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

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 ( ) – Malawi (2004) – Zimbabwe ( ) Life course approach by using five-year retrospective marital history calendars

Marital History Calendar DHS Malawi 2004 ……

Analytic Samples EthiopiaKenyaMalawiTanzaniaZimbabwe Q1: All women14,0708,19511,69810,3298,907 Q2: All children born in calendar11,2106,40912,26810,0406,073

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 Kenya Malawi Zimbabwe Cumulative Risk of Single Motherhood

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 Where = hazard that child i of mother j dies at time t Marstat=Marital status of mother (time-varying) Mother=Mother’s characteristics Child=Child’s characteristics  =Child’s age (time function) u=Mother-level random effect

Key Variables Ethiopia Kenya Malawi Tanzania Zimbabwe Child died < 57.9%8.1%9.0%8.1%6.4% Marital Status a Never SM b 93.0%83.0%84.5%84.1%82.1% Ever SM7.0%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

Types of Single Motherhood Ethiopia Kenya Malawi Tanzania Zimbabwe Marital Status a Never SM b 93.0%83.0%84.5%84.1%82.1% Ever SM7.0%17.0%15.5%15.9%18.0% Premarital SM0.8% 8.8% 3.6% 6.4% 6.0% Postmarital SM 6.1% 8.2% 11.9% 9.5% 12.0% Divorced c (3.8%)(5.1%)(7.0%)(5.8%)(6.6%) Widowhood c (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

(Re)marriage among Single Mothers Ethiopia Kenya Malawi Tanzania Zimbabwe Marital Status a Never SM b 93.0%83.0%84.5%84.1%82.1% Premarital SM0.6% 6.2% 1.9% 3.9% 4.3% Postmarital SM5.6% 7.6% 9.6% 8.0% 11.0% (Re)married0.8%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.

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 45 th 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 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