Carren Ginsburg

South African-ness among Adolescents: The Emergence of a Collective Identity within the Birth to Twenty Cohort Study.

The authors assessed the emergence of a South African identity among Black, Colored (mixed ancestral origin), White (predominantly English speaking), and Indian adolescents participating in a birth cohort study called “Birth to Twenty” in Johannesburg, South Africa. They examined young peoples certainty of their self-categorization as South African; the centrality of their personal, racial, linguistic, and South African identities in their self-definition; and their perceptions of South African life and society today. These results reflect a historical opportunity for full citizenship and national enfranchisement that the end of apartheid heralded for Black and Colored individuals. Black and Colored youth tend to be more certain about their South African-ness, have a more collective identity, and have a more positive perception around South Africa. In contrast, White and Indian youth are less certain about their South African-ness, have a more individualistic identity, and have a less positive perception about South Africa today.

In-migration and Living Conditions of Young Adolescents in Greater Johannesburg, South Africa

Abstract While migration in South Africa has been studied on a broad canvas, there have been few accounts of childrens migration and the effects on living conditions and wellbeing. This article compares the access to services, housing and household amenities, and family characteristics of children born in the Greater Johannesburg metropolis with those of in-migrant children. The article also examines other indicators of child wellbeing related to parental care and schooling. In-migrant children, particularly children who have lived previously in rural areas and/or have recently migrated into the city, are significantly disadvantaged in comparison to long-term resident children in terms of parental education and occupation, housing type and ownership, access to electricity, refuse removal, water and sanitation. In-migrant children also live in households that are less likely to have amenities such as a refrigerator, television, washing machine, telephone and motor vehicle. In terms of child indicators, in-migrant children enjoy less frequent parental contact and are twice as likely to start school later than resident children. Whilst urbanisation to South Africas metropolitan centres is generally associated with several widely recognised benefits, for children, these benefits may be tempered by the disadvantages of in-migrant families known to be associated with child wellbeing.

Healthy or unhealthy migrants? : Identifying internal migration effects on mortality in Africa using health and demographic surveillance systems of the INDEPTH network

Migration has been hypothesised to be selective on health but this healthy migrant hypothesis has generally been tested at destinations, and for only one type of flow, from deprived to better-off areas. The circulatory nature of migration is rarely accounted for. This study examines the relationship between different types of internal migration and adult mortality in Health and Demographic Surveillance System (HDSS) populations in West, East, and Southern Africa, and asks how the processes of selection, adaptation and propagation explain the migration-mortality relationship experienced in these contexts. The paper uses longitudinal data representing approximately 900 000 adults living in nine sub-Saharan African HDSS sites of the INDEPTH Network. Event History Analysis techniques are employed to examine the relationship between all-cause mortality and migration status, over periods ranging from 3 to 14 years for a total of nearly 4.5 million person-years. The study confirms the importance of migration in explaining variation in mortality, and the diversity of the migration-mortality relationship over a range of rural and urban local areas in the three African regions. The results confirm that the pattern of migration-mortality relationship is not exclusively explained by selection but also by propagation and adaptation. Consequences for public health policy are drawn.

The silent truth of teenage pregnancies - Birth to Twenty cohort's next generation

To the Editor: By the 1970s teenage pregnancies were recognised as a problem worldwide. Initially the major concern focused on the potential biological risks of obstetric complications in adolescents. Subsequent studies indicated that teen pregnancies do not present any problems unanticipated among primipara generally.1 Studies on the possible social and psychological problems associated with adolescent childbearing confirmed that lack of social support was a risk factor for the adjustment and development of both young mothers and their children.2 Recent concerns about teen pregnancies have centred on the disruption that childbearing causes to the educational and occupational trajectories of young women, consequently maintaining and exacerbating poverty.3 While teen pregnancy rates have fallen in most European countries except the UK, they remain an enormous challenge in the USA, where 1 in 3 women conceives her first child before the age of 20. South African newspapers have again recently reported escalating pregnancy rates among schoolgoing girls.4 Speculation that child support grants could be acting as an incentive for young girls to fall pregnant prompted the Department of Social Development to undertake a formal investigation into this possibility.5 However, available data suggest that there is no connection between the two. There has been no systematic enquiry into the characteristics of the men who impregnate teenage girls. It is frequently claimed, although less often substantiated, that adolescent girls are often involved sexually with older men in relationships where gifts of money, clothes, school fees and other goods are exchanged for sexual favours. There is a barely disguised moral opprobrium towards teen sexuality, especially among young women, and a deep ambivalence about teenage pregnancies, how they should be recognised and managed, and how they might be prevented and/or serviced to reduce negative effects on young parents and their children. In 1990 the Department of Health estimated the teenage pregnancy rate to be 330/1 000 women under the age of 19 years (52/1 000 in the USA in 2000). Among blacks, the proportion of births resulting from teenage pregnancies is reported to have risen from 12.4% in 1984 to 15.5% in 1991. In 1994, the rate in KwaZulu-Natal was estimated at 15.3%. The 1998 South African Demographic and Health Survey revealed that approximately 2.4% of the adolescent girls surveyed had fallen pregnant by the age of 15, with 35% of the sample reporting a pregnancy by the age of 19. The LoveLife survey conducted by the Reproductive Health Research Unit in 2003 indicated that the rate of teenage pregnancies in South Africa had not diminished despite initiatives to improve reproductive health counselling and related services. These included sexuality education in the lifeskills curriculum in schools, access to contraception and termination of pregnancy without parental consent through public health services, widespread communication campaigns, access to condoms through HIV prevention efforts, and national campaigns to challenge mens coercive sex domination of women. The Birth to Twenty longitudinal study of child health and development conducted at the University of the Witwatersrand provides insight into some issues around teenage pregnancy. In 1989/1990, 3 273 pregnant women were enrolled into the study. At the time of delivery, 29 women (approximately 1% of the sample) were aged 15 years or younger and 12% of the sample were 19 years of age or younger. This study is currently moving into the next generation and children who formed part of the original birth cohort have begun to fall pregnant. To date, there have been 6 pregnancies reported within the second-generation cohort, with all the girls under the age of 14 years when they fell pregnant. Three of these young mothers were themselves children of teen mothers. A preliminary investigation demonstrated that young women, the fathers (18 - 22 years old), and their parents are locked into a silence of fear and shame preventing them from providing mutual support and from accessing available services. Sexual and reproductive health and educational services for young people are also subject to moral paralysis, rendering them equivocal in their dealings with teenage mothers and fathers, and leading young parents to experience these services as distant and inaccessible. In the case of Birth to Twentys first reported pregnancy, the young mother was 14 years old when she delivered her baby. At the time of her pregnancy, at just over 13 years of age, she was living with her mother and attending school. Despite having been exposed to school life skills programmes and having the benefit of family support, she was not using any form of contraception and had not accessed any counselling or health care services. She had not disclosed the pregnancy to her mother until the birth was imminent, and her mother did not say anything even though she could see that her daughter was pregnant. Johannesburg-Soweto is the most urbanised and one of the best-resourced areas of the country. Yet we were unable to offer sufficient help to this young mother with regard to the choice to be pregnant or not, enjoyment of a normal pregnancy, preparations for the baby with family support, and having her mother meet the boy and his family. One of the greatest barriers to assisting young people is their fear and shame about talking to the people who could potentially help them, viz. family, educators and health professionals. To date none of the young women we have seen told such people that they were pregnant until it was too late. They and their partners – at least those men who knew about the pregnancy – were depressed and anxious and did not know what to do about the situation. Other studies suggest that young people who become pregnant feel confused about their options and are ashamed and worried about the response of their families, teachers and others.6 Open and accepting communication among people who can help is necessary to deal with the personal and social problems of unwanted early pregnancies. Family members, teachers and professional nurses say that they wish teens in trouble would speak to them, so that they can assist them in making the best choices. However, studies of sexuality communication indicate that even when parents and schools think that they are talking to teens about sex, adolescents feel that they have not communicated enough.7 If we are serious about reducing teen pregnancy rates, when it comes to teen sexuality and protection, repeated talking and listening are required. Young people must be reassured that when they get into difficulty they can turn to us, and our behaviour must demonstrate that we will assist them rather than harangue and harass them. Access to services that enable adolescent boys and girls to make sexual and reproductive choices with the assistance of caring adults requires change to a mindset that is genuinely helpful.

Residential mobility, socioeconomic context and body mass index in a cohort of urban South African adolescents.

Adolescents who are changing residence, as well as their social and economic circumstances may experience lifestyle changes that have an effect on body composition outcomes such as undernutrition, overweight or obesity. This paper uses data from Birth to Twenty, a birth cohort of South African urban children, to determine the relationship between residential mobility and body mass index (BMI) amongst Black adolescents aged 15 (n=1613), and to examine the role of changes in household socioeconomic status (SES). The prevalence of overweight and obesity in the sample was 25% in females and 8% in males. Amongst the females, a strong positive association between residential mobility and BMI was observed for those who also experienced an increase in household SES between birth and 15 years (β=0.42, SE=0.13), while no effect was identified for males. The study shows the potential for environmental change and increased resources to influence the risk for obesity. It also highlights the value in considering the range of social environmental factors and changes across the early life course that might play a part in evolving nutritional patterns in urban transitioning environments.

A training manual for event history data management using Health and Demographic Surveillance System data

ObjectiveThe objective of this research note is to introduce a training manual for event history data management. The manual provides a first comprehensive guide to longitudinal Health and Demographic Surveillance System (HDSS) data management that allows for a step-by-step description of the process of structuring and preparing a dataset for the calculation of demographic rates and event history analysis. The research note provides some background information on the INDEPTH Network, and the iShare data repository and describes the need for a manual to guide users as to how to correctly handle HDSS datasets.ResultsThe approach outlined in the manual is flexible and can be applied to other longitudinal data sources. It facilitates the development of standardised longitudinal data management and harmonization of datasets to produce a comparative set of results.

Youth migration, livelihood prospects and demographic dividend: A comparison of the Census 2011 and Agincourt Health and Demographic Surveillance System in the rural northeast of South Africa

The 2011 South African national census shows a cohort of young adults comprising an increasing share of the population. This finding is borne out in longitudinal data from the Agincourt Health and Demographic Surveillance System (HDSS). This primarily descriptive paper uses the Agincourt HDSS to examine the migration, employment and unemployment patterns in young adults. The study reveals high levels of temporary labour migration linking rural areas to metropolitan areas and secondary urban places. The type of work conducted by young adults in the Agincourt population is predominantly unskilled labour for both sexes. However, there is some evidence of female employment increasing in more educated sectors. Across all working ages there is pronounced unemployment, but the main pressure is felt by the younger adult population. Education and skills development for both sexes should be strengthened to support the countrys efforts to vastly improve labour force participation amongst the youth.