Thomas LeGrand

Teenage pregnancy and child health in the urban Sahel.

Longitudinal data for more than 20,000 live births in the cities of Bamako (Mali) and Bobo-Dioulasso (Burkina Faso) are used to study the effects of young maternal age (less than 18 years and 18-19) on birth weight, child health care and feeding behavior, and child mortality, after controlling for other socioeconomic and demographic factors. Teenage pregnancies are associated with significantly worse prenatal health care and vaccination behavior, lower birth weights, earlier weaning, and, especially during the second year of life, higher mortality. A proxy for mothers school enrollment at the time of pregnancy is strongly linked to worse prenatal health behavior and weakly associated with other poor behaviors and health outcomes. Overall, the results highlight the importance of behavioral factors relative to strictly biological factors for explaining child health differentials.

The Effect of Fertility Reductions on Infant and Child Mortality: Evidence from Matlab in Rural Bangladesh

The role of family planning programmes and declining fertility in improving infant and child survival has been the subject of considerable debate. In this paper, we analyse data from Matlab, Bangladesh, to assess the net effect of falling total fertility on the mortality rates of young children. A real time-series models are estimated to determine the role of fertility decline after having controlled for the effects of other health service interventions. The results show that fertility reductions have little effect on neonatal and post-neonatal mortality, possibly a small effect on toddler (second-year) mortality, and a significant and relatively large impact on the mortality of children aged between two and four years. Possible explanations for these findings and their implications are discussed.

Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis

While the importance of antenatal care for maternal and child health continues to be debated, several researchers have documented its impact on intermediate variables affecting survival such as birth weight. These studies have also highlighted the problems of causality that are typically not taken into account when estimating the effects of antenatal care on skilled birth attendance. In this study, we revisit this relation in the rural areas of four countries: Ghana, Kenya, Uganda and Tanzania. Using a structural equation modeling approach that corrects for endogeneity, in all four countries we find that the usual simpler probit (or logit) models tend to underestimate the direct effect of antenatal care on skilled birth attendance. Furthermore, in two of the countries, this estimated effect is mediated by the range of services offered to women during antenatal care. These results suggest that governments and NGOs should place more importance on the role of antenatal care providers and on the services they offer, in efforts to promote skilled birth attendance.

Reproductive Decision Making and the HIV/AIDS Epidemic in Zimbabwe

The fertility-stimulating effect of high rates of child mortality on reproductive decision making (RDM) is a central tenet of population studies, yet the effects of the HIV/AIDS epidemic on RDM have not been thoroughly explored in the literature. This paper investigates how RDM is articulated in the context of high HIV/AIDS prevalence in Zimbabwe. Using qualitative methods (35 focus groups and 46 in-depth interviews), we found that childbearing is extremely important in the lives of adult Zimbabweans and that children are needed to cement the couples relationship, whether it is the first or subsequent marriage. Most respondents said that rates of both adult and child mortality were greatly increasing due to the AIDS epidemic. However, contrary to expectations based upon the insurance strategy, most respondents said that they would have fewer children as a result of the perceived increase in child mortality. They were also hesitant to continue childbearing after a child death, indicating only weak replacement motivation. Instead, many respondents expressed the desire to limit family size due to concerns about their own mortality and its negative effects on their children. Furthermore, new reproductive strategies seem to be emerging, which focus upon the health of parents and child and are based upon perceptions of 100 per cent maternal-infant HIV transmission. Adult HIV status is linked to child survival as respondents explained that having a healthy child who survives to age five indicates that the parents are also free of the virus and, at this point, they can safely continue childbearing. Additionally, couples who have experienced the death of a child are hesitant to give birth again because they believe future children would die. Finally, there was some talk of having children early in an attempt to avoid contracting HIV. This study presents evidence that Zimbabweans are altering their reproductive strategies in order to protect both parents and children from the threat of AIDS.

Profile: The Ouagadougou Health and Demographic Surveillance System

The Ouagadougou Health and Demographic Surveillance System (Ouaga HDSS), located in five neighbourhoods at the northern periphery of the capital of Burkina Faso, was established in 2008. Data on vital events (births, deaths, unions, migration events) are collected during household visits that have taken place every 10 months. The areas were selected to contrast informal neighbourhoods (∼40 000 residents) with formal areas (40 000 residents), with the aims of understanding the problems of the urban poor, and testing innovative programmes that promote the well-being of this population. People living in informal areas tend to be marginalized in several ways: they are younger, poorer, less educated, farther from public services and more often migrants. Half of the residents live in the Sanitary District of Kossodo and the other half in the District of Sig-Nonghin. The Ouaga HDSS has been used to study health inequalities, conduct a surveillance of typhoid fever, measure water quality in informal areas, study the link between fertility and school investments, test a non-governmental organization (NGO)-led programme of poverty alleviation and test a community-led targeting of the poor eligible for benefits in the urban context. Key informants help maintain a good rapport with the community. The Ouaga HDSS data are available to researchers under certain conditions.

The Impact of Childhood Mortality on Fertility in Six Rural Thanas of Bangladesh

In this article, we examine the relationship between child mortality and subsequent fertility using prospective longitudinal data on births and childhood deaths occurring to nearly 8,000 Bangladeshi mothers observed over the 1982–1993 period, a time of rapid fertility decline. Generalized hazard-regression analyses are employed to assess the effect of infant and child mortality on the hazard of conception, with controls for birth order and maternal age and educational attainment. Results show that childhood mortality reduces the time to subsequent conception if the death occurs within a given interval, representing the combined effect of biological and volitional replacement. The time to conception is also reduced if a childhood death occurs during a prior birth interval, a finding that signifies an effect of volitional replacement of the child that died. Moreover, mortality effects in prior birth intervals are consistent with hypothesized insurance (or hoarding) effects. Interaction of replacement with elapsed time suggests that the volitional impact of child mortality increases as the demographic transition progresses. This volitional effect interacts with sex of index child. Investigation of higher-order interactions suggests that this gender-replacement effect has not changed over time.

Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa

In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries.

The Possible Effects of Child Survival on Women's Ages at First Union and Childbirth in Sub-Saharan Africa

Improvements in childsurvival may lead to lower fertility throughseveral pathways. To date, most studies havefocused on the physiological and replacementeffects, whose impacts are known to be modestin size. Few have examined the potentially moreimportant insurance effect on fertility withinunion, and almost none have considered thepossible relationship between child mortalityand marriage, which could also grow out of aninsurance strategy. In this study, we use datafrom 21 sub-Saharan African countries to assessthe relationship between child mortality andyoung womens ages at first marriage andchildbirth. The results show that lower levelsof mortality are strongly associated with latermarriages and first births, even aftercontrolling for the effects of a large numberof other variables. The implications of thefindings are discussed and alternativeexplanations for this relationship arepresented.

Youth Migration and Transitions to Adulthood in Developing Countries

The articles in this volume address the following three themes: (1) migration in the context of transitions to adulthood, including schooling, employment, and family formation; (2) consequences of migration for health, reproductive outcomes, and childbearing; and (3) migration strategies and consequences. The articles demonstrate the diversity of situations of youth migration, transitions to adulthood, and the contexts in which they occur across developing countries. For some adolescents and young adults, migration brings with it serious risks and often negative consequences, while for others it opens horizons and is associated with expanding opportunities in both the social and economic spheres.

Is the Tap Locked? An Event History Analysis of Piped Water Access in Ouagadougou, Burkina Faso

In many respects, easy access to water of good quality and in adequate quantity can be regarded as a basic social service that is central to both health and socioeconomic development. Having piped water in the dwelling or in the yard remains the best way of having low cost and easily accessible water, compared with water vendors or standpipes. However, international data estimate that only 35 per cent of urban population in sub-Saharan Africa have piped water access. This research uses event history analysis methods to study the factors affecting sustained piped water access in Ouagadougou, the capital city of Burkina Faso, where only 23 per cent of the urban population had piped water in 2010. The analysis demonstrates the relationship between aspects of one’s life history—particularly residential status—and access to piped water. These results are discussed from the perspective of social and health issues.