Relationships between Marriage and Fertility Changes in Six sub-Saharan African Countries

Marriage and fertility are institutions that comprise a fundamental part of adult life in Africa. Decades ago, universal and early marriage ensured that women spent the majority of their reproductive lives married; and marriage was the main locus of childbearing. However, while both institutions in recent decades have transformed, changes in relationships between marriage and fertility in various parts of the region have not yet been established. Relatively little is known about 1) changes in aggregate fertility that is due to either shifts in marriage rates or to changes in marital and nonmarital fertility; 2) shifting determinants of marital and nonmarital fertility in diverse African contexts; 3) how measures of parity progression are influenced by changes in women¿s timing of fertility and marriage events; 4) the variation in contraceptive use by marital status across a varied group of African countries. This dissertation addresses these gaps in four empirical chapters. The dissertation uses Demographic and Health Survey data from six countries (Namibia, Zimbabwe, Kenya, Rwanda, Benin, and Nigeria) to explore the association between marriage and fertility over the past four decades. The first chapter offers descriptive accounts of how changes in proportions married, and rates of marital and nonmarital fertility are captured in overall fertility changes. The second chapter explores direct and indirect determinants of fertility changes of married and single women. The third chapter focuses on cohort fertility, and examines whether women¿s marital status influences parity progression estimates. The fourth chapter examines differences in contraceptive use for women of different marital status. Taken together, these findings imply that marriage and fertility are still closely linked in sub-Saharan Africa. For instance, I find that changes in proportions married matter more for fertility changes in countries with higher fertility compared with those with lower fertility, while the determinants of fertility across and within the six countries I study. These results demonstrate variations across the region: the nature, strength, and determinants of the relationships between marriage and fertility tend to be country-specific and are changing over time

Fertility, birth intervals, and their proximate determinants in Zimbabwe

Includes bibliographical references (leaves 70-72).It is found that birth intervals have increased from about 28 months in the 1960s to about 51 months by the year 2000, with the greater part of this increase occuring after 1985. Fertility fell from birth intervals are congruent with each other, in terms of timing and tempo. Of the two main proximate determinants identified; marital status and contraceptive use, the latter is founf to be the more dominant force behind changes in birth spacing. Differentials by marital status are not significant. The research adds to a growing body of studies on the nature of fertility tansitions in sub-Sahara Africa, and would particularly be useful in explaining observed differences in fertility transitions between countries in the region

Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type

Abstract Background Low use of maternal health services, as well as poor quality care, contribute to the high maternal mortality in sub-Saharan Africa (SSA). In particular, poor person-centered maternity care (PCMC), which captures user experience, contributes both directly to pregnancy outcomes and indirectly through decreased demand for services. While many studies have examined disparities in use of maternal health services, few have examined disparities in quality of care, and none to our knowledge has empirically examined disparities in PCMC in SSA. The aim of this study is to examine factors associated with PCMC, particularly the role of household wealth, personal empowerment, and type of facility. Methods Data are from a survey conducted in western Kenya in 2016, with women aged 15 to 49 years who delivered in the 9 weeks preceding the survey (N = 877). PCMC is operationalized as a summative score based on responses to 30 items in the PCMC scale capturing dignity and respect, communication and autonomy, and supportive care. Results We find that net of other factors; wealthier, employed, literate, and married women report higher PCMC than poorer, unemployed, illiterate, and unmarried women respectively. Also, women who have experienced domestic violence report lower PCMC than those who have never experienced domestic violence. In addition, women who delivered in health centers and private facilities reported higher PCMC than those who delivered in public hospitals. The effect of employment and facility type is conditional on wealth, and is strongest for the poorest women. Poor women who are unemployed and poor women who deliver in higher-level facilities receive the lowest quality PCMC. Conclusions The findings imply the most disadvantaged women receive the lowest quality PCMC, especially when they seek care in higher-level facilities. Interventions to reduce disparities in PCMC are essential to improve maternal outcomes among disadvantaged groups

Additional file 2: of Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type

Empowerment questions. Shows questions used to create empowerment scores. (PDF 151 kb

Additional file 1: of Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type

Distribution of person-centered maternity care variables. Table showing distribution of individual items used to create the PCMC scores. (DOCX 41 kb

Birth intervals, postponement, and fertility decline in Africa: a new type of transition?

We investigated birth-interval dynamics in 24 African countries using data from 76 Demographic and Health Surveys conducted since 1986. Controlling for selection bias in the birth-history data using the Brass-Juárez method and regression models produced almost identical results. Birth intervals have lengthened in every country examined. This analysis uncovered a distinctive and previously undocumented pattern of childbearing that is prevalent across sub-Saharan Africa. After allowing for time trends in birth-interval length, the lengthening of birth intervals in almost every country varies little by women's age or parity. Moreover, in several countries, birth intervals are now too long to be explicable by birth spacing contingent on the age of women's youngest child. Rather, women are postponing births for other reasons. These findings offer empirical support for the idea that the fertility transition in sub-Saharan Africa is following a different pattern from that observed elsewhere

Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide