Children’s household contexts and their living arrangements in sub-Saharan Africa have long been a research focus within family demography. Households are, on average, larger and more diverse than those in other world regions (Esteve et al. 2024; Pohl et al. 2025), and children often live temporarily or permanently in households without one or both of their biological parents. This is due to relatively high adult mortality, frequent union dissolution and repartnering, and fostering, a traditional child-rearing practice. The experiences and implications of orphanhood and child fostering have received substantial research attention (e.g., Beagle et al. 2010; Cotton 2021). However, the trends and links between children’s living arrangements and their educational outcomes have been less widely studied from a comparative perspective.

In a recent paper, leveraging 60 IPUMS-International census samples across 24 African countries from 1976 to 2019, we explored how children’s living arrangements are associated with school enrolment trends (Pohl, Batyra, Esteve 2026).

Educational expansion in Sub-Saharan Africa

Sub-Saharan Africa has experienced a significant educational expansion in recent decades, yet progress toward universal school enrolment still differs across countries. Despite international initiatives like the Sustainable Development Goals, many countries struggle with low primary completion rates and limited secondary education access, often hindered by the historical legacies of colonial rule, rapid population growth, and the economic burden that education places on both governments and private households (Figure 1). Southern African nations have reached near universal school enrolment, and most East African countries, like Malawi, have seen rapid increases and nearly doubled their enrolment rates over three decades. Rates remain low in Ethiopia and South Sudan, however. In West Africa, school enrolment remains below 80% in most countries, despite notable improvements. Nonetheless, even modest percentage increases represent vast achievements in absolute terms, as educational systems have had to keep pace with population growth.

Why do living arrangements matter for school enrolment? 

While the importance of macro-level factors like public infrastructure for school enrolment is well-documented, the household environment is an understudied dimension that reflects broader enrolment inequalities. The household serves as a pivotal site for resource allocation and socialization, and is crucial in influencing a child’s development and human capital accumulation. In the African context, kinship-based relationships and family networks are core pillars of societal organization. Compared to other world regions, parental absence from the household is relatively more common and is sometimes a strategic move to enable children to access better educational opportunities (Akresh 2009; Bachan 2014). Parental absence is also frequently a response to domestic crises such as death or union dissolution. Subsequently, children living in a household without one or both biological parents may face disadvantages due to resource dilution and socioeconomic instability linked to parental absence, even though factors like remittances from migrant parents or the presence of grandparents may mitigate these gaps. 

The relationship between family structure and education is moderated by macro-level dynamics. In countries where school enrolment is high, the role of living arrangements may be less important, whereas in low-enrolment countries, the household environment remains a critical determinant of access to schooling. Furthermore, the social acceptance of family forms plays a role: where single motherhood or fostering is common, such arrangements may not carry the same educational penalties as they do elsewhere.

The living arrangements of children in sub-Saharan Africa

Children’s living arrangements across the countries included in our analysis show a remarkable degree of stability over time, though regional variations persist (Figure 2). In most East and West African countries, over half of children reside with both biological parents, while in Southern African countries the share of children in this arrangement has declined sharply, with increases in mother-only or no-parent households. West Africa maintains a relatively high prevalence of children living without biological parents. Few children in countries across all regions live in a household with only the biological father present. The relative stability over time suggests that broad economic, social, and demographic changes experienced by many sub-Saharan African countries do not necessarily translate into changes in children’s living arrangements.

The emergence of a “mother-advantage”?

The results of our regression analysis indicate that, even after controlling for individual and household characteristics, children’s living arrangements remain a significant predictor of school enrolment, though the dynamics vary over time and by country. As shown in Figure 3, children living without parents or with only their father consistently face lower odds of enrolment compared to those with both parents, and a notable “mother-only” advantage has emerged in several countries. These findings are in line with research suggesting that women may have a stronger preference for their children’s educational attainment (Crespin-Boucaud and Hotte, 2021) and that women’s decision autonomy is positively associated with preference for schooling, at least in the case of daughters (Luz and Agadjanian 2015).

Further regression results shown in Figure 4 highlight that as school enrolment increases over time, the disparities between different household structures tend to diminish; however, in more traditional or homogeneous societies, the educational gap for children not living with both biological parents remains pronounced. While enrolment is rising across countries, the persistent influence of family structure highlights that the road to educational equity is shaped by specific domestic contexts. 

Conclusions

Overall, our analysis reveals that children’s living arrangements are a crucial determinant of school enrolment in the context of educational expansion in sub-Saharan Africa. We find a “mother-advantage” in several countries, particularly in West Africa, where children living with only their mother often have higher enrolment rates than those in two-parent homes. Children residing only with their biological father or without any biological parents face persistent disadvantages. While the traditional fosterage system can sometimes facilitate educational access, children in these non-parental arrangements generally remain the most vulnerable to being left behind.

Importantly, our results suggest that the influence of living arrangements tends to weaken as countries move toward universal primary education. In nations like Botswana, where diverse family structures are socially common and enrolment is high, differences in enrolment across living arrangements have decreased substantially. However, in more traditional societies where two-parent homes are the norm, children in alternative arrangements continue to face educational disadvantages. We argue that achieving the goal of universal school enrolment requires moving beyond macro-level policies to address the barriers faced by children in different household contexts.

References

Bachan, L. (2014). Anticipatory child fostering and household economic security in Malawi. Demographic Research, 30, 1157–1188. https://doi.org/10.4054/DemRes.2014.30.40

Beegle, K., Filmer, D., Stokes, A., & Tiererova, L. (2010). Orphanhood and the Living Arrangements of Children in Sub-Saharan Africa. World Development, 38(12), 1727–1746. https://doi.org/10.1016/j.worlddev.2010.06.015

Cotton, C. (2021). An Enduring Institution? Child Fostering in Sub‐Saharan Africa. Population and Development Review, 47(4), 1179–1206. https://doi.org/10.1111/padr.12439

Crespin-Boucaud, J., & Hotte, R. (2021). Parental divorces and children’s educational outcomes in Senegal. World Development, 145, 105483. https://doi.org/10.1016/j.worlddev.2021.105483

Esteve, A., Pohl, M., Becca, F., Fang, H., Galeano, J., García-Román, J., Reher, D., Trias-Prats, R., & Turu, A. (2024). A global perspective on household size and composition, 1970–2020. Genus, 80(1), 2. https://doi.org/10.1186/s41118-024-00211-6

Luz, L., & Agadjanian, V. (2015). Women’s decision-making autonomy and children’s schooling in rural Mozambique. Demographic Research, 32, 775–796. https://doi.org/10.4054/DemRes.2015.32.25

Pohl, M., Batyra, E., & Esteve, A. (2026). School Enrolment and Living Arrangements of Children in Sub‐Saharan Africa. Population and Development Review, padr.70045. https://doi.org/10.1111/padr.70045

Pohl, M., Esteve, A., & Galeano, J. (2025). African households: National and subnational trends from censuses and surveys. Population Studies, 1–21. https://doi.org/10.1080/00324728.2024.2427580

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Although unintended pregnancy rates have globally decreased in the last decades, they remain high in some parts of the world, most notably in Africa and Latin America (Bearak et al. 2022). Thus, both researchers and policymakers continue to be interested in examining the consequences of unintended childbearing. Many studies have attempted to establish whether pregnancy intentions are important for children’s outcomes, but the empirical evidence so far has been inconsistent, in large part because it is difficult to separate the effect of pregnancy intentions from the sociodemographic characteristics typically associated with such intentions, and both may affect children’s well-being.

In a recent article, we examined the association between a mistimed birth (wanted later by the respondent) or an unwanted birth (the responded did not want any more children) and one of the key markers of health, namely infant mortality, across Asia, Africa and Latin America (Väisänen and Batyra 2024). Our approach differs from most previous studies on the topic in that we compared the survival chances of children born to the same mother, but differing in intention status, as reported by the mother. This modelling approach, called “fixed-effects”, allows us to automatically account for all the mother’s characteristics that do not change over time.

Birth intentions matter for infant mortality

We used data collected in Demographic and Health Surveys in 60 countries between 2000 and 2020 to analyse to what extent the likelihood of surviving to the first birthday differs by birth intention status within families; and whether this relationship depends on the wider societal context, as measured by the human development index (HDI).

The usual way to tackle this problem is to compare the destiny of children born to different mothers with different intentions, but this “between” (different mothers) approach makes it difficult to spot the true cause: is it intentions or is it mothers’ heterogeneity? Instead, we compared the destiny of children (of different birth orders, to be sure) born to the same mother, but not necessarily with the same intention each time (births desired, mistimed, or unwanted), as reported by the mothers themselves. With this “within” (same mother) approach, we can safely assume that intentions play a prominent part in the child’s destiny.

Our results show that in 41 countries out of 60, births that were unwanted or mistimed, or both, were associated with a higher likelihood of infant mortality, and that in none of the countries did wanted births have a higher likelihood of infant mortality than unintended births. This may be due to different behaviours during and after pregnancy, such as the use of antenatal care or breastfeeding; or the circumstances in which that child is born, such as birth interval, birth order and family resources after the birth of an additional child. 

Mistimed births are different from unwanted births

Most previous studies have not distinguished between mistimed and unwanted births. However, we show that in many countries the association with infant mortality differs between the two groups. For example, Figure 1 shows that among all categories of birth intention status, unwanted pregnancies had the highest probability of infant mortality in the Americas, while this was more often the case for mistimed pregnancies in West Africa. These results cast new light on the variation in the consequences of pregnancy intentions and highlight that, in some settings, becoming pregnant too early, or too soon after a previous birth, may be equally or more disruptive than becoming pregnant when not wanting any more children. 

Birth intention status matters more in contexts with a low human development index

We also examined whether the association between birth intention status and infant mortality varies by the level of “development” of each country. As is known, the probability of infant mortality decreases with the country’s HDI. This is true across all birth intention groups but the decline is strongest for mistimed births (Figure 2). These results suggest a particularly heavy mortality burden associated with mistimed pregnancies, which is magnified in contexts characterized by low HDI. Thus, children born following unintended pregnancies are disadvantaged when it comes to survival and this disadvantage is even larger in less developed settings. It is possible that as social, economic, and health conditions improve, it may be easier for women to deal with the difficulties arising from  mistimed pregnancy and childbirth.

Conclusions

Children tend to have a higher risk of infant mortality if the pregnancy was unintended – even children (of different birth orders) born to the same mother. However, the strength of the association and the type of intention that matters the most (unwanted or mistimed pregnancy) depend on the context. Overall, these effects are more pronounced in contexts with lower levels of development, as measured by the HDI. This highlights the importance of conducting analyses at the finest possible territorial level (country rather than region) to better understand contextual differences. Also, it is important to distinguish between unwanted and mistimed births as they have different associations with infant mortality depending on context.

References

Bearak, J. M., Popinchalk, A., Beavin, C., Ganatra, B., Moller, A.-B., Tunçalp, Ö., & Alkema, L. (2022). Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019. BMJ Global Health, 7(3), e007151. https://doi.org/10.1136/bmjgh-2021-007151

Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The Effects of Unintended Pregnancy on Infant, Child, and Parental Health: A Review of the Literature. Studies in Family Planning, 39(1), 18–38. https://doi.org/10.1111/j.1728-4465.2008.00148.x

Väisänen, H., & Batyra, E. (2024). Birth Intention Status and Infant Mortality: Fixed-Effects Analysis of 60 Countries. Population and Development Review, Online first. https://doi.org/10.1111/padr.12652

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The positive association between the level of women’s education and the age at which they start forming families is one of the most studied relationships in the discipline of demography. However, researchers have focused on examining this association at only one point of the distributions of age at first union and age at first birth. Existing studies ascertain how additional schooling shifts the mean of age at first union and first birth, or the proportion of women who experience these events by a given age (for example, first union before age 18). These approaches, however, ignore the variation in the association between education and the timing of family formation within populations.

In a recently published paper, I take a different approach and use quantile regression analysis to study heterogeneity in the link between additional schooling and age at first union and first birth across the distributions of these events in 50 low- and middle-income countries (Batyra 2024). In other words, I study whether the effect of additional schooling on relatively early union formation and childbearing (i.e., the left parts of the distributions of these two events) is similar or different to its effect on other parts of the distributions, those that correspond to later ages.

Links between additional schooling and timing of family formation: differences by quantiles  

I took a cross-country perspective and focused on 50 nations in Africa, the Americas, Asia and the former Soviet Republics. I explored if an additional year at school is associated with postponement of family formation uniformly in the lower quantiles (i.e., where age at family formation is lower, thus early) and the upper quantiles (i.e., where age at family formation is higher, thus late). Figure 1 presents the results of the quantile regressions for the 25th and 75th percentiles for age at first union in two selected regions, namely the Americas and the former Soviet Republics. Where the confidence intervals for the two estimates do not overlap, the difference (marked as Diff.) between these two point estimates is noted. 

All the coefficients are positive, indicating that completing more years of education delays first union formation, as expected. However, in many countries, the magnitude of the relationship varies across the distribution. Namely, an additional year of schooling raises the 75th percentile by more than it raises the 25th percentile. These findings highlight heterogeneity in how education is related to the timing of union formation, with the association being weaker in the lower than the upper parts of the age-at-first-union distribution. This pattern of heterogeneity is visible in almost all countries in the Americas as well as West Africa, the majority of countries in East and Central Africa and Asia, and half of the countries in the former Soviet Republics. Similar conclusions are reached when the link between years of schooling and age at first birth is considered.

Substantively, these results mean that additional schooling has a weaker effect on the reduction of early unions and births than on later ones. The existence of marked differences in the coefficients of the quantile regressions and a weaker association in the lower parts of the age at first union and first birth distributions also mean that there is a tendency for the dispersion of these distributions to grow with increasing years of schooling. In other words, education increases heterogeneity in the timing of family formation within countries. 

Conclusions

Receiving more schooling does not translate into uniform changes in the timing of family formation for women in many low- and middle-income countries. These findings provide pointers for understanding the persistence of high levels of early marriage and pregnancy despite educational expansion, and the large disparities in age at first union and first birth. They are also relevant from a policy perspective, as they underline that, despite the generally positive association between additional schooling and age at family formation, expanded access to education may provide insufficient impetus for reducing early unions and childbearing. My findings are in line with the mounting evidence that many students in low- and middle-income countries receive poor-quality education and that disparities in educational quality are high within countries (Prichett 2013; Psaki et al. 2018). In such contexts, spending more time in school may not mean learning more, or enhancing labor market prospects. If schooling – one of the channels through which education influences family formation behavior – brings little in terms of learning and work opportunities for some women, then the way education is related to family formation is likely to vary across the population. The extent to which disparities in education quality drive the heterogeneous association between schooling and the timing of family formation requires further research. What emerges clearly, however, is the importance of considering the whole distributions of age at first union and first birth when studying the link between these events and education.

References

Batyra, E. (2024) The Relationship between Education and the Timing of Family Formation: Evidence from Quantile Regression Analysis of 50 Countries. Development and Change. Online First. https://onlinelibrary.wiley.com/doi/10.1111/dech.12846

Pritchett, L. (2013) The Rebirth of Education: Schooling Ain’t Learning. New York: Center for Global Development.

Psaki, S.R., K.J. McCarthy, and B.S. Mensch (2018) Measuring Gender Equality in Education: Lessons from Trends in 43 Countries. Population and Development Review 44(1): 117–42.

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The term “nini” encapsulates the plight of young adults who find themselves disconnected from both work and education (De Hoyos, Popova, & Rogers, 2016). It’s estimated that almost 20% of youths between 15 to 25 years old in Latin America are part of this group. At the same time, early parenthood and union formation are widespread in Latin America, where many young adults, particularly women, are occupied with household and care work. To cast light on this complex socio-economic landscape, in a recently published paper, we explored the dynamics between parenthood, gender roles on one side, and labour force and formal educational participation on the other (Liu, Castro Torres & Batyra, 2023).

The “nini” phenomenon: gender and social class dynamics

In the 12 Latin American countries under study, a significant proportion of women aged 20 to 25, at least one out of every four, can be categorized as “ninis”. In Guatemala, Honduras, and Nicaragua, this proportion is even higher, above 50%. On the other hand, among men in the same age group, the percentage is notably lower, below 20% (Figure 1).

The discussion pertaining to “ninihood” is delicate. Latin America is a region with large informal labour markets, with many people working in the shadow economy, and therefore rarely captured in official data. Thus, the term is controversial because informal and uncompensated work is often left out of the picture. Despite the importance of these under-acknowledged work activities, those not engaged in formal education or the formal labour market have been found to experience high levels of insecurity. The “nini” phenomenon, essentially an early disengagement from education and work, has wide-ranging consequences, such as limited lifetime earnings, economic vulnerability and social marginalization. At the societal level, untapped human potential hampers economic growth, while unmet needs may fuel social unrest.

Given the stark differences in “ninihood” between men and women observed in Latin America (Figure 1), our study delves into the intricate relationship between early family formation, especially for women, and the accumulation of human capital. The gender and social class gradients that emerge underscore the challenges women face in remaining visible in the formal public sphere: disengagement primarily affects socially disadvantaged women, especially in Central America. Women from lower social origins who leave the parental home to enter conjugal union and parenthood at younger ages are particularly at risk. Being in a partnership increases the risk of being a “nini” for women, but reduces it for men, confirming the pervasiveness of the male breadwinner model in conjugal households. 

Implications for policy and gender equality

Early family formation heightens the risk of exclusion from formal institutions and social safety nets. For those who fall into the “nini” category, transitioning into adulthood is fraught with challenges, leading to disparities in access to vital resources like unemployment insurance, healthcare, and pension schemes. Our findings emphasize the critical role of women’s engagement in the formal labour market, particularly in a context of limited social protection and single motherhood, and prompts us to reconsider how we view women’s engagement with public life, especially in the Global South.

This work on early parenthood, gender roles, and labour force participation in Latin America shines a light on the complexities behind the “nini” phenomenon.  The results underscore the urgent need for governments to address the issue of disengagement from the public sphere, by improving access to employment and education, for example, especially among women and lower socio-economic classes. As Latin America strives for inclusive growth and development, acknowledging the role of early family formation and gender dynamics is essential for fostering economic security, social equality, and individual well-being.

References

De Hoyos, R., Popova, A., & Rogers, H. (2016). Out of school and out of work: A diagnostic of ninis in Latin America (Working Paper No. 7548). World Bank. Retrieved from https://openknowledge.worldbank.org/handle/10986/23723

Liu, C., Castro Torres, A. F., & Batyra, E. (2023). A gender story of social disengagement of young adults in Latin America. Sociology Compass. https://doi.org/10.1111/soc4.13138

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According to data from the 2010 round of population censuses in Spain and the United States, roughly 10 percent of young couples (aged 30–39) involve a native and a foreign-born partner. However, the macro-level characteristics of these couples have rarely been researched and to date, most studies on cross-national couples in high-income Western countries have focused on the migrant’s perspective (Qian, Glick, and Batson 2012, Kulu and Hannemann 2018). In a recently published paper, we shift attention to the natives (Esteve, Elwert and Batyra 2023). We examine differences in union patterns of native women and men in cross-national unions. In a context of profound transformation of gender norms and roles in high-income countries, we aim to stimulate research on the gender dynamics that shape interactions of native populations with foreign-born individuals in an increasingly global world (van de Putte et al. 2009, Esteve, Garcia-Roman and Permanyer 2012).

Gender differences in country of birth, age, and education 

We use samples from the International Integrated Public Use Microdata Series and focus on cross-national couples formed by women and men aged 30-39. We compute the age gap between spouses and dichotomize education according to whether each partner has tertiary education or not. 

Finally, we analyze gender asymmetry in cross-national couples as follows: for each country of birth of the international partner, if there are at least 50 unions of this type (otherwise we drop all observations), we calculate the share of those where the native is the man. A share of 0.5 indicates that native men and native women are equally likely to partner with immigrants from a given country. To systematize the gender patterns that might exist in relation to these unions, we classify countries based on their level in the human development index (HDI). For each dyad, we compute the HDI gap between the native country (i.e., the United States or Spain) and the country of birth of the international partner. 

Figure 1 shows the relationship between gender asymmetry in cross-national couples and the HDI gap, separately for Spain and the United States. Although the origins of international partners differ across the two countries, the results for the two nations suggest a similar pattern. Cross-national couples have very distinct gender profiles, with native men and native women partnering with immigrants from countries at very different levels of development. In both countries, gender asymmetry in cross-national couples increases with the HDI gap. 

This means that unions between a native and a foreigner from a less developed country (HDI gap above zero) are formed predominantly by native men, as opposed to native women. For example, see the case of the Philippines: in both Spain and the United States, more than 80 percent of mixed unions with individuals from the Philippines involve a native man and less than 20 percent a native woman. Conversely, women tend to be overrepresented in unions where a spouse is from a country with a similar or a higher level of development (HDI gap around or below zero). This pattern is clearly visible for unions of natives with immigrants from Western Europe such as Belgium, Germany, or the United Kingdom. For example, 60 percent of unions with Belgians in Spain involve Spanish women and only 40% involve Spanish men. 

With reference to Spain, Figure 2 provides further evidence about gender asymmetries in cross-national unions according to age and education. Native men in cross-national unions (top panels) tend to partner with younger women (spousal age gaps > 0) and the difference tends to increase sharply with HDI gap. This pattern reverses in the case of native women (bottom panels), for whom the spousal age gap tends to decrease and become negative with an increasing HDI gap (Figure 2, left panels). Similar patterns are found for the United States (not shown here). 

Despite stark asymmetries in age between spouses in cross-national couples and between unions of native women and native men, the right panels of Figure 2 show that educational profiles are rather similar across genders. There is no clear link between educational attainment of natives in cross-national unions and HDI, although in many dyads, natives tend to be have an above-average educational level. This pattern is even more visible in the United States (not shown here). 

Conclusion

We find distinct cross-national marriage patterns between native men and native women. Native men who partner with immigrant women from less developed backgrounds form unions with rather traditional patterns of spousal age differences, especially when the HDI gap is large.

At the same time, some native women might be challenging this pattern by forming unions with younger men from countries with a lower development level. 

References

Esteve A., A. Elwert, E. Batyra. 2023. Gender Asymmetries in Cross-National Couples. Population and Development Review.

Esteve A., J. Garcia-Roman, I. Permanyer. 2012. The Gender-Gap Reversal in Education and Its Effect on Union Formation: The End of Hypergamy? Population and Development Review 38(3): 535–546.

Kulu H., T. Hannemann. 2018. Mixed Marriage among Immigrants and Their Descendants in the United Kingdom: Analysis of Longitudinal Data with Missing Information. Population Studies 73(2), 1–18. 

Qian Z., J.E. Glick, C.D. Batson. 2012. Crossing Boundaries: Nativity, Ethnicity, andMate Selection. Demography 49(2): 651–675.

Van de Putte B., F. van Poppel, S. Vanassche, M. Sanchez, S. Jidkova, M. Eeckhaut, M. Oris, K. Matthijs. 2009. The Rise of Age Homogamy in 19th Century Western Europe. Journal of Marriage and Family 71(5): 1234–1253.

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More than 200 million women and girls alive today are estimated to have undergone female genital mutilation/cutting (FGM/C), a practice widely recognized to be a violation of human rights and harmful to the health of women and girls (Kimani, Muteshi, and Njue 2016). Most of these women live in Africa (UNICEF 2016). In 2015, the United Nations General Assembly agreed a series of Sustainable Development Goals (SDGs), including a specific target to eliminate FGM/C by 2030 (UN 2015). However, despite such international commitments to end FGM/C, very little is known about the effectiveness of national policies in contributing to the abandonment of this practice. Moreover, although it is known that FGM/C prevalence has been declining in a number of African countries (Koski and Heymann 2017), there is little research documenting the settings where FGM/C prevalence has been falling most rapidly and how socioeconomic differences in the prevalence of FGM/C have changed over time.

In recently published papers, we investigated long-terms trends in FGM/C prevalence in Africa using Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). First, we evaluated the impact of a law banning FGM/C in Mauritania and explored whether the new legislation had a significant impact on reducing FGM/C prevalence (Cetorelli et al. 2020). Second, we reconstructed trends in FGM/C prevalence across 23 African countries (Batyra et al. 2020). We examined where the FGM/C rates have changed fastest and whether differentials in prevalence by women’s education and urban-rural residence have been converging or diverging over the last 35 years.

Ineffectiveness of policies banning FGM/C

Alongside intensified global efforts to end FGM/C, multiple stakeholders in some African countries have made significant efforts to legislate and communicate about FGM/C in order to eliminate its practice. To help understand whether national policies have been effective in reducing FGM/C prevalence we studied Mali and Mauritania. These countries have marked similarities with respect to practices of FGM/C, but differing legal contexts: a law banning FGM/C was introduced in Mauritania in 2005, while in Mali, FGM/C is not legally prohibited. We reconstructed trends in FGM/C prevalence in both countries from 1997 to 2011. We evaluated the impact of the 2005 law in Mauritania by contrasting trends in FGM/C prevalence before and after implementation of the law, using Mali as the counterfactual country that has not introduced similar legislation.

Figure 1 shows that trends in FGM/C prevalence by birth cohort in Mauritania and Mali were parallel and relatively stable during the late 1990s. FGM/C prevalence in Mauritania began to decline slowly for girls born in the early 2000s, and this decline accelerated for girls born after 2005 when the law banning FGM/C was introduced. However, a similar trend is observable in neighbouring Mali, where no equivalent law has been passed. This suggests that the introduction of the 2005 law in Mauritania did not affect FGM/C prevalence. We conducted additional statistical analysis using a quasi-experimental, difference-in-difference design to ensure that our results are not explained by unmeasured differences between the two countries. The analysis confirmed that the 2005 law did not have a significant impact on reducing FGM/C prevalence in Mauritania.

Slower reductions in FGM/C in the highest prevalence countries

Although decreasing rates of FGM/C in Mauritania cannot be attributed to the law banning the practice, and prevalence among the youngest women is as high as 40%, it is evident that the percentage of women with FGM/C has declined across cohorts. Downward trends in FGM/C prevalence have been identified in several African countries, but the settings where declines have been fastest have not been clearly identified. We reconstructed long-term trends in FGM/C rates for women born between 1965 and 1999 for 23 countries and examined the relationship between the initial FGM/C prevalence (among cohorts born around 1965) and the rate of change in prevalence between women born around 1965 and around 1999.

Figure 2 shows a negative relationship between these two measures: FGM/C prevalence has declined fastest in countries with lower initial prevalence, and more slowly in countries with higher initial prevalence. Our results suggest that in settings with higher initial prevalence, FGM/C practice is likely to be more entrenched and to change more slowly.

Increasing socioeconomic inequality in FGM/C prevalence

Vast differences in FGM/C prevalence and its rate of change in Africa exist not only between, but also within countries. FGM/C prevalence is known to differ according to women’s socioeconomic status (UNICEF 2016), but there has been lack of cross-national evidence to understand whether differentials in FGM/C rates within countries have been converging or diverging. We estimated differences in prevalence according to women’s education, which is also a proxy for their parents’ socioeconomic status, and place of residence.

Figure 3 shows that prevalence in Africa has been changing at different rates among women with no education and women with some education, over the 35-year period. Despite substantial variation between countries, in the majority of settings these changes have increased the educational differentials in FGM/C prevalence, in particular in countries with moderate-to-high prevalence levels. Our study shows that in many countries, differentials in FGM/C also increased between urban and rural areas. These results can be interpreted as evidence of increasing socioeconomic inequality in the practice of FGM/C in Africa.

Conclusions

Our findings are important for documenting and understanding the progress towards abandonment of FGM/C in Africa. First, the introduction of laws banning the practice alone might be insufficient to instigate behavioral change with regard to FGM/C and careful assessment of the extent to which declines in prevalence can be attributed to policy changes is needed. Although our results confirm that FGM/C has been decreasing in the majority of African countries, we show that settings with the highest initial prevalence experienced slower relative declines than those where FGM/C was already a minority practice among older cohorts. Given that we also find evidence of increasing educational and urban-rural inequalities in FGM/C, our results highlight that interventions towards abandonment of the practice must be designed to accommodate the vast heterogeneity in FGM/C that exists between and within countries. Attention needs to be focused on implementing and enforcing laws and policies that account for diversity across a wide range of sociocultural and educational domains.

References

Batyra, E., Coast, E., Wilson, B., and Cetorelli, V. (2020). The socioeconomic dynamics of trends in female genital mutilation/cutting across Africa. BMJ Global Health 5:1–9.

Cetorelli, V., Wilson, B., Batyra, E., and Coast, E. (2020). Female Genital Mutilation/Cutting in Mali and Mauritania: Understanding Trends and Evaluating Policies. Studies in Family Planning 51(1):51–69.

Kimani, S., Muteshi, J., and Njue, C. (2016). Health Impacts Of Female Genital Mutilation/Cutting: A Synthesis Of The Evidence. New York: Population Council.

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