Educational reversals and first-birth timing in sub-Saharan Africa: a dynamic multilevel approach

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.

Intramarital Status Differences across Africa's Educational Expansion

OBJECTIVE

This paper documents how intra-marital differences in educational status vary across Africa's heterogeneous educational expansion, which has encompassed an enormous breadth of educational opportunities over the past 50 years.

BACKGROUND

Educational expansion influences intra-marital status differences both by altering the educational composition of men and women and by reconfiguring the social conventions associated with a given educational context. Status differentials between marital partners can influence spousal wellbeing and, in the aggregate, determine the extent to which marriage provides a pathway to upward social mobility.

METHOD

Using Demographic and Health Survey data representing 32 sub-Saharan African countries and 5 decades of birth cohorts, the paper examines the prevalence and propensity of educational pairings as a function of educational access (the percentage of a cohort who ever attended school) and wife's education level.

RESULTS

Educational expansion created gendered changes in educational compositions of married individuals, which led to increased prevalence of hypergamy (wives who married "up") in most countries. Educational expansion has also led hypogamous marriages to become less of a social aberration: in lower-education contexts (but less so in higher-education contexts), conventions lead women to "marry down" at far lower rates than would be expected based on the sex-specific compositions of husbands and wives.

CONCLUSION

Educational attainment remains a central determinant of social positioning in African society. However, as schooling expands across the continent, social conventions regarding educational status are playing a weakening role in determining who marries whom.

Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries

BACKGROUND

Women's empowerment has a direct impact on maternal and child health care service utilization. Large scope measurement of contraceptive use in several dimensions is paramount, considering the nature of empowerment processes as it relates to improvements in maternal health status. However, multicountry and multilevel analysis of the measurement of women's empowerment indicators and their associations with contraceptive use is vital to make a substantial intervention in the Sub-Saharan Africa context. Therefore, we investigated the impact of women's empowerment on contraceptive use among women in sub-Saharan Africa countries.

METHODS

Secondary data involving 474,622 women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 32 Sub-Saharan Africa region was used in this study. Contraceptive use was the primary outcome variable. Multilevel analysis was conducted to examine the impact of women's empowerment on contraceptive use. Percentages were conducted in univariate analysis. Furthermore, multilevel logistic regression models were used to analyze the association between individual, compositional and contextual factors of contraceptive use.

RESULTS

Results showed large disparities in the number of women who reportedly ever use contraceptive methods; this range from as low as 6.7% in Chad and as much as 72% in Namibia. More than one-third of the respondents had no formal education and more than half were active labor force. Contraceptive use was significantly more common among respondents from the richest households (28.5% versus 18.9%). Various components of women's empowerment were positively significantly associated with contraceptive use after adjusting for demographic and socioeconomic factors. There was a significant variation in the odds of contraceptive use across the 32 countries (σ2= 1.12, 95% CrI 0.67 to 1.87) and across the neighbourhoods (σ2= 0.95, 95% CrI 0.92 to 0.98).

CONCLUSIONS

Our findings suggest that an increase in contraceptive use and by better extension maternal health care services utilization can be achieved by enhancing women's empowerment. Also, an increase in decision-making autonomy by women, their participation in labour force, reduction in abuse and violence and improved knowledge level are all key issues to be considered. Health-related policies should address inequalities in women's empowerment, education and economic status which would yield benefits to individuals, families, and societies in general.

The Geography of Gender Inequality

Reducing gender inequality is a major policy concern worldwide, and one of the Sustainable Development Goals. However, our understanding of the magnitude and spatial distribution of gender inequality results either from limited-scale case studies or from national-level statistics. Here, we produce the first high resolution map of gender inequality by analyzing over 689,000 households in 47 countries. Across these countries, we find that male-headed households have, on average, 13% more asset wealth and 303% more land for agriculture than do female-headed households. However, this aggregate global result masks a high degree of spatial heterogeneity, with bands of both high inequality and high equality apparent in countries and regions of the world. Further, areas where inequality is highest when measured by land ownership generally are not the same areas that have high inequality as measured by asset wealth. Our metrics of gender inequality in land and wealth are not strongly correlated with existing metrics of poverty, development, and income inequality, and therefore provide new information to increase the understanding of one critical dimension of poverty across the globe.

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.

The Oportunidades conditional cash transfer program: effects on pregnancy and contraceptive use among young rural women in Mexico

CONTEXT

Oportunidades is a large conditional cash transfer program in Mexico. It is important to examine whether the program has any direct effect on pregnancy experience and contraceptive use among young rural women, apart from those through education.

METHODS

Data from the 1992, 2006 and 2009 waves of a nationally representative, population-based survey were used to describe trends in pregnancy experience, contraceptive use and education among rural adolescent (15-19) and young adult (20-24) women in Mexico. To examine differences in pregnancy experience and current modern contraceptive use among young women, multivariable logistic regression analyses were conducted between matched 2006 samples of women with and without exposure to Oportunidades, predicted probabilities were calculated and indirect effects were estimated.

RESULTS

Over the three survey waves, the proportion of adolescent and young adult women reporting ever being pregnant stayed flat (33-36%) and contraceptive use increased steadily (from 13% in 1992 to 19% in 2009). Educational attainment rose dramatically: The proportion of women with a secondary education increased from 28% in 1992 to 46% in 2009. In multivariable analyses, exposure to Oportunidades was not associated with pregnancy experience among adolescents. Educational attainment, marital status, pregnancy experience and access to health insurance--but not exposure to Oportunidades--were positively associated with current modern contraceptive use among adolescent and young adult women.

CONCLUSION

Through its effect on education, Oportunidades indirectly influences fertility among adolescents. It is important for Mexico to focus on strategies to increase contraceptive use among young rural nulliparous women, regardless of whether they are enrolled in Oportunidades.

Fertility Transitions and Schooling: From Micro- to Macro-Level Associations

Research on the schooling implications of fertility transitions often faces an aggregation problem: despite policy interest in macro-level outcomes, empirical studies usually focus on the micro-level effects of sibsize on schooling. This article proposes an aggregation framework for moving from micro- to macro-level associations between fertility and schooling. The proposed framework is an improvement over previous aggregation methods in that it considers concurrent changes in the effects of sibsize, socioeconomic context, and family structure. The framework is illustrated with data from six sub-Saharan countries. Possible extensions are discussed.

Neighborhoods and Fertility in Accra, Ghana: An AMOEBA-based Approach

Fertility levels remain high in most of sub-Saharan Africa, despite recent declines, and even in a large capital city such as Accra, Ghana, women are having children at a pace that is well above replacement level and this will contribute to significant levels of future population growth in the city. Our purpose in this paper is to evaluate the way in which neighborhood context may shape reproductive behavior in Accra. In the process, we introduce several important innovations to the understanding of intra-urban fertility levels in a sub-Saharan African city: (1) despite the near explosion of work on neighborhoods as a spatial unit of analysis, very little of this research has been conducted outside of the richer countries; (2) we characterize neighborhoods on the basis of local knowledge of what we call "vernacular neighborhoods"; (3) we then define what we call "organic neighborhoods" using a new clustering tool-the AMOEBA algorithm-to create these neighborhoods; and then (4) we evaluate and explain which of the neighborhood concepts has the largest measurable contextual effect on an individual woman's reproductive behavior. Multi-level regression analysis suggests that vernacular neighborhoods are more influential on a woman's decision to delay marriage, whereas the organic neighborhoods based on socioeconomic status better capture the factors that shape fertility decisions after marriage.

Reproductive inequality in sub-Saharan Africa: differentials versus concentration

Within developing countries, our understanding of reproductive inequality-how fertility is distributed within a population-has been shaped largely by studies of fertility differentials, a practical but partial-information measure. In this study, we examine whether exclusive reliance on differentials biases this understanding. Findings based on recent data from sub-Saharan Africa show bias. We find that historical and especially cross-country comparisons can yield substantially different conclusions about the magnitude and even the direction of inequality patterns and trends, depending on whether differentials or fuller-information measures are used. For instance, the fertility differentials associated with education have remained relatively stable as national fertility has fallen, but inequality (as calculated by a fuller measure) has increased. Such results underscore the value of complementing existing studies of fertility differentials with analyses based on fuller-information measures. The analyses also show how change in differential fertility behavior and in the educational composition of national populations has shaped recent variations in reproductive inequality in the region.