Single Motherhood and Child Mortality in Sub-Saharan Africa: A Life Course Perspective

Single motherhood in sub-Saharan Africa has received surprisingly little attention, although it is widespread and has critical implications for children’s well-being. Using survival analysis techniques, we estimate the probability of becoming a single mother over women’s life course and investigate the relationship between single motherhood and child mortality in 11 countries in sub-Saharan Africa. Although a mere 5 % of women in Ethiopia have a premarital birth, one in three women in Liberia will become mothers before first marriage. Compared with children whose parents were married, children born to never-married single mothers were significantly more likely to die before age 5 in six countries (odds ratios range from 1.36 in Nigeria to 2.61 in Zimbabwe). In addition, up to 50 % of women will become single mothers as a consequence of divorce or widowhood. In nine countries, having a formerly married mother was associated with a significantly higher risk of dying (odds ratios range from 1.29 in Zambia to 1.75 in Kenya) relative to having married parents. Children of divorced women typically had the poorest outcomes. These results highlight the vulnerability of children with single mothers and suggest that policies aimed at supporting single mothers could help to further reduce child mortality in sub-Saharan Africa.     

The links between women’s employment and children at home: Variations in low- and middle-income countries by world region

As fertility declines in low- and middle-income countries, the time women devote to childbearing and rearing may also be reduced. This shift has been described as one of the positive consequences of the demographic transition, as it opens opportunities for women to pursue educational and employment opportunities that were previously constrained by the demands of bearing and raising children. We estimate the numbers of children residing at home (with their mother) for women in 58 countries in Asia, Latin America, the Middle East and North Africa, and sub-Saharan Africa. We then examine the association between women’s employment and having children at home. Finally, we assess trends over recent decades in the relationship between employment and childbearing, and differences in this relationship by mother’s occupation. We find a negative association between women’s employment and having children at home; this association varies substantially by world region, age of child, and mother’s occupation.     

The Impact of Family Transitions on Child Fostering in Rural Malawi

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3–14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children’s current foster homes offers new insights into the reasons children are sent to live with others besides their parents.     

Maternal union instability and childhood mortality risk in the Global South, 2010–14

Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children’s mortality risk in Africa, Latin America and the Caribbean, and Asia using children’s actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability—regardless of current union status—may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.     

HIV and fertility in Africa: first evidence from population-based surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. We utilize recent rounds of the demographic and health surveys that link an individual woman’s fertility outcomes to her HIV status based on testing. The data allow us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that although HIV-infected women have significantly lower fertility, local community HIV prevalence has no significant effect on noninfected women’s fertility.     

Organized Violence and Institutional Child Delivery: Micro-Level Evidence From Sub-Saharan Africa, 1989–2014

The conditions under which a mother gives birth greatly affect the health risk of both the mother and the child. This article addresses how local exposure to organized violence affects whether women give birth in a health facility. We combine geocoded data on violent events from the Uppsala Conflict Data Program with georeferenced survey data on the use of maternal health care services from the Demographic and Health Surveys. Our sample covers 569,201 births by 390,574 mothers in 31 countries in sub-Saharan Africa. We use a mother fixed-effects analysis to estimate the effect of recent organized violence events within a radius of 50 km of the home of each mother on the likelihood that her child is born in a health facility. The results indicate that geographical and temporal proximity to organized violence significantly reduces the likelihood of institutional births. Although the level of maternal health care overall is lower in rural areas, the negative effect of violence appears to be stronger in urban areas. The study further underscores the importance of household and individual resilience, indicating that the effect of organized violence on institutional child delivery is greater among poor and less-educated mothers.     

Parents’ education as a determinant of educational childcare time

We analyze the relationship between parents’ education and the time devoted to childcare activities, with a focus on activities aimed at increasing the child’s human capital. We use the sample of opposite-sex couples with children under age 18, from Spain (2002) and the UK (2000), included in the Multinational Time Use Study. By estimating a seemingly unrelated regressions tobit model, we find that mothers’ education is associated with an increase in the time devoted to educational childcare by fathers in both Spain and the UK, while it is associated with an increase in the time devoted to educational childcare by mothers in Spain. We also find that fathers’ education has no effect on the time devoted to educational childcare time by either parent. It seems that what really matters in determining the time devoted to educational childcare at the couple level is the educational level of the mother.     

The Impact of the AIDS Pandemic on Health Services in Africa: Evidence from Demographic and Health Surveys

We document the impact of the AIDS crisis on non-AIDS-related health services in 14 sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is the largest in regions that have developed the highest rates of HIV. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions shouldering the heaviest burdens have seen the largest erosion in non-HIV-related health services for pregnant women and children. Using semiparametric techniques, we can date the beginning of the divergence in the use of antenatal care and in children’s immunizations between high- and low-HIV regions to the mid-1990s.     

Rural–Urban Child Height for Age Trajectories and Their Heterogeneous Determinants in Four Developing Countries

The large literature on health differentials between rural and urban areas relies almost exclusively on cross-sectional data. Bringing together the demographic literature on area-level health inequalities with the bio-physiological literature on children’s catch-up growth over time, this paper uses panel data to investigate the stability and origins of rural–urban health differentials. Using data from the Young Lives longitudinal study of child poverty, I present evidence of large level differences but similar trends in rural versus urban children’s height for age in four developing countries. Further, observable characteristics of children’s environment such as their household wealth, mother’s education, and epidemiological environment explain these differentials in most contexts. In Peru, where they do not, children’s birthweight and mothers’ health and other characteristics suggest that initial endowments—even before birth—may play an important role in explaining "residual" rural–urban child height inequalities. These latter results imply that prioritizing maternal nutrition and health is essential—particularly where rural–urban height inequalities are large. Interventions to reduce area-level health inequalities should begin even before birth.     

New evidence about effects of reproductive variables on child mortality in sub-Saharan Africa

There is still considerable uncertainty about how reproductive factors affect child mortality. This study, based on Demographic and Health Survey data from 28 countries in sub-Saharan Africa, shows that mortality is highest for firstborn children with very young mothers. Other children with young mothers, or of high birth order, also experience high mortality. Net of maternal age and birth order, a short preceding birth interval is associated with above average mortality. These patterns change, however, if time-invariant unobserved mother-level characteristics of importance for both mortality and fertility are controlled for in a multilevel–multiprocess model. Most importantly, there are smaller advantages associated with longer birth intervals and being older at first birth. The implications of alternative reproductive ‘strategies’ are discussed, taking into account that if the mother is older at birth, the child will also be born in a later calendar year, when mortality may be lower.     

Children's living arrangements in developing countries

This paper documents the wide variation in living arrangements experienced by children in developing regions using data from 19 Demographic and Health Surveys. Traditionally, researchers and policymakers concerned with child welfare have assumed that, apart from exceptional cases, children live with their mothers, experience childhood together with their siblings, and have access to resources from both biological parents. Data presented in this paper contradict this assumption. The data demonstrate that, in many countries of sub-Saharan Africa and Latin America as opposed to parts of Asia and North Africa, children spend substantial proportions of their childhood years apart from one or both parents and, by extension, apart from at least some of their siblings. The mothers of many of these children do not live with a partner or are in marital circumstances that may attenuate the link between the child and the father. In countries where child fostering is practiced, the likelihood that children will live apart from their mothers is negatively related to their mother's access to the resources of their fathers and other relatives and positively related to the number of younger siblings. The focus of the paper is on four essential elements of children's living arrangements that influence their access to resources: (1) mother-child co-residence, (2) father-child coresidence, (3) household structure and (4) the number, presence and spacing of siblings. The research suggests that significant proportions of young children, particularly in sub-Saharan Africa, benefit from the support provided by family members other than their parents. This support, which involves the coresidence of family members beyond the nuclear unit, can take many forms: the co-residence of three generations within the same household, the inclusion of a single mother and her children as a sub-family within a more complex household, or the exchange of children between kin. Surprisingly, despite enormous variations between countries in current fertility rates (ranging from roughly 2 to 7 births per woman), children in countries as diverse as Thailand and Mali spend their childhood with no more than 2 to 3 children on average sharing the same household. Thus, childhood as it is experienced in many parts of the developing world has much that is common despite apparent differences and much else that is different despite apparent similarities.This is a substantially revised version of a paper presented at the Demographic and Health Surveys World Conference in Washington, DC, 5–7 August 1991.     

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.     

The intergenerational transmission of human capital: the role of skills and health

We provide new evidence on some of the mechanisms reflected in the intergenerational transmission of human capital. Applying both an adoption and a twin design to rich data from the Swedish military enlistment, we show that greater parental education increases sons’ cognitive and non-cognitive skills, as well as their health. The estimates are in many cases similar across research designs and suggest that a substantial part of the effect of parental education on their young adult children’s human capital works through improving their skills and health.     

Educational reversals and first-birth timing in sub-saharan africa: A dynamic multilevel approach

In many areas throughout sub-Saharan Africa, young adult cohorts are less educated than their predecessors because of declines in school enrollments during the 1980s and 1990s. Because a woman with little education typically becomes a mother earlier and has more children than one with better education, and because of a similar well-established relationship between current education and current fertility at the societal level, one might expect such education reversals to raise fertility. However, if there is an additional negative effect of low educational level among currently young women compared with that in the past, which would accord with ideas about the impact of relative deprivation, the total effect of an education reversal may run in either direction. This possibility has not been explored in earlier studies, which have taken a more static approach. We focus on the initiation of childbearing. Using Demographic and Health Survey data from 16 sub-Saharan African countries with multiple surveys, we estimate a fixed-effects multilevel model for first births that includes the woman's own education, community education, and community education relative to the past. There are negative effects of individual and community education, but no effect of relative education. Thus we conclude that education reversals do seem to speed up entry into parenthood.     

The consequences of HIV/AIDS in Eastern Africa on mothers,children, and orphans

Orphanhood is a sad and unique problem of the HIV pandemic, compared with other epidemics, for generally both parents will be infected and will tend to die during young adulthood, leaving behind young children. The rising morbidity and mortality of HIV-infected mothers and fathers threaten to decrease the care and resources spent on children and to increase the prevalence of orphanhood. However, the extent and impact of orphanhood due to HIV/AIDS are not known. This paper presents two aspects of HIV infection and its impact on women and children in sub-Saharan Africa: the results of two analyses of the HIV-attributable mortality of mothers and the orphanhood of their young children.     

Altruism Within the Family: A Comparison of Father and Mother Using Life Happiness and Life Satisfaction

Studies on intra-household allocation of resources show that exogenous increase in mothers’ income has larger effect on children’s outcomes than the same increase in fathers’ income, suggesting gender differences may exist in parents’ altruism towards their children. Using self-reported life happiness and life satisfaction, we investigate the differences by gender in mutual altruism between father and child as well as mother and child dyads in Singapore. We found that mutual altruism exists between mother and child, but not between father and child. These findings are robust to the measure of self-reported well-being. Further, we find that gender difference in altruism of fathers and mothers is not driven by the difference in the extent of future old age support desired by fathers and mothers from their children.     

Early Childbearing,School Attainment,and Cognitive Skills: Evidence From Madagascar

Female secondary school attendance has recently increased in sub-Saharan Africa, and so has the risk of becoming pregnant while attending school. We analyze the impact of teenage pregnancy on young women’s human capital using longitudinal data in Madagascar that capture the transition from adolescence to adulthood for a cohort aged 21–24 in 2012, first interviewed in 2004. We find that early childbearing increases the likelihood of dropping out of school and decreases the chances of completing secondary school. This pregnancy-related school dropout also has a detrimental impact on standardized test scores in math and French. We instrument early pregnancy with the young woman’s community-level access and her exposure to condoms since age 15 after controlling for pre-fertility socioeconomic conditions. Our results are robust to different specifications that address potential endogeneity of program placement and instrument validity.     

When Does Time Matter? Maternal Employment,Children’s Time With Parents,and Child Development

This study tests the two assumptions underlying popularly held notions that maternal employment negatively affects children because it reduces time spent with parents: (1) that maternal employment reduces children’s time with parents, and (2) that time with parents affects child outcomes. We analyze children’s time-diary data from the Child Development Supplement of the Panel Study of Income Dynamics and use child fixed-effects and IV estimations to account for unobserved heterogeneity. We find that working mothers trade quantity of time for better “quality” of time. On average, maternal work has no effect on time in activities that positively influence children’s development, but it reduces time in types of activities that may be detrimental to children’s development. Stratification by mothers’ education reveals that although all children, regardless of mother’s education, benefit from spending educational and structured time with their mothers, mothers who are high school graduates have the greatest difficulty balancing work and childcare. We find some evidence that fathers compensate for maternal employment by increasing types of activities that can foster child development as well as types of activities that may be detrimental. Overall, we find that the effects of maternal employment are ambiguous because (1) employment does not necessarily reduce children’s time with parents, and (2) not all types of parental time benefit child development.     

Africa's expanding population: old problems,new policies

Sub-Saharan Africa faces an historic challenge: to achieve economic and social progress while experiencing extraordinary population growth. With an estimated 1989 population of 512 million, the 42 countries of sub-Saharan Africa have the highest birth and death rates of any major world region. While death rates have fallen since the 1960s, persistently high birth rates yield annual growth rates above 3% in many countries. The United Nations projects that the region's population will increase 2.7 times by 2025--to 1.4 billion. Throughout the region, population has outstripped economic growth since the mid-1970s. In addition, many African countries are experiencing an epidemic of AIDS (Acquired Immunodeficiency Syndrome). The extent and demographic impact of the epidemic still are unknown, but disturbing social and political effects are already being felt. The region's population growth will slow only when African couples begin to have fewer children. The average number of children per woman ranges from 6 to 8 for most countries. The Africans' preference for large families is deeply rooted in the culture and fed by the perceived economic benefits they receive from their children. Economic stagnation during the 1980s prompted many national governments to recognize that rapid population growth was hindering their socioeconomic development. The political climate has shifted away from pronatalist or laissez-faire attitudes toward official policies to slow population growth. The policy formation process--detailed here for 4 countries (Zambia, Nigeria, Zaire, and Liberia)--is ponderous and beset with political and bureaucratic pitfalls, However, policy shifts in more and more countries combined with evidence of increased contraceptive use and fertility downturns in a few countries give some hope that the region's extraordinary population growth may have peaked and will start a descent. Whatever the case, the decade of the 1990s will be crucial for the future of sub-Saharan Africa.     

Disparities in Children’s Family Experiences by Mother’s Socioeconomic Status: The Case of Finland

A well-known argument claims that socioeconomic differentials in children’s family structures have become increasingly important in shaping child outcomes and the resources available to children in developed societies. One assumption is that differentials are comparatively small in Nordic welfare states. Our study examines how children’s experiences of family structures and family dynamics vary by their mother’s educational attainment in Finland. Based on register data on the childbearing and union histories of women in Finland born from 1969 onwards, we provide life-table estimates of children’s (N?=?64,162) experiences of family dissolution, family formation, and family structure from ages 0–15 years, stratified by mother’s education level at the child’s birth. We find huge socioeconomic disparities in children’s experiences of family structures and transitions. Compared to children of highly educated mothers, children of mothers with low levels of education are almost twice as likely to be born in cohabitation and four times as likely to be born to a lone mother. They are also much more likely to experience further changes in family structure—particularly parental separation. On average, children of low-educated mothers spend just half of their childhood years living with both their parents, whereas those of high-educated mothers spend four-fifths of their childhood with both parents. The sociodemographic inequalities among children in Nordic welfare states clearly deserve more scholarly attention.