modern contraception.

METHODS

The study was a household survey of 729 married adolescent girls in 23 villages of two governorates in Upper Egypt. Listing and enumeration of all households in the selected villages were performed prior to data collection, to recruit married adolescent girls below 20 years of age. The girls were interviewed using a structured questionnaire.

RESULTS

Only 6% of married adolescent girls were using a modern contraceptive method; 10.6% had ever used a modern contraceptive method, mostly a short-acting method. Considerable proportions of participants believed that using contraception would reduce a woman's fertility and that women should not delay their first pregnancy (34% and 54.3%, respectively); only 50.2% believed that contraception could be used for birth spacing. Predictors of the ever use of a modern method of contraception among married adolescent girls were: accepting that contraception could be used for birth spacing (B = 1.82, p < .001), older age (B = 0.42, p < .01), better reproductive health knowledge (B = 0.23, p < .05) and sharing in contraceptive decision making (B = 0.55, p < .05).

CONCLUSION

Married adolescent girls' current use and ever use of modern contraception were very low in rural Upper Egypt. Changing the social norms to create the desire to delay first childbirth, improving adolescent girls' reproductive health knowledge, correcting myths about contraception and building girls' agency to use contraception may increase their contraceptive use.

Unmet Need for Family Planning after Internal Migration: Analysis of Ethiopia 2017-2018 PMA Survey Data

Internal migration's effect on family planning behavior depends upon migration circumstances. While many studies describe instability and displacement's effect on family planning access, fewer studies consider the positive association between internal migration and family planning behavior. Using Performance Monitoring for Action (PMA) survey data, we examine the relationship between internal migration and unmet need for family planning in Ethiopia from 2017-2018. We describe determinants of family planning behavior by migrant status and model migration's effect on unmet need for family planning using multilevel logistic regression. Internal migrants studied tend to be more educated and wealthier and have less unmet need than non-migrants, likely due to different fertility preferences and human capital. This contributes to existing research by illustrating how rural-urban migration in Ethiopia relates to family planning behaviour. Findings will be of interest to social scientists and policymakers evaluating family planning resource allocation to reduce unmet need in African contexts.

Trends in fertility and fertility preferences in sub-Saharan Africa: the roles of education and family planning programs

A common explanation for the high fertility prevailing in sub-Saharan Africa (SSA) is a widespread desire for large families. This situation poses a challenge to population policy-makers in the continent. If the desired family size is high, then presumably family planning programs can only have a limited effect on fertility because these programs aim to assist women in achieving their reproductive goals. But this conclusion is based on the assumption that family planning programs do not affect the desired family size, which is questionable and is investigated here. This study examines the determinants of trends wanted and unwanted fertility in SSA using fixed-effects regressions of country-level data. The dependent variables include the total fertility rate, and its wanted and unwanted components. Explanatory variables include a family planning program score and four socioeconomic variables (women’s educational attainment, child mortality, GNI per capita, and percent urban). Data come from 103 DHS surveys in 25 countries in SSA with at least two DHS surveys between 1989 and 2019. Women’s education and family planning programs are found to be the dominant determinants of fertility decline and their effects operate by reducing both wanted and unwanted fertility. The effects of education are not surprising but the finding that family planning programs can reduce wanted fertility implies that their impact can be larger than conventional wisdom suggests. Indeed, in a few poor countries, the implementation of high-quality programs has been associated with substantial declines in wanted fertility (e.g., Ethiopia, Malawi, Rwanda). The mechanism through which this effect operates is unclear but likely involves media programs that diffuse knowledge about the benefits of smaller families.

The influence of health facility-level access measures on modern contraceptive use in Kinshasa, DRC

Expanding access to family planning (FP) is a principal objective of global family planning efforts and has been a driving force of national family planning programs in recent years. Many country programs are working alongside with the international family planning community to expand access to modern contraceptives. However, there is a challenging need for measuring all aspects of access. Measuring access usually requires linking information from multiple sources (e.g., individual women and facilities). To assess the influence of access to family planning services on modern contraceptive use among women, we link four rounds of individual women and service delivery points survey data from PMA2020 in Kinshasa. Multilevel logistics regression on pooled data is performed to test the influence of facility-level access factors on individual-level contraceptive use. We add variables tailored from a conceptual framework to cover elements of access to family planning: administrative access, geographic or physical access, economic access or affordability, cognitive access, service quality, and psychological access. We find that the effect of community and facility-level access factors varies extensively but having fewer stocked-out facilities and more facilities with long-acting permanent methods (LAPM) increases the odds of using modern contraceptives among women in Kinshasa. Our study shows that reliable supply chain with a broad array of method mix will increase the odds of modern contraceptive use at community level among women in Kinshasa. Using to community-oriented practices and service delivery along with empowering women to make health-related decisions should become a priority of family planning programs and international stakeholders in the country.

Deriving Niger’s Demographic and Education Future to 2062 with Stakeholders: Which Results?

Niger has the fastest population growth in the world while being among the least developed countries. With an average fertility above seven children per woman in the last decades, rapid population growth will continue in the medium to long term representing a planning challenge for Niger's development whose actual population is likely to double within the next two decades. At the same time, socio-economic variables whether in terms of health, wealth, and education levels are lagging behind, also relatively to many countries in sub-Saharan Africa. While both demographic and education variables occupy a central position in the government strategy, they are not necessarily linked. However, the future of Niger will largely be a reflection of its ability to meet both challenges. Within a project piloted by the Ministry of Planning and funded by the United Nations Children’s Fund, we have derived together with local experts and stakeholders narratives about the possible future of Niger. These were further translated into five scenarios with assumptions about different future paths of demographic and educational development for Niger that were used to project the population, also at sub-national level, using multi-state population projection models with the aim to inform policy. This article reports some projection results related to educational and demographic developments.

Community gender systems and a daughter's risk of female genital mutilation/cutting: Multilevel findings from Egypt

We tested a feminist social-ecological model to understand community influences on daughters' experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15-49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. However, an integrated multilevel-level framework is lacking. We theorized that a more favorable community-level gender system, including stronger gender norms opposing FGMC and expanded extra-familial opportunities for women in the village or neighborhood, would be associated with a daughter's lower risk of FGMC and would strengthen the negative association of a mother's opposition to FGMC with her daughter's risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women's opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems framework of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and structural opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters, may be needed for sustainable declines in the practice.

Does Parents' Union Instability Disrupt Intergenerational Advantage? An Analysis of Sub-Saharan Africa

The long arm of childhood, with its wide-ranging influence on individuals' life chances, highlights the importance of understanding the determinants of health in early life. Research has established that parents' education is a major determinant of childhood health, but children across the globe increasingly experience their parents' divorce and subsequent remarriage, raising questions of whether union instability alters these intergenerational processes. Does divorce and remarriage interfere with parents' education benefiting their young children's health? I explore this question in sub-Saharan Africa, a world region where parents' education plays a major role in protecting children against severe health risks, and where young children commonly experience parental divorce and remarriage. Moreover, sub-Saharan Africa features distinct family lineage systems, affording an opportunity to explore this question in both majority matrilineal and patrilineal contexts. Analyses of Demographic and Health Survey data on 271,292 children in 30 sub-Saharan African countries offer no evidence that the high levels of union instability in the region will weaken the health benefits of parents' education for future generations. Following divorce, children benefit from their biological parents' education to the same degree as children with married parents-a finding that is consistent across lineage contexts. Moreover, stepfathers' education corresponds with pronounced health benefits for their coresident stepchildren, particularly in patrilineal regions where these children benefit less dramatically from their mothers' education. Together, the study results offer a renewed sense of the importance of parents'-including stepfathers'-education for early childhood health across diverse family structures.

Education and fertility in Egypt: Mediation by women's empowerment

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.

Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa

OBJECTIVES

We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes.

METHODS

Data from the Africa Research, Implementation Science, and Education Network cross-sectional adolescent health surveys were used to examine the associations of current school enrolment, self-reported general health and four major adolescent health domains: (i) sexual and reproductive health; (ii) nutrition and non-communicable diseases; (iii) mental health, violence and injury; and (iv) healthcare utilisation. We used multivariable Poisson regression models to calculate relative risk ratios with 95% confidence intervals (CI), controlling for demographic and socio-economic characteristics. We assessed heterogeneity by gender and study site.

RESULTS

Across 7829 adolescents aged 10-19, 70.5% were in school at the time of interview. In-school adolescents were 14.3% more likely (95% CI: 6-22) to report that their life is going well; 51.2% less likely (95% CI: 45-67) to report ever having had sexual intercourse; 32.6% more likely (95% CI: 9-61) to report unmet need for health care; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrolment was not significantly associated with malnutrition, low mood, violence or injury. Substantial heterogeneity was identified between genders for sexual and reproductive health, and in-school adolescents were particularly less likely to report adverse health outcomes in settings with high average school enrolment.

CONCLUSIONS

School enrolment is strongly associated with sexual and reproductive health and healthcare utilisation outcomes across nine sites in sub-Saharan Africa. Keeping adolescents in school may improve key health outcomes, something that can be explored through future longitudinal, mixed-methods, and (quasi-)experimental studies.

Structured additive distributional hurdle Poisson modelling of individual fertility levels in Nigeria

Fertility is one of the dynamic components of population and has been modelled through children ever born per woman, which is a count variable that can be characterized with excessive zeros origination from women without any births. In order to examine the spatial variation across states of Nigeria, we proposed the use of hurdle models that classifies the data into a truncated count and point mass of zeros. We adopt distributional regression model that allows all parameters of the hurdle model to be linked to covariates of different types so as to allow for accessing the spatial variations and nonlinear forms of metrical covariates on the level of fertility and in the likelihood of having no child. Data was sourced from the 2013 Nigeria Demographic and Health Survey. Findings reveal the existence of north-south divide in the average level of fertility and in the likelihood of a woman not giving birth to any child. Women with higher level of education and those from richer or richest households have higher likelihood of having no child, but this is not the case for women with primary or secondary education, users of traditional or modern contraceptive, ever-married women and those working. There is therefore the need to strengthen family planning policies so that investment in contraceptive would yield the expected results in Nigeria.

From Privilege to Prevalence: Contextual Effects of Women's Schooling on African Marital Timing

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.

Timing between age at first sexual intercourse and age at first use of contraception among adolescents and young adults in Niger: What role do education and place of residence play?

Background: Low contraceptive use among women in Niger is one of main causes of early childbearing and unwanted pregnancies, which affect maternal and child health. Education and place of residence have been cited as factors affecting modern contraceptive use. Methods: We investigated the separate and joint effects of the place of residence and education on the time to modern contraceptive uptake among women aged 15-24 in Niger. The study used data from the second round of the 2016 Niger Performance Monitoring and Accountability 2020 (PMA2020) project. Survival analysis was applied for 830 women. Results: Nelson-Aalen curves show that urban women had higher hazards of (and shorter delays in) modern contraceptive uptake as compared to their rural counterparts. Also, the higher the level of education, the higher the hazards of (and the shorter the delays in) modern contraceptive uptake. Findings from the multivariate (survival) analysis confirms these figures and provides the net effect of the place of residence on modern contraceptive uptake. Whether living in urban or rural areas of Niger, what matters more is the level of education. Conclusions: Family planning programmes concerning adolescent and young women should focus more on women with no education and those that are illiterate.

Modelling fertility in rural South Africa with combined nonlinear parametric and semi-parametric methods

Background

Central to the study of populations, and therefore to the analysis of the development of countries undergoing major transitions, is the calculation of fertility patterns and their dependence on different variables such as age, education, and socio-economic status. Most epidemiological research on these matters rely on the often unjustified assumption of (generalised) linearity, or alternatively makes a parametric assumption (e.g. for age-patterns).

Methods

We consider nonlinearity of fertility in the covariates by combining an established nonlinear parametric model for fertility over age with nonlinear modelling of fertility over other covariates. For the latter, we use the semi-parametric method of Gaussian process regression which is a popular methodology in many fields including machine learning, computer science, and systems biology. We applied the method to data from the Agincourt Health and Socio-Demographic Surveillance System, annual census rounds performed on a poor rural region of South Africa since 1992, to analyse fertility patterns over age and socio-economic status.

Results

We capture a previously established age-pattern of fertility, whilst being able to more robustly model the relationship between fertility and socio-economic status without unjustified a priori assumptions of linearity. Peak fertility over age is shown to be increasing over time, as well as for adolescents but not for those later in life for whom fertility is generally decreasing over time.

Conclusions

Combining Gaussian process regression with nonlinear parametric modelling of fertility over age allowed for the incorporation of further covariates into the analysis without needing to assume a linear relationship. This enabled us to provide further insights into the fertility patterns of the Agincourt study area, in particular the interaction between age and socio-economic status.

The Differential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1-3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.

Assessment of Contraceptive Use by Marriage Type Among Sexually Active Men in Nigeria

Marital status, from the perspective of men (and especially sexually active men), as a potential factor that influences contraceptive use for the purposes of fertility control, has received little consideration in the scientific literature. This study thus assesses contraceptive use among sexually active men occupying different marital statuses. The study employed the 2013 Nigeria Demographic and Health Survey dataset. Using a total sample of 11,476 weighted sexually active men, the study revealed that 30% of the sampled population were currently using contraceptives, with condom as the dominant method (65.9%). The unadjusted odds of contraceptive use was significantly higher (9.4; confidence interval [8.1, 10.9]) among single men than married. Other factors include wealth, educational attainment, ethnicity, region, religion, and age. The study concludes that there are significant differences in contraceptive use between the single and married men and, therefore, recommends that policy and programs be put in place to promote consistent use of contraceptives among married men in Nigeria.

The effect of partners' education on women's reproductive and maternal health in developing countries

The effect of partners' education on women's and children's health in developing countries has received relatively little attention to date. This study uses couple data from 37 recent Demographic and Health Surveys fielded in sub-Saharan African and Asian countries to assess the effect of partners' schooling on women's modern contraceptive use, frequency of antenatal care visits, and skilled birth attendance. Using multilevel logistic regressions, the study shows that partners' schooling has strong effects on their spouses' maternal healthcare utilization; especially when partners had secondary or higher levels of schooling. Overall, women whose partners had an above secondary level of education were 32% more likely to use modern contraceptives, 43% more likely to attend at least four antenatal care visits, and 55% more likely to deliver their most recent baby with a health professional, compared to women whose partner had no education, after controlling for individual and community-level covariates. Finally, interacting the partners' years of schooling, we found that an additional year of partners' schooling was 1) positively associated with modern contraceptive use when the women had low educational attainment (substitution effect), but negatively associated when women were better educated, 2) positively and increasingly associated with the frequency of antenatal care visits as women's education increased (multiplicative effect), and 3) positively and significantly associated with skilled birth attendance for less educated women (substitution effect). This study highlights the importance of male education in shaping their wife's health behaviours in developing countries and provides strong impetus for male education beyond primary level (as well as for women), something that has been neglected in past policy discourse.

Modelling period fertility: Schooling and intervals following a birth in Eastern Africa

We describe a regression-based approach to the modelling of age-, order-, and duration-specific period fertility, using retrospective survey data. The approach produces results that are free of selection biases and can be used to study differential fertility. It is applied to Demographic and Health Survey data for Ethiopia, Kenya, Tanzania, and Zimbabwe to investigate differential trends in fertility by education. Parity progression fell and the intervals following each birth lengthened between the 1970s and 2000s in all four countries. Fertility fell most among women with secondary education. In contrast to other world regions, postponement of successive births for extended periods accounted for much of the initial drop in fertility in these African countries. However, family size limitation by women with secondary education in Ethiopia and Kenya and longer birth spacing in Zimbabwe also played significant roles. Thus, birth control is being adopted in Eastern Africa in response to diverse changes in fertility preferences.

Is a woman's first pregnancy outcome related to her years of schooling? An assessment of women's adolescent pregnancy outcomes and subsequent educational attainment in Ghana

Background

Adolescent pregnancy and childbearing pose challenges to young women’s educational attainment. Studies show that while adolescent childbearing reduces educational attainment, not becoming pregnant and resorting to induced abortion when pregnant increases women’s educational levels. This study examined relationships between adolescents’ resolution of their first pregnancies and subsequent educational outcomes, for all women ages 20–49 years and across three age cohorts: 20–29, 30–39 and 40–49 year olds.

Methods

Using the 2007 Ghana Maternal Health Survey (GMHS) dataset, we conducted ANOVA, bivariate and multivariate linear regression analyses on 8186 women ages 20–49 years. Women’s first adolescent pregnancy outcomes were measured as live births, induced abortions, spontaneous abortions or no pregnancy, while educational attainment constituted their years of schooling.

Results

Findings showed years of schooling was highest for women who had induced abortions, and lowest for those who experienced live births. Women with live births as teenagers experienced significantly fewer years of schooling compared to their counterparts who terminated their pregnancies. Also, women with miscarriages and stillbirths exhibited levels similar to those who gave birth. Although women with no teenage births had higher educational levels than their childbearing counterparts, controlling for age at first pregnancy resulted in similar years of schooling compared to those who gave birth. Finally, the 30 to 39 year olds were the only age group whose results contradicted those of all women. These findings may be due to the socio-economic and political events that affected women’s educational attainment at the time.

Conclusions

Childbearing during adolescence does impact women’s educational attainment levels. Therefore, in addition to encouraging young mothers to continue schooling, all other interventions to help keep young girls in school must focus on preventing and/or delaying their adolescent pregnancies.

Effect of socio-economic characteristics on fertility and under-five mortality: examples from the Santals of Birbhum district, West Bengal, India

Fertility and under-five mortality are considered as key health indicators of a population. Both the fertility and under-five mortality varies accross countries, regions, ethnic groups and so on, which may bedue to disparities in socio-economic and cultural factors. The study aimed to better understanding the association of fertility and under-five mortality with selected socio-economic characteristics of the Santal labourer group of Birbhum district, West Bengal. Cross-sectional data have been collected on fertility, mortality and socio-economic characteristics from 627 ever-married Santal women. Descriptive statistics, multivariate logistic regression and Cox proportion hazard analysis have been done. Total fertility rate (TFR) of the present study group was 2.9 and the mortality rate was 105.1. In the present study, educational status, age and household size of the women have significant association with fertility. Under-five mortality has significant association with educational status of mother and birth order of the children. The study indicated that education was the one of the important factors (socio-economic characters) that had most significant impact on both fertility and under-five mortality of the Santal labourer group.

Desired Numbers of Children, Fertility Preferences and Related Factors among Couples Who Referred to Pre-Marriage Counseling in Alborz Province, Iran

Background

The Islamic Republic of Iran has experienced a dramatic decrease in fertility rates in the past three decades. One of the main issues in the field of fertility is the couple's preferences and the desire to bear children. This study aimed to determine desired number of children, fertility preference, and related factors among people referring pre-marriage counseling to clarify their presumed behavior in case of fertility.

MATERIALS AND METHODS

This study was a descriptive analytic cross-sectional survey, conducted during 8 months. The participants were 300 couples came to pre-marriage counseling centers of two health centers of Karaj and asked to complete a 22 items questionnaire about of demographic characteristics, participants' interest, preference about fertility, and economic situation.

RESULTS

Majority of the males were between the ages of 20-30 years (66.6%) while majority of the females were below 25 years of age (57%). About 17 percent of men and 22.3 percent of women stated that they want to have 1 child and equally 52.7 percent of men and 52.7 percent of women wanted to have 2 children. The only factor that contributed to the female participant's decision for a desirable number of children was the number of siblings that they have. In male participants with an increasing age at marriage and aspiration for higher educational level, the time interval between marriage and the birth of the first child has increased. There was a convergence in desired number of children in male and female participants.

CONCLUSION

Majority of the participants express their desire to have only one or two children in future but in considering the fact that what one desires does not always come into reality, the risk of reduced fertility is generally present in the community. Appropriate policies should be implemented in order to create a favorable environment for children.

Community Context and Child Health: A Human Capital Perspective

Human capital theory suggests that education benefits individuals' and their children's health through the educational skills people acquire in school. This perspective may also be relevant at the community level: the greater presence of adults with educational skills in a community may be a reason why living in a more highly educated setting benefits health. I use Demographic and Health Survey data for 30 sub-Saharan African countries to investigate whether the percentage of literate adults-specifically women-in a community is associated with children's likelihood of survival. I characterize 13,785 African communities according to the prevalence of women who are literate. Multilevel discrete-time hazard models ( N = 536,781 children) confirm that living in a community where more women are literate is positively associated with child survival. The study supports the conceptualization of literacy, and potentially other educational skills, as forms of human capital that can spill over to benefit others.

Desired Fertility and Number of Children Born Across Time and Space

Economists have often argued that high fertility rates are mainly driven by women's demand for children (and not by family planning efforts) with low levels of unwanted fertility across countries (and hence with little room for family planning efforts to reduce population growth). We study the relationship between wanted fertility and number of children born in a panel of 200 country-years controlling for country fixed effects and global time trends. In general, we find a close relationship between wanted and actual fertility, with one desired child leading to one additional birth. However, our results also indicate that in the last 20 years, the level of unwanted births has stayed at 2 across African countries but has, on average, decreased from 1 to close to 0 in other developing countries. Hence, women in African countries are less able to translate child preferences into birth outcomes than women in other developing countries, and forces other than fertility demand have been important for previous fertility declines in many developing countries. Family planning efforts only partially explain the observed temporal and spatial differences in achieving desired fertility levels.

Playing the Fertility Game at Work: An Equilibrium Model of Peer Effects

We study workplace peer effects in fertility decisions using a game theory model of strategic interactions among coworkers that allows for multiple equilibria. Using register-based data on fertile-aged women working in medium sized establishments in Denmark, we uncover negative average peer effects. Allowing for heterogeneous effects by worker type, we find that positive effects dominate across worker types defined by age or education. Negative effects dominate within age groups and among low-education types. Policy simulations show that these estimated effects make the distribution of where women work an important consideration, beyond simply if they work, in predicting population fertility.

Women's Education and Health Inequalities in Under-Five Mortality in Selected Sub-Saharan African Countries, 1990-2015

Background

The aim of the study was to analyse trends in the relationship between mother’s educational level and mortality of children under the year of five in Sub-Saharan Africa, from 1990 to 2015.

Data and Methods

Data used in this study came from different waves of Demographic and Health Surveys (DHS) of Sub-Saharan countries. Logistic regression and Buis’s decomposition method were used to explore the effect of mother’s educational level on the mortality of children under five years.

Results

Although the results of our study in the selected countries show that under-five mortality rates of children born to mothers without formal education are higher than the mortality rates of children of educated mothers, it appears that differences in mortality were reduced over the past two decades. In selected countries for our study, we noticed a significant decline in mortality among children of non-educated mothers compared to the decrease in mortality rates among children of educated mothers during the period of 1990–2010. The results show that the decline in mortality of children under five years was much higher among the children born to mothers who have never received formal education—112 points drop in Malawi, over 80 in Zambia and Zimbabwe, 65 points in Burkina Faso, 56 in Congo, 43 in Namibia, 27 in Guinea, Cameroon, and 22 to 15 in Niger. However, we noted a variation in results among the countries selected for the study—in Burkina Faso (OR = 0.7), in Cameroon (OR = 0.8), in Guinea (OR = 0.8) and Niger (OR = 0.8). It is normally observed that children of mothers with 0–6 years of education are about 20% more likely to survive until their fifth year compared to children of mothers who have not been to school. Conversely, the results did not reveal significant differences between the under-five deaths of children born to non-educated mothers and children of low-level educated mothers in Congo, Malawi and Namibia.

Conclusion

The decline in under-five mortality rates, during last two decades, can be partly due to the government policies on women’s education. It is evident that women’s educational level has resulted in increased maternal awareness about infant health and hygiene, thereby bringing about a decline in the under-five mortality rates. This reduction is due to improved supply of health care programmes and health policies in reducing economic inequalities and increasing access to health care.

Like Mother(-in-Law) Like Daughter? Influence of the Older Generation's Fertility Behaviours on Women's Desired Family Size in Bihar, India

This paper investigates the associations between preferred family size of women in rural Bihar, India and the fertility behaviours of their mother and mother-in-law. Scheduled interviews of 440 pairs of married women aged 16–34 years and their mothers-in-law were conducted in 2011. Preferred family size is first measured by Coombs scale, allowing us to capture latent desired number of children and then categorized into three categories (low, medium and high). Women’s preferred family size is estimated using ordered logistic regression. We find that the family size preferences are not associated with mother’s fertility but with mother’s education. Mother-in-law’s desired number of grandchildren is positively associated with women’s preferred family size. However, when the woman has higher education than her mother-in-law, her preferred family size gets smaller, suggesting that education provides women with greater autonomy in their decision-making on childbearing.

Pregnancy history and current use of contraception among women of reproductive age in Burundi, Kenya, Rwanda, Tanzania and Uganda: analysis of demographic and health survey data

OBJECTIVE

To examine the relationship between pregnancy history and the use of contraception among women of reproductive age (15-49 years) in East Africa.

METHODS

Demographic and Health Surveys data from Burundi (2010), Kenya (2008-2009), Rwanda (2010), Tanzania (2010) and Uganda (2011) were used in the analysis. Logistic regression was used to determine the effects of women's pregnancy history on their use of contraception.

SETTING

Burundi, Kenya, Rwanda, Tanzania and Uganda.

PARTICIPANTS

3226, 2377, 4396, 3250 and 2596 women of reproductive age (15-49 years) from Burundi, Kenya, Rwanda, Tanzania and Uganda, respectively, were included in the analysis.

RESULTS

Women who had experienced a mistimed pregnancy were more likely to use a modern contraceptive method during their most recent sexual encounter in Kenya, Rwanda, Burundi and Uganda. Other significant correlates of women's contraceptive use were: desire for more children, parity, household wealth, maternal education and access information through radio. In-country regional differences on use of modern contraceptive methods were noted across five East African countries.

CONCLUSIONS

Women's birth histories were significantly associated with their decision to adopt a modern contraceptive method. This highlights the importance of considering women's birth histories, especially women with mistimed births, in the promotion of contraceptive use in East Africa. Variations as a result of place of residency, educational attainment, access to family planning information and products, and wealth ought to be addressed in efforts to increase use of modern contraceptive methods in the East African region.

Education and fertility decline in China during transitional times: A cohort approach

We examine the effect of education on birth outcomes in China during the period of economic transition and large-scale changes in mass education and population control measures. Retrospective micro data from the 2008 Chinese General Social Survey and discrete time event history analysis are used to examine the fertility history of several cohorts of women born between 1945 and 1968. We observed births at different parities, distinguishing the education effect across cohorts and rural/urban sectors. We found differences across cohorts consistent with unique features of the Chinese context, such as the radical egalitarian era of educational expansion, and the Reform Era. We also found that despite the increase in some education levels across cohorts (e.g., junior high school in rural areas), birth chances were more likely to be concentrated among less educated women, suggesting the impact of factors related to returns to education and hence the desire for children.

Female Literacy Rate is a Better Predictor of Birth Rate and Infant Mortality Rate in India

BACKGROUND

Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively.

MATERIALS AND METHODS

Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables.

RESULTS

CBRs were inversely related to literacy rates (slope parameter = -0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = -0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = -1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = -0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630).

CONCLUSION

Female literacy is relatively highly important for both population stabilization and better infant health.

Does Schooling Affect Women's Desired Fertility? Evidence From Malawi, Uganda, and Ethiopia

Demographic scholarship suggests that schooling plays an important role in transforming fertility preferences in the early stages of fertility decline. However, there is limited evidence on the relationship between schooling and fertility preferences that addresses the endogeneity of schooling. I use the implementation of Universal Primary Education (UPE) policies in Malawi, Uganda, and Ethiopia in the mid-1990s to conduct a fuzzy regression discontinuity analysis of the effect of schooling on women's desired fertility. Findings indicate that increased schooling reduced women's ideal family size and very high desired fertility across all three countries. Additional analyses of potential pathways through which schooling could have affected desired fertility suggest some pathways--such as increasing partner's education--were common across contexts, whereas other pathways were country-specific. This analysis contributes to demographic understandings of the factors influencing individual-level fertility behaviors and thus aggregate-level fertility decline in sub-Saharan Africa.

The Demographic Promise of Expanded Female Education: Trends in the Age at First Birth in Malawi

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.

Community influences on contraceptive use in Mozambique

Fertility in sub-Saharan Africa remains the highest in the world. Yet, the average contraceptive prevalence in Africa is the lowest in major world regions and there is limited understanding of the mechanisms through which community context shapes contraceptive use in the region. Using data from the 2011 Mozambique Demographic and Health Survey, we examine the mechanisms through which community context influences women's use of modern methods of contraception in Mozambique. We find that community context influences the use of modern methods of contraception by shaping the environment in which women live.

Unintended pregnancies among young women living in urban slums: evidence from a prospective study in Nairobi city, Kenya

BACKGROUND

Despite the significant proportion of young people residing in slum communities, little attention has been paid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harsh environment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes, especially during this key developmental period. This paper aims to fill this research gap by examining the levels of and factors associated with unintended pregnancies among young women aged 15-22 in two informal settlements in Nairobi, Kenya.

METHODS

We use data from two waves of a 3-year prospective survey that collected information from adolescents living in the two slums in 2007-2010. In total, 849 young women aged 15-22 were considered for analysis. We employed Cox and logistic regression models to investigate factors associated with timing of pregnancy experience and unintended pregnancy among adolescents who were sexually active by Wave 1 or Wave 2.

FINDINGS

About two thirds of sexually experienced young women (69%) have ever been pregnant by Wave 2. For 41% of adolescents, the pregnancies were unintended, with 26% being mistimed and 15% unwanted. Multivariate analysis shows a significant association between a set of factors including age at first sex, schooling status, living arrangements and timing of pregnancy experience. In addition, marital status, schooling status, age at first sex and living arrangements are the only factors that are significantly associated with unintended pregnancy among the young women.

CONCLUSIONS

Overall, this study underscores the importance of looking at reproductive outcomes of early sexual initiation, the serious health risks early fertility entail, especially among out-of school girls, and sexual activity in general among young women living in slum settlements. This provides greater impetus for addressing reproductive behaviors among young women living in resource-poor settings such as slums.

Disparities in modern contraception use among women in the Democratic Republic of Congo: a cross-sectional spatial analysis of provincial variations based on household survey data

This study investigates inequalities at the province level of the use of modern contraception and the proportion of short birth intervals among women in the DRC using data from the 2007 Demographic and Health Survey. Logistic regression and Bayesian geo-additive models were used. The posterior odds ratio and the associated 95% credible interval (95% CI) were estimated using Markov Chain Monte Carlo (MCMC) techniques. Posterior spatial effects were mapped at the province level with the associated posterior probability maps showing statistical significance at 5%. The overall rates of modern contraception use among the entire sample of women (15-49 years old; N = 7172) and youth (15-24 years old; N = 1389) were 5.7% and 6.0% respectively. However, there was striking variation in contraceptive use between the two groups across provinces with a clear east-to-west gradient. The highest use in the total sample was in Nord-Kivu (OR 1.32; 95% CI 1.12, 1.55) and Bas Congo provinces (1.47; 1.22, 1.78). For the youth, the highest use was observed in Nord-Kivu (1.19; 0.92, 1.65). In multivariate Bayesian geo-additive regression analyses among the entire sample of women, factors consistently associated with lower use of modern contraception were living in rural areas (0.71; 0.62, 0.82), living in low-income households (0.67; 0.54, 0.80) and having no education (0.83; 0.67, 0.97). For the youth sample, living in low-income households (0.57; 0.41, 0.84) and no breast-feeding (0.64; 0.47, 0.86) were consistently associated with a lower use of modern contraception. The study shows a distinct geographic pattern in the use of modern contraception in youth and the entire sample of women in the DRC, suggesting a potential role for socioeconomic factors, such as accessibility, affordability and availability, as well as environmental factors at the province level beyond individual-level risk factors.

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

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.

Community-level education accelerates the cultural evolution of fertility decline

Explaining why fertility declines as populations modernize is a profound theoretical challenge. It remains unclear whether the fundamental drivers are economic or cultural in nature. Cultural evolutionary theory suggests that community-level characteristics, for example average education, can alter how low-fertility preferences are transmitted and adopted. These assumptions have not been empirically tested. Here, we show that community-level education accelerates fertility decline in a way that is neither predicted by individual characteristics, nor by the level of economic modernization in a population. In 22 high-fertility communities in Poland, fertility converged on a smaller family size as average education in the community increased-indeed community-level education had a larger impact on fertility decline than did individual education. This convergence was not driven by educational levels being more homogeneous, but by less educated women having fewer children than expected, and more highly educated social networks, when living among more highly educated neighbours. The average level of education in a community may influence the social partners women interact with, both within and beyond their immediate social environments, altering the reproductive norms they are exposed to. Given a critical mass of highly educated women, less educated neighbours may adopt their reproductive behaviour, accelerating the pace of demographic transition. Individual characteristics alone cannot capture these dynamics and studies relying solely on them may systematically underestimate the importance of cultural transmission in driving fertility declines. Our results are inconsistent with a purely individualistic, rational-actor model of fertility decline and suggest that optimization of reproduction is partly driven by cultural dynamics beyond the individual.