Pauvreté et fécondité en Côte-d’Ivoire. Pourquoi le malthusianisme de la pauvreté ne se vérifie-t-il pas ?

Après avoir rapporté les expériences de la baisse de la fécondité dans des populations pauvres du Bangladesh et de l’Amérique latine, les auteurs analysent les ressorts du début de la transition de la fécondité en Côte-d’Ivoire. Ils commencent par décrire l’émergence d’une volonté individuelle et gouvernementale de contrôle de la fécondité sous l’effet de la crise. Ils analysent ensuite, à partir des données des Enquêtes démographiques et de santé, les liens entre pauvreté individuelle, forte fécondité et faible pratique contraceptive. Finalement, les auteurs mettent en évidence, à l’aide d’une analyse multiniveau, les relations entre les niveaux de vie et les comportements de reproduction. Les résultats de ces analyses leur permettent de discuter des conditions de la transition de la fécondité et de montrer que le début de la baisse de la fécondité en Côte-d’Ivoire relève davantage d’une première phase d’une transition de modernisation dans un contexte de crise que d’un réel malthusianisme de la pauvreté.After presenting fertility decline in poor populations in Bangladesh and Latin America, the authors analyse the impulses behind the beginnings of fertility transition in Côte-d’Ivoire. They describe first the emergence of positive attitudes towards fertility control at both individual and governmental levels in this context of socio-economic crisis. After analysing the links between individual poverty, high fertility and low rates of contraceptive practice, using Demographic and Health Survey data, they use multilevel analysis to examine the relationship between standards of living and reproductive behaviour. The results provide the context for a discussion of the pre-conditions for fertility transition, and show that early fertility decline in Côte-d’Ivoire is a consequence of modernisation in a context of economic crisis rather than a real Malthusian response to poverty

Démographie et développement en Afrique : éléments rétrospectifs et prospectifs

Cet article examine les relations entre démographie, croissance économique et développement social en Afrique. Après avoir retracé les grandes lignes des dynamiques démographiques et montré la spécificité du continent dans le panorama général des transitions démographiques à l’échelle mondiale, les auteurs replacent les débats relatifs aux politiques de population et de développement dans le contexte africain. Ils analysent ensuite les relations générales en Afrique entre croissance démographique et développement, en mettant en évidence la spécificité du Maghreb et le rôle de l’amélioration du capital humain dans les changements démographiques. Sur cette base sont proposées ensuite trois trajectoires démo-économiques possibles à moyen terme. En conclusion l’accent est mis sur la nécessité de donner une spécificité régionale aux politiques de développement.This article examines the relationship between population, economic growth and social development in Africa. After setting out the broad outlines of demographic dynamics and demonstrating the specificity of the continent in the general picture of demographic transitions, the authors reconsider policy debates on population and development in the light of the African situation. They analyze the general relationship between population growth and development in Africa, highlighting the specificity of the Maghreb region and the role of improvements in human capital in demographic change. On this basis, three possible future demo-economic trajectories and medium term impacts are presented. The conclusion emphasises the need for specific regional development policies

The family at the heart of the household : evolution and differentiation of household structure in Côte d'Ivoire, 1975-98

This article analyses the evolution of household structure from the middle of the 1970s to the end of the 1990s in Côte d'Ivoire, as recorded in three data collection operations (1975, 1988 and 1998). It suggests that there is more than one principle of organization of family structure, and that the various socioeconomic groups behave differently. Various forces that bind or dissolve families, such a nuclearization, the hosting of other relatives, individualization or marital instability, are encountered within the households, and account for their particular morphology in line with the distribution of characteristics that vary by socioeconomic group. The particular mix is determined at least in part by the economic and financial ability of the groups to withstand the constraints of the crises encountered by Ivorian society since the early 1980s, but also in part by the demographic characteristics of sex and age of the heads of household. The structure of households is a joint function of the economic and social position of their heads, but also of the stage of the life cycle in which they are located. The analysis shows that Côte d'Ivoire, in the last twenty years, has witnessed an evolution of the family model, that is of the mode of more or less stable communal living specific to economic groups. This evolution is linked to the transformations of marital and kinship solidarity. It developed under the influence of the modernization of socioeconomic structures, which continued through recession and crises. Little by little, the household models diverge by social strata. At the same time, the members of the family nucleus and, beyond them, the members of the kinship group, represent a larger share of households. More than ever, the family is at the heart of the household

La demande d'enfants en Afrique subsaharienne

47 pages;4 figures;15 tableaux dont 8 annexeThis chapter studies the demand of children in sub-Saharan Africa in order to better understand the bases of the high fertility in the region. The authors first present the role of the concept in the various formulations of the theory of the demographic transition. They show then the specificity of Africa in the matter. After having highlighted the contributions and limits of the variables used to apprehend the concept of children demand, the authors analyze the variation between different countries of the area and the evolution in the time of desire of children, ideal number of children and total wanted fertility rate. This variation is noted at different level: all women as well as young women or men. The comparison of the children demand and the level of fertility shows, that in general, women have more children than they want, whereas the opposite is noted for men. The retrospective approach, suggests that the transition of fertility in Côte d'Ivoire, Kenya and Niger, begins with a decrease in the demand of children before a reduction in non desired fertility. The multinomial logistic model, applied to the data, shows that age, instruction level, availability of source of family planning and standard of living are the most important factors in the children demand. At last, the authors suggest, on the basis of comprehensive analysis framework of the evolution of fertility, a number of research priorities for a better understanding of the evolutions of the children demand and their roles in those of fertility.Ce chapitre étudie la demande d'enfants en Afrique subsaharienne afin de mieux comprendre les fondements de la forte fécondité. Les auteurs présentent tout d'abord le rôle qui est dévolu à la notion de demande d'enfants dans les différentes formulations de la théorie de la transition démographique, avant de montrer la spécificité de l'Afrique au sud du Sahara à cet égard. Après avoir mis en évidence les apports et les limites des variables utilisées pour appréhender la notion de demande d'enfants, les auteurs analysent la variation entre les différents pays de la région et l'évolution dans le temps des différents indicateurs : désir immédiat d'enfants, nombre idéal d'enfants souhaités, indice synthétique de fécondité désirée. Cette variation se constate chez l'ensemble des femmes, comme chez les jeunes femmes ou les hommes. La mise en relation de la demande d'enfants et du niveau de fécondité montre, qu'en général, les femmes ont davantage d'enfants qu'elles n'en souhaitent, alors que le contraire se vérifie chez les hommes. L'approche rétrospective, menée ensuite à propos de la Côte d'Ivoire, du Kenya et du Niger, permet de constater que la transition de la fécondité débute par une baisse de la demande d'enfants avant de se poursuivre par une diminution de la fécondité non désirée. Le modèle logistique multinomial, appliqué aux mêmes pays, met en exergue l'âge, l'instruction, la disponibilité de source de planification familiale et le niveau de vie comme facteurs communs de la demande d'enfants. Au terme de cette analyse, les auteurs proposent, sur la base d'un cadre global d'analyse de l'évolution de la fécondité, quelques priorités de recherche pour mieux appréhender les évolutions de la demande d'enfants et leurs rôles dans celles de la fécondité

Disclosure of HIV positive status : gender differences within the TEMPRANO trial participants, Côte d'Ivoire - ANRS 12239

For people living with HIV, disclosure of HIV status is an important challenge : informed friends or family members can be supportive, or on the contrary can stigmatise the HIV-positive person. We aimed to compare HIV status disclosure among men and women, since gender relationships create different opportunities and difficulties for both sexes. The study was conducted among HIV-positive adults enrolled in the TEMPRANO randomized trial in Côte d'Ivoire, which aims to compare very early antiretroviral treatment versus treatment initiation as per WHO current guidelines. All participants in this trial were asked questions on HIV status disclosure after 24 months of follow- up. Univariate and multivariate analyses were performed to compare disclosure patterns among men and women, disclosure to people living inside and/or outside the household, and in particular to the spouse or regular partner, and to identify the factors associated with disclosure. HIV status disclosure was frequent (more than 80%) among HIV patients, with no difference between men and women (p=0.45). For both, the regular partner was the most frequent confidant. But patterns of disclosure were different : men more frequently disclosed to a regular partner than women (74.1% vs 64.9%, p=0.004), because they were more likely to live with a regular partner (58.6% of men vs 35.8% of women). Men and women living with a regular partner reported similar levels of disclosure to the spouse (82.1% for men and 82.4% for women). Women disclosed more often than men to their children, siblings and mother. For both, the confidants were more often women (sisters, mother) than men (brothers, father). Our study shows that differences in the living conditions of men and women living with HIV and differences in gender roles induce gendered differences in HIV disclosure that should be considered in the care of the patient

Disclosure of HIV positive status : gender differences within the TEMPRANO trial participants, Côte d'Ivoire - ANRS 12239

For people living with HIV, disclosure of HIV status is an important challenge : informed friends or family members can be supportive, or on the contrary can stigmatise the HIV-positive person. We aimed to compare HIV status disclosure among men and women, since gender relationships create different opportunities and difficulties for both sexes. The study was conducted among HIV-positive adults enrolled in the TEMPRANO randomized trial in Côte d'Ivoire, which aims to compare very early antiretroviral treatment versus treatment initiation as per WHO current guidelines. All participants in this trial were asked questions on HIV status disclosure after 24 months of follow- up. Univariate and multivariate analyses were performed to compare disclosure patterns among men and women, disclosure to people living inside and/or outside the household, and in particular to the spouse or regular partner, and to identify the factors associated with disclosure. HIV status disclosure was frequent (more than 80%) among HIV patients, with no difference between men and women (p=0.45). For both, the regular partner was the most frequent confidant. But patterns of disclosure were different : men more frequently disclosed to a regular partner than women (74.1% vs 64.9%, p=0.004), because they were more likely to live with a regular partner (58.6% of men vs 35.8% of women). Men and women living with a regular partner reported similar levels of disclosure to the spouse (82.1% for men and 82.4% for women). Women disclosed more often than men to their children, siblings and mother. For both, the confidants were more often women (sisters, mother) than men (brothers, father). Our study shows that differences in the living conditions of men and women living with HIV and differences in gender roles induce gendered differences in HIV disclosure that should be considered in the care of the patient

Disclosure of HIV positive status : gender differences within the TEMPRANO trial participants, Côte d'Ivoire - ANRS 12239

For people living with HIV, disclosure of HIV status is an important challenge : informed friends or family members can be supportive, or on the contrary can stigmatise the HIV-positive person. We aimed to compare HIV status disclosure among men and women, since gender relationships create different opportunities and difficulties for both sexes. The study was conducted among HIV-positive adults enrolled in the TEMPRANO randomized trial in Côte d'Ivoire, which aims to compare very early antiretroviral treatment versus treatment initiation as per WHO current guidelines. All participants in this trial were asked questions on HIV status disclosure after 24 months of follow- up. Univariate and multivariate analyses were performed to compare disclosure patterns among men and women, disclosure to people living inside and/or outside the household, and in particular to the spouse or regular partner, and to identify the factors associated with disclosure. HIV status disclosure was frequent (more than 80%) among HIV patients, with no difference between men and women (p=0.45). For both, the regular partner was the most frequent confidant. But patterns of disclosure were different : men more frequently disclosed to a regular partner than women (74.1% vs 64.9%, p=0.004), because they were more likely to live with a regular partner (58.6% of men vs 35.8% of women). Men and women living with a regular partner reported similar levels of disclosure to the spouse (82.1% for men and 82.4% for women). Women disclosed more often than men to their children, siblings and mother. For both, the confidants were more often women (sisters, mother) than men (brothers, father). Our study shows that differences in the living conditions of men and women living with HIV and differences in gender roles induce gendered differences in HIV disclosure that should be considered in the care of the patient

Effect of early antiretroviral therapy on sexual behaviors and HIV-1 transmission risk in adults with diverse heterosexual partnership status in Cote d'Ivoire.: Effect of early ART on sexual behaviors

International audienceBackground. The effect of early antiretroviral therapy (ART) on sexual behaviors and HIV-1 transmission risk has not been documented beyond the specific population of stable serodiscordant couples.Methods. Based on a behavioral study nested in a randomized controlled trial (Temprano-ANRS12136) of early ART, we compared proportions of risky sex (unprotected sex with a partner of negative/unknown HIV status) reported 12 months after inclusion between participants randomized to initiate ART immediately ('early ART') or according to WHO criteria ('standard ART'). Group-specific HIV-transmission rates were estimated based on sexual behaviors and viral load-specific per-act HIV-1 transmission probabilities. Their ratio was computed to estimate the protective effect of early ART.Results. Among 957 participants (baseline CD4: 478/mm(3)), 46.0% reported sexual activity in the past month, 41.5% of them with non-cohabiting partners. Proportion of risky sex was 10.0% vs. 12.8%, respectively, in participants on early vs. standard ART (p=0.17). Accounting for sexual behaviors and viral load, the estimated protective effect of early ART was 90% (95%CI 81-95%).Conclusion. Twelve months after inclusion, patients on early and standard ART reported similar sexual behaviors. Early ART decreased the estimated risk of HIV transmission by 90%, suggesting a major prevention benefit among both stable and casual partners