single motherhood and child mortality in sub-saharan africa: a life course perspective

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Single Motherhood and Child Mortality in Sub-Saharan Africa: A Life Course Perspective Shelley Clark Associate Professor of Sociology Canada Research Chair in Youth, Gender and Global Health McGill University Dana Hamplová Assistant Professor & Research Associate Charles University & Institute of Sociology, ASC Social Statistics Speakers’ Series McGill University November 9, 2011

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Single Motherhood and Child Mortality in Sub-Saharan Africa: A Life Course Perspective. Shelley Clark Associate Professor of Sociology Canada Research Chair in Youth, Gender and Global Health McGill University Dana Hamplová Assistant Professor & Research Associate - PowerPoint PPT Presentation

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Page 1: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Single Motherhood and Child Mortality in Sub-Saharan Africa:

A Life Course Perspective

Shelley ClarkAssociate Professor of Sociology

Canada Research Chair in Youth, Gender and Global HealthMcGill University

 

Dana HamplováAssistant Professor & Research Associate

Charles University & Institute of Sociology, ASC

Social Statistics Speakers’ SeriesMcGill UniversityNovember 9, 2011

Page 2: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Consequences of Single Motherhood

in North America & Europe

1) Greater poverty among single mothers (Bianchi, Subaiya and Kahn 1999; Holden and Smock 1991)

2) Poorer child outcomes (Amato 2000; Seltzer 1994)– cognitive development (Gennetian 2005)– behavioral adjustment (Magnuson and Berger 2009)– health outcomes (Angel and Worobey 1988; Dawson 1991)

Page 3: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Consequences of Single Motherhood

in Sub-Saharan Africa

1) Greater poverty among single mothers???

2) Poorer child outcomes???

Page 4: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Consequences of Female-Headed Households

on Poverty– Belief that rising rates of female-headed households

(FHHH) are evidence of the “feminization of poverty”

– Quisumbing and colleagues (2001) provide a careful study of the link between FHHH and poverty in 10 countries and discover that this link is rather weak and not consistent

– In studies of individual countries, sometimes FHHH are poorer and sometimes they are richer!

Page 5: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Consequences of Female-Headed Households

on Children’s Health

– South Africa: no relationship between the sex of household head and childhood mortality (Hargreaves et al. 2004)

– Kenya: Children in FHHH are more likely to be stunted, but less likely to suffer from wasting (Onyango, Tucker and Eisemon 1994).

– Several other studies describe a positive association between female-headed households and child health, as measured by food security and child nutrition

Page 6: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Problem with Measures of Female-Headed Households

• Why are some female-headed households richer?– Includes women married to migrant men– Over-represents economic “survivors”– Excludes “sub-families” or “disguised” FHHH– Ignores long-term effects for remarried women and their

children • Why are some children in FHHH healthier?

– All of the above– Women tend to invest a higher proportion of household

resources towards children

Page 7: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

We need a better measure!

Single Motherhood Over the Life Course

Page 8: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Our Research Questions

1) How common is it for women to experience an episode of single motherhood over their life course?

2) What are the effects of single motherhood on child mortality rates?

Page 9: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Data and Analytic Approach

• Demographic and Health Surveys (DHS)– Ethiopia (2005)– Kenya (2003)– Tanzania (2004-2005)– Malawi (2004)– Zimbabwe (2005-2006)

• Life course approach by using five-year retrospective marital history calendars

Page 10: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Marital History Calendar

DHS Malawi 2004

……

Page 11: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Analytic Samples

Ethiopia Kenya Malawi Tanzania Zimbabwe

Q1: All women 14,070 8,195 11,698 10,329 8,907

Q2: All children born in calendar 11,210 6,409 12,268 10,040 6,073

Page 12: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Question #1

How common is it for women to experience an episode of single motherhood over their life

course?

Page 13: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Pathways into Single MotherhoodPre-marital SM

• Gave birth before date of first marriage

Post-marital SM• Divorced or widowed with at

least one child under the age of 15

Page 14: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Data for Q1

• Marital Histories– Full dates of all union formations and dissolutions

during the calendar– Date of first union– Number of unions– Martial status at time of survey

• Birth Histories– Full birth dates of all children ever born– Full death dates if the child has died

Page 15: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Measure of Single Motherhood

• Examples of Premarital SM:

• Examples of Postmarital SM:

Marital History Calendar

Marital History Calendar

Marital History Calendar

Marital History Calendar

Marital History Calendar? ?

Page 16: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Models for Q1• Premarital SM: Competing risks models of having a first birth

before first marriage (1=premarital birth, 2=marriage, 3=censored (Coviello and Boggess 2004)

• Post-marital SM: Kaplan-Meier cumulative risk of becoming a single mother after first marriage by age. Left truncation for 13% of women in Zimbabwe and 19% in Ethiopia.

• Total SM: Kaplan-Meier cumulative failure curves for entry into single motherhood either before or after first marriage.

Page 17: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia

KenyaMalawi

Zimbabwe

Cumulative Risk of Single Motherhood

Page 18: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age

premarital single motherhood postmarital single motherhoodtotal single motherhood

Ethiopia

Page 19: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age

premarital single motherhood postmarital single motherhoodtotal single motherhood

Kenya

Page 20: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age

premarital single motherhood postmarital single motherhoodtotal single motherhood

Malawi

Page 21: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age

premarital single motherhood postmarital single motherhoodtotal single motherhood

Tanzania

Page 22: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age

premarital single motherhood postmarital single motherhoodtotal single motherhood

Zimbabwe

Page 23: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Nairobi, Kenya (HDSS)

Page 24: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Single Motherhood over the Life Course vs.

Current Measures of Female Headed Households

– 30% to 70% lifetime risk of single motherhood

– 9% to 16% currently single mothers

– 13% to 20% current FHHH

Page 25: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Question #2

What are the effects of single motherhood on child mortality rates?

Page 26: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Models for Q2

Random-effects discrete-time logit model

tijhWhere = hazard that child i of mother j dies at time t

Marstat=Marital status of mother (time-varying)Mother=Mother’s characteristicsChild=Child’s characteristics=Child’s age (time function)u=Mother-level random effect

Page 27: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Key Variables

  Ethiopia   Kenya   Malawi   Tanzania   Zimbabwe

Child died < 5 7.9% 8.1% 9.0% 8.1% 6.4%

Marital Statusa

Never SMb 93.0% 83.0% 84.5% 84.1% 82.1%

Ever SM 7.0% 17.0% 15.5% 15.9% 18.0%

                   a: In the last month of observation. b: Includes women married at the time of the child's birth or within six months of that date.

Page 28: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Mother’s Characteristics

• Education (4% Z to 77% E; no education) • Religion• Urban residence (11% M to 26% K & Z)• Household wealth (quintiles)• Region

Page 29: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Child’s Characteristics• Sex• Mother’s age at birth (16% E to 21% M; < 20)• Birth order• Previous birth interval (< 2 years)• Previous sibling’s death• Child’s age () (mean 2.5 years)

– First month– First year (months 1-11)– One to two years– Two to three years– Three to five years

Page 30: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia Kenya Malawi Tanzania Zimbabwe0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

The Effects of Ever Being a Single Mother on Child MortalityO

dds R

atio

- 1

**

***

*****

***

Page 31: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia Kenya Malawi Tanzania Zimbabwe-0.10

0.10

0.30

0.50

0.70

0.90

1.10

The Effects of Single Motherhood and Education on Child Mortality

Ever SM No Educ/Secondary

Odd

s Rat

io -

1

**

* **

***

***

*

*

***

**

Page 32: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Types of Single Motherhood

  Ethiopia   Kenya   Malawi   Tanzania   Zimbabwe

Marital Statusa

Never SMb 93.0% 83.0% 84.5% 84.1% 82.1%

Ever SM 7.0% 17.0% 15.5% 15.9% 18.0%

Premarital SM 0.8%   8.8%   3.6%   6.4%   6.0%

Postmarital SM 6.1%   8.2%   11.9%   9.5%   12.0%

Divorcedc (3.8%) (5.1%) (7.0%) (5.8%) (6.6%) Widowhoodc (1.7%) (2.5%) (2.1%) (1.8%) (4.1%)

                   

a: In the last month of observation.

b: Includes women married at the time of the child's birth or within six months of that date.

c: Excludes children whose mothers remarry by the time of the survey

Page 33: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia Kenya Malawi Tanzania Zimbabwe0

0.2

0.4

0.6

0.8

1

1.2

Effects of Premarital and Postmarital SM on Child Mortality

Never SM (ref)Premarital SMPostmarital SM

Odd

s Rat

io -

1

***

******

***

***

*

***

Page 34: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia Kenya Malawi Tanzania Zimbabwe

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

1.2

1.4Effects of Divorce and Widowhood on Child Mortality

Never SM (ref)Premarital SMDivorcedWidowed

Odd

s Rat

io -

1

*** **

***

***

**

***

***

*

Page 35: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

(Re)marriage among Single Mothers

  Ethiopia   Kenya   Malawi   Tanzania   Zimbabwe

Marital Statusa

Never SMb 93.0% 83.0% 84.5% 84.1% 82.1% Premarital SM 0.6%   6.2%   1.9%   3.9%   4.3% Postmarital SM 5.6%   7.6%   9.6%   8.0%   11.0% (Re)married 0.8% 3.2% 4.1% 4.0% 2.7%                   a: In the last month of observation. b: Includes women married at the time of the child's birth or within six months of that date.

Page 36: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Ethiopia Kenya Malawi Tanzania Zimbabwe0

1

2

3

4

5

6

Effects of Types of Single Motherhood on Child Mortality

Never SM (ref)

Premarital SM

Postmarital SM

(Re)married M

Odd

s Rat

io -

1

**

***

***

***

* **** *

Page 37: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Discussion and Conclusions• If current trends continue between 30% and 70% of young women in these

countries can expect to become a single mother at some point before reaching their 45th birthday.

• The pathways into single motherhood differ across countries.

• Having a single mother increases the odds of dying before the age of 5 between 43% and 83%.

• Children born to never married mothers are more likely to die in 3 of 5 countries, while children whose mothers are divorced or widowed have significantly higher rates of mortality in 4 of 5 countries.

• Children of divorced women tend to fare worse than children of widows.

• (Re)marriages do not tend to significantly improve the survival chances of children.

Page 38: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Data LimitationsWhat are the mechanisms linking single motherhood to poverty and child mortality?

– To what extent does greater poverty account for the relationship between single motherhood and child mortality?

– Where do the children of premarital, postmarital, and remarried single mothers live?

– What is it about these households that causes these children to suffer higher rates of mortality?

Page 39: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Postmarital SM and Poverty0.

000.

250.

500.

751.

00

10 15 20 25 30 35 40 45age

v190 = poorest v190 = poorerv190 = middle v190 = richerv190 = richest

Malawi: postmar after 1st mar: all

Page 40: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

0.00

0.25

0.50

0.75

1.00

10 15 20 25 30 35 40 45age

v190 = poorest v190 = poorerv190 = middle v190 = richerv190 = richest

Tanzania: postmar after 1st mar: all

Postmarital SM and Poverty

Page 41: Single  Motherhood  and Child Mortality  in  Sub-Saharan Africa:   A Life Course  Perspective

Future Research

• Need better retrospective and prospective data

1) (H)DSS in Ouagadougou, Burkina Faso• Urban setting with a mix of Muslim and Christian population• 80,000 individuals • Interviewed once a year

2) (H)DSS in Nairobi, Kenya• Straddles two slums in Nairobi, Korogocho and Viwandani• 70,000 men, women, and children is extremely poor• Collects data twice a year

3) (H)DSS in Agincourt, South Africa • Rural site covers one of the former homelands• 120,000 individuals in this site are refugees from Mozambique• Twice a year, follows moves and migrants

• Need qualitative interviews on women’s motherhood and marital histories