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

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 Health

McGill University

Dana HamplováAssistant Professor & Research Associate

Charles University & Institute of Sociology, ASC

Social Statistics Speakers’ SeriesMcGill University

November 9, 2011

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)

Consequences of Single Motherhood

in Sub-Saharan Africa

1) Greater poverty among single mothers???

2) Poorer child outcomes???

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!

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

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

We need a better measure!

Single Motherhood Over the Life Course

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?

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

Marital History Calendar

DHS Malawi 2004

……

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

Question #1

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

course?

Pathways into Single Motherhood

Pre-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

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

Measure of Single Motherhood

• Examples of Premarital SM:

• Examples of Postmarital SM:





Marital History Calendar? ?

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.

Ethiopia

KenyaMalawi

Zimbabwe

Cumulative Risk of Single Motherhood

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

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age


Kenya

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age


Malawi

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age


Tanzania

0.1

.2.3

.4.5

.6.7

.8.9

1

10 15 20 25 30 35 40 45age


Zimbabwe

Nairobi, Kenya (HDSS)

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

Question #2

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

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

Key Variables


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.

Mother’s Characteristics

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

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

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

dd

s R

atio

- 1

**

***

*****

***

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

Od

ds

Rat

io -

1

**

* **

***

***

*

*

***

**

Types of Single Motherhood


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

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 SM

Postmarital SM

Od

ds

Rat

io -

1

***

******

***

***

*

***


-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 SM

Divorced

Widowed

Od

ds

Rat

io -

1

*** **

***

***

**

***

***

*

(Re)marriage among Single Mothers


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.

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

Od

ds

Rat

io -

1

**

***

***

***

* **

** *

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.

Data Limitations

What 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?

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

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

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

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

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