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.

Koski, A. and Heymann, J. (2017). Thirty-year trends in the prevalence and severity of female genital mutilation: A comparison of 22 countries. BMJ Global Health 2:1–8.

UN (2015). Transforming Our World: The 2030 Agenda for Sustainable Development. New York, United Nations.

UNICEF (2016). Female Genital Mutilation/Cutting: A Global Concern. New York: UNICEF.

The post Female genital mutilation/cutting in Africa: ineffective policies and persistent inequalities appeared first on N-IUSSP.

Low fertility and policies

Concerns about low fertility and population aging have triggered considerable interest in whether and how family-friendly policies can increase fertility. Drawing on evidence that desired fertility exceeds actual fertility in many low-fertility countries, the European Union (EU) has promoted a policy agenda to reduce childbearing costs, to help citizens realize their fertility desires (Davies, 2013; European Commission, 2006; Frejka et al., 2008) Despite this agenda, total fertility rates (TFRs) have remained very low in Central and Eastern Europe (CEE), although migrants from the region have higher fertility abroad (see Graph 1).

While researchers and policy makers often assume that individuals only consider circumstances in the place they currently live while making fertility decisions, and argue about the adequacy of nationally implemented fertility-enhancing policies, in an interconnected Europe, nationals are likely aware of circumstances abroad and compare conditions across countries. Such international comparisons, and the feelings of relative deprivation or advantage that result, may influence how people evaluate and respond to “family friendly” policies. At least, this is what seems to emerge in the case of Poland. What our research tries to explain is why the TFR of Polish migrants in the UK (2.1 children per woman) is higher than the TFR in Poland (1.3), and higher than the TFR of UK born women (1.8). Poland’s TFR has remained very low since early 2000s, despite numerous family-friendly policies introduced since the mid-2000s, such as extended paid maternity and paternity leaves, birth grants, more generous universal cash payments for families with children, and more childcare places. Besides, c while the UK has quickly become one of the main destination countries for Polish migrants (see Graph 2). Thus, the Polish context allows us to explore whether individuals consider circumstances in other countries when they take their childbearing decisions, even if they are not actively seeking to migrate themselves.

Comparing living standards and family policies: Poland vs. UK

In a recent study (Marczak et al., 2018) we explored whether and how cross-national comparisons inform decisions about childbearing in contemporary Europe by comparing Polish nationals living in Poland (Krakow) and the UK (London). Data were collected until a point of saturation was reached, and no new information was provided (Kvale and Brinkmann, 2008). The sample included 44 individuals: 13 mothers and 9 fathers in London, 11 mothers and 11 fathers in Krakow (see table 1). We ensured a similar number of individuals with certain characteristics (e.g. similar educational status) in both cities. Respondents were recruited purposively through advertisements in local newspapers, online fora and in Polish shops and churches in London. By conducting in-depth, semi-structured interviews (44), we gathered detailed information about the complex factors that were important when parents of one child considered having another. In the course of the interviews, respondents spontaneously used cross-national comparisons to justify their childbearing intentions.

Although not specifically prompted to consider cross-national comparisons, 16 out of 22 respondents in Krakow and 18 out of 22 in London made such comparisons of family-friendly policy packages, wages, living standards and more broadly family-friendly contexts when talking about their childbearing choices. Conditions in Poland were often evaluated using West European living standards (wages, material and housing conditions) as a benchmark, particularly when describing what parents feel they need to provide for their children. Living standards were often reported to be much lower in Poland than in West European nations, childrearing costs were deemed high and state support for raising children considered inadequate, relative to that offered elsewhere in Europe. Respondents often reported that they felt relatively deprived in Poland compared to what they perceived was available in other, richer European countries and used such cross-national comparisons to explain why they had decided to delay or avoid having another child.

Individuals reported detailed, although imperfect, knowledge of disparities in living standards and policy contexts between different EU nations. Eleven out of 22 respondents in Poland had some personal migration experiences, many had family members and friends living abroad, many also referred to media coverage of cross-national differences in living standards and social support for families. Through these contacts, respondents formed an idea of differences between different European countries.

In London, respondents often compared living standard and state support for families between Poland and the UK and expressed relative satisfaction with their living conditions. They explained that it was easier to provide their children with necessities because of lower costs of living relative to wages, and better state support for families with children. Respondents in London felt relatively advantaged (compared to Poland) after migrating, even if they were relatively disadvantaged in their new context compared to natives. Such perceptions of relative advantage, if typical of migrants from other CEE countries, may help us to better understand reasons behind higher fertility levels of migrants from this region.

Fertility decisions in modern, increasingly interconnected societies

Our data suggest that cross-national comparisons, at least in certain cases, may shape the way people evaluate living standards and childbearing costs. In highly migratory contexts, such as Poland, individuals may not assess living standard and policy innovations against the recent (national) past, but instead compare them to the circumstances prevailing in other nations they could move to. Indeed, Polish immigrants to the UK tended to compare their circumstances in the UK to those they enjoyed in Poland, although they usually left other, sometimes more generous, European countries out of the picture.

This tendency to make international comparisons, if generalizable, can provide an additional explanation for the persistence of very low fertility in poorer European countries. This effect is reinforced by the fact that, if migrants feel relatively advantaged in the destination country, they may prefer to settle there when they start their families or think about having more children, rather than return home,

Although our findings focus on Polish nationals, they may have broader implications for understanding fertility in increasingly interconnected societies. Although “Brexit” is likely to pose restrictions on migration between the UK and EU, easy and cheap travel within Europe permits relatively easy relocation for leisure, visiting relatives, and employment for EU citizens. Importantly, European integration has brought unprecedented opportunities for cross-border exchanges of social, political, cultural and economic ideas and practices. As the spread of Western standards becomes ever more present in shaping desired living standards globally, we suggest that cross-national comparisons may become increasingly salient for the ways in which individuals think about future fertility.

References

Davies, R. (2013). Promoting fertility in the EU. Social policy options for Member States: Library of the European Parliament

European Commission. (2006). The demographic future of Europe: From challenge to opportunity. Brussels: European Commission

Eurostat (2018). Population and social conditions: Fertility indicators.

Frejka, T., Sobotka, T., Hoem, J. M., & Toulemon, L. (2008). Childbearing trends and policies in Europe. Demographic Research, 19 (Special Collection), 1–46.

Kvale, S., & Brinkmann, S. (2008). InterViews: Learning the craft of qualitative research interviewing (2nd ed.). London: Sage Publications.

Marczak, J., Sigle, W., & Coast, E. (2018). When the grass is greener: Fertility decisions in a cross-national context. Popul Stud (Camb), 1-16. doi:10.1080/00324728.2018.1439181

Statistics Poland (2018) Main directions of emigration and immigration in the years 1966-2014 (migration for permanent residence).

World Bank (2018). DataBank: World development indicators.

The post Fertility decisions in Poland: looking beyond national boundaries appeared first on N-IUSSP.

To accurately understand population change – its scale, speed, determinants and variants – we need accurate data on the age of a population’s members. In low-income countries, whilst levels of knowledge of age or date of birth are increasing, there remain substantial problems of age reporting and recording for older people and for those who are unschooled. These problems are particularly acute in sub-Saharan Africa, where, until recently, low levels of education and vital registration have been combined with a widespread social irrelevance of knowing absolute age, although relative age has always been important in terms of social relationships, behaviour and respect. For example the initiation of age-sets in many East African populations is part of an attribution of social, economic and political roles and many West African kinship terminologies implicitly refer to relative age (older brother, younger brother).

The impact of the lifecourse on patterns of physical aging and mental health and competence in old age is unclear for African populations. It seems likely that past disease stresses, high fertility and nutritional problems in childhood lead to more rapid deterioration, but these could just be strong selective forces. These cannot be assessed without reliable age data. There is considerable concern that old age poverty will become a growing problem for developing countries, including increasing stresses that younger adults face in caring for older parents whilst themselves confronting unemployment and demands from their own children. Other difficult policy issues relate to the provision of health and social care to populations with increasing absolute numbers of older people, even when the proportion of the older population remains stable.

Questions about the quality of data for older people

Are data inaccurate because many older Africans do not know their ages? Are there gender differences in age data quality? Is there any evidence that different methodological approaches (survey vs. census) generate different patterns of age and other errors for older people? A key issue is whether data are accurate enough to provide meaningful denominators for rates. Age reporting from censuses and surveys will also indicate whether ages provided by other sources (e.g., administrative or hospital data) are good enough to provide meaningful numerators.

We analysed age data quality of nationally representative datasets (census, DHS) for a range of sub-Saharan African countries. Sample surveys are often assumed to generate better quality data than a census because more time can be spent on interviewer training and data quality control. We compare the quality of age data reporting for older (over 60) and younger people in census and DHS data using standard demographic techniques (Whipple’s index and a modified Whipple’s index for older people). The index provides a measure of the general reliability of the age distribution, ranging from “Highly accurate” to “Very rough”. We observe that:

1. In most countries except those in Southern Africa, DHS data for the younger adult population are ‘rough data’. For 5 countries (Mali, Burkina Faso and Niger, Benin and Ethiopia) they are ‘very rough’.]
2. Age reporting for older adults is substantially worse than that for younger adults, with the exception of Mozambique.
3. The age reporting is worse for older women than for older men, with the exceptions of Southern African countries, Kenya, Tanzania, and Ivory Coast.
4. DHS data are more accurate than the census (see Figure 1) for the Southern African countries and Ethiopia, but censuses have better age reporting than DHS in the Sahelian countries (Mali, Burkina Faso, and Niger)

Getting better data on older Africans

It is clear from our analysis that different field methodological approaches generate contradictory data on older Africans: furthermore different methods appear to work better in different countries. With the exception of Southern Africa, it is impossible to assess accurately the basic demographic structure of the older population. Other analyses (Figure 2) looking at the sex ratios of 10 year age groups (thus smoothing out some of the age misreporting) show that the DHS seems to under-enumerate older women in Sahelian countries compared to men, and compared to the census.

This suggests that the survey methodology itself may contribute to the omission of older women, interacting with local cultural values and living arrangements, although we must remember that DHS surveys are largely focused around reproductive-age women, so there is little pressure on interviewers to assiduously pursue potential omitted older people. These statistically invisible older women are probably among the most vulnerable and the poorest in society. Their exclusion from the data will contribute to reinforcing the stereotype, encountered frequently in our qualitative research in Burkina Faso with statisticians, academics and NGO workers, that most older Sahelians are cared for by their children and are usually co-residential with them, because such situations are those that are best captured by the data that are collected.

Understanding lifecourse trajectories to old age and developing appropriate and equitable policies for older people in Africa require accurate and reliable data. It is seems clear that, outside Southern Africa, existing data cannot even accurately assess older African population structures, let alone provide the detailed information needed to advise policy decision-making. In many Sub-Saharan countries’ national statistics the population of older Africans remains miscounted, badly represented, and at times invisible. The most vulnerable elderly people are probably totally statistically invisible, since the stereotypes around the situation of the elderly that permeate all stages of the data collection process mean that they are likely to be omitted altogether, at least in the Sahelian countries. Clearly such stereotypes must be challenged. Moreover, the reality that poor, old people (particularly widows) live alone and without the support of their families must be recognised. In order to do this, better data are needed. As a first step, improving the focus of census and survey questions and developing ways to overcome barriers to accurate data collection would lead to better data for informing policy directions which respond to the specific, yet largely unknown, needs of older Africans.

Reference

Randall Sara and Coast Ernestina (2016) The quality of demographic data on older Africans. Demographic Research, 34, pp. 143-174.

Demographic-research.org-volumes

The post Demographic data are inadequate for many older Africans appeared first on N-IUSSP.