In many parts of the globe, having a child as an unmarried woman comes with a host of social and economic challenges, and can affect the timing and the quality of a woman’s eventual marriage (Smith-Greenaway and Clark 2018; Smith-Greenaway, Koski, and Clark 2021). Despite focusing on high-mortality contexts, like contemporary Africa, research on this question often makes a rather heroic assumption: that the out-of-wedlock child survives. In reality, however, child mortality remains high in Africa (Smith-Greenaway et al. 2021), and children born outside marriage are especially vulnerable to premature death (Clark and Hamplová 2013). 

What happens when an unwed mother’s child dies?  

This raises the question of whether a child’s survival alters unmarried mothers’ lives, including their eventual entry into marriage. How does the death of a premaritally born child affect the mother’s future marital outcomes? Does the child’s death deepen any observed disadvantage or can it “remove” the stigmatizing status of single motherhood, and improve her chances of marrying? Alternatively, given the high frequency of child fostering in Africa (Cotton 2021), are unwed mothers’ life trajectories unaffected by the loss of a child? 

In a recent paper, we tested these competing hypotheses by examining unmarried mothers’ subsequent marital trajectories after a first birth as a function of their child’s survival (Lin et al. 2025). We used the most recent round of Demographic and Health Surveys, collected between 2011 and 2023, spanning 26 countries in sub-Saharan Africa. On average, 17% of women of reproductive age (15–49) across these countries experienced a premarital birth, yielding a study sample of 69,800 women. Among them, 3% experienced the death of their firstborn during infancy, allowing us to assess how marital timing and union quality differ between women whose premaritally born child died and those whose child survived. 

Premarital child loss and mothers’ marital outcomes 

Unwed mothers whose first child died during infancy marry sooner relative to their unmarried counterparts whose first child survived (Figure 1). This pattern persists after controlling for mothers’ socioeconomic characteristics, including education. However, these analyses offer no qualitative distinctions as to the nature of these women’s marital unions , a topic that has been largely overlooked in the literature. 

Closer scrutiny reveals that following their child’s death, women tend to marry partners with 0.3 fewer years of schooling, are 16% more likely to enter polygynous unions, and 26% more likely to experience domestic violence. 

As child mortality declines, do these patterns change? 

While the broader question concerns women’s marital trajectories following child loss, a natural follow-up is whether these patterns persist as deaths, including child deaths, become rarer over time. 

In our main analyses, we focused on all reproductive-age women in the Demographic and Health Surveys. These include women born in different cohorts who have navigated romantic relationships, childbearing, and marriage under distinct circumstances. As such, we analyzed whether our findings varied across birth cohorts—including women born in the 1970s (or earlier), 1980s, or 1990s (or later).  

We found that inequalities in both marital timing and quality between unmarried mothers by children’s vital status are largest for the youngest cohort in our data, the cohort with the lowest rates of child mortality. Specifically, experiencing an infant death is associated with substantially faster entry into marriage among women born in or after the 1990s, compared to those born in or before the 1980s (Figure 2). Moreover, the spousal educational gap between mothers whose child died versus survived is considerably larger among women born in the 1980s and 1990s than among those born in or before the 1970s.

This suggests that the death of a firstborn child before marriage has become more consequential for women’s subsequent marriage outcomes, with respect to both marriage timing and quality, despite secular decreases in child mortality.

Final remarks 

Our work demonstrates that a child’s death is not only an outcome of inequality but may also be a future source of disadvantage. Future research should examine more closely how child loss reshapes women’s life trajectories and highlights the unique double burden of unwed mothers who may not only bear a child outside marriage but also, in some cases, lose that child. Although child mortality has been declining in Africa, our findings suggest that it is becoming a more consequential event for women, attesting to the need to further understand the impact of child loss on women’s lives and wellbeing. 

References 

Clark, Shelley, and Dana Hamplová. 2013. “Single Motherhood and Child Mortality in Sub-Saharan Africa: A Life Course Perspective.” Demography 50 (5): 1521–1549. https://doi.org/10.1007/s13524-013-0220-6. 

Cotton, Cassandra. 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. 

Lin, Yingyi, Emily Smith-Greenaway, Camila Cortes Rodriguez, and Shelley Clark. 2025. “From Birth to Death: The Marital Consequences of Child Loss for Unmarried Mothers.” Studies in Family Planning. Advance online publication. https://doi.org/10.1111/sifp.70041 

Smith-Greenaway, Emily, Diego Alburez-Gutierrez, Jenny Trinitapoli, and Emilio Zagheni. 2021. “Global Burden of Maternal Bereavement: Indicators of the Cumulative Prevalence of Child Loss.” BMJ Global Health 6: e004837. https://doi.org/10.1136/bmjgh-2020-004837. 

Smith-Greenaway, Emily, and Shelley Clark. 2018. “Women’s Marriage Behavior following a Premarital Birth in Sub-Saharan Africa.” Journal of Marriage and Family, 80(1): 256–270. https://doi.org/10.1111/jomf.12433.

Smith-Greenaway, Emily, Alissa Koski, and Shelley Clark. 2021. “Women’s Marital Experiences Following Premarital Fertility in Sub-Saharan Africa.” Journal of Marriage and Family 83 (2): 394–408. https://doi.org/10.1111/jomf.12704.

The post Life trajectories of African unwed mothers after the loss of their child appeared first on N-IUSSP.

Despite being socially and economically disadvantaged (e.g., in terms of education and wealth), for decades, Muslims in India experienced lower child mortality than Hindus. This “paradox”, long discussed in the specialized literature (e.g. Bhalotra et al., 2010; Guillot & Allendorf, 2010), has been attributed to various socio-economic and religion-specific cultural factors, such as better sanitation practices and a higher percentage urban among Muslims, and son preference among Hindus. However, we argue below that this is, at best, only part of the explanation. 
This child-mortality gap between Hindus and Muslims has shrunk over time, and is barely noticeable today (IIPS & ORC Macro, 1995; IIPS & ICF, 2017). 

Why are Hindus catching up with Muslims?

In 1992-93, under-5 (or child) survival was markedly lower among Hindus than among Muslims and other religions (Figure 1). Over time, however, as child survival improved for all religions, Hindus (in blue) progressively caught up with other groups, and notably with Muslims (in brown), from whom they were virtually indistinguishable by 2015-16. 

Part of the explanation must be sought in the caste system, a hierarchical social division of Indian society. People affiliated to lower caste groups such as Scheduled Castes (SCs) and Scheduled Tribes (STs) have historically been oppressed, and forced to live in socio-economically and geographically marginalized locations. Not surprisingly, child mortality is higher among lower caste children (Dommaraju et al., 2008). 
Fortunately, under-five mortality has declined markedly among all Indian groups and castes in the past 30 years or so, and within-group differences have declined very strongly (Figure 2). The trend has been more favourable for Hindus than for Muslims, both within the General castes (also called Upper or Other castes) and within in the others (SCs/STs). Hindus lagged behind in 1992-93, but their situation is now comparable (SCs/STs) or even better (General castes) than that of Muslims. 

However, the structural composition of the two religious groups is markedly different. Among Hindus, SCs/STs represent a large and increasing share of the population (39% at the end of the period). Conversely, among Muslims they represent a mere 6%. The two factors (differential mortality by caste and different structural caste composition of the two religious groups) explain both the initial difference in child mortality between Hindus and Muslims, and its evolution over time.

Maternal and child health programmes have played a key role in improving in child survival in India, especially among SCs/STs, and, for structural reasons, this has benefited Hindus in particular (Goli et al. 2020; Ganguly, Goli, & Rammohan 2022). 
A few key maternal and child health indicators, for instance, while evolving favourably for all groups, have progressed most notably for SCs/STs, especially among the Hindus, whose internal differences in this respect have considerably shrunk. For instance, the gap between SC/STs and other castes in the share of pregnant women receiving at least four antenatal visits declined from 12.6% to 3.3% among Hindus between 1992 and 2021, but not among Muslims. During the same period, the caste-wise gap in births in a health facility fell more than three-fold among Hindus, but much less so among Muslims, and the same holds for full child immunization (Table 1).

To conclude

Progress in socio-economic and demographic factors, and in maternal and child health care utilization in India, especially after the launch of the Reproductive and Child Health programme in the mid-1990s, has been the driving force in closing the gap between Hindu and Muslim child survival. From a policy perspective, two important conclusions emerge. 
First, in comparing child survival across different socio-economic or religious groups, the structural composition of these groups, e.g. in terms of castes, must be taken into account. Second, both socio-economic and maternal and child health care policies play a key role not only in improving standards of living on average, but also in closing the gaps across subpopulations.  

References

Bhalotra, S., Valente, C., & Soest, A. V. (2010). The puzzle of Muslim advantage in child survival in India. Journal of Health Economics, 29(2): 191–204.

Dommaraju, P., Agadjanian, V., & Yabiku, S. (2008). The pervasive and persistent influence of caste on child mortality in India. Population Research and Policy Review, 27(4): 477–495.

Ganguly, D., Goli, S., & Rammohan, A. (2022). Explaining the diminishing of Muslim advantage in child survival in India. Genus, 78(1): 1–42.

Goli, S, Moradhvaj, James KS, Singh D, Srinivasan V. Road to family planning and RMNCHN related SDGs: Tracing the role of public health spending in India (2020.) Glob Public Health. Apr;16(4): 546–562. 

Guillot, M., & Allendorf, K. (2010). Hindu-Muslim differentials in child mortality in India. Genus, 66(2). 

International Institute for Population Sciences (IIPS) and ORC Macro. (1995). National Family Health Survey (NFHS-1), 1992–1993, IIPS, Mumbai, India.

International Institute for Population Sciences (IIPS) and ICF. (2017). National Family Health Survey (NFHS-4), 2015–2016, IIPS, Mumbai, India.

The post Child survival in India: Hindus now catching up with Muslims appeared first on N-IUSSP.

Mothers are important for under-five child survival, but so are siblings. The timing of sibling births, or birth spacing, is important, especially in low- and middle-income countries. Generally, an interval of at least 24 months between births is recommended, to avoid maternal depletion due to excessive “competition for care”, to allow sufficient breastfeeding time and to lower the risk of disease transmission.

To disentangle the effects of siblings and mothers on child survival, longitudinal data are needed. Covering diverse contexts across sub-Saharan Africa, and a large number of children under-five years old (~560,000), Health and Demographic Surveillance Systems (HDSS) provide a unique opportunity to explore these effects.

The confirmed role of mothers in child survival

The risk of child mortality depends on a number of maternal factors, including her age at childbirth, and her presence in the child’s day-to-day life. It is higher for mothers aged under 20 or over 36 at the time of the birth. Likewise, when a mother migrates and leaves her child(ren), her absence is associated with a higher risk of child death. This is probably because she is not present to provide direct care including breastfeeding, or to make sure her child follows immunization schedules. Potential financial benefits, through remittances, do not seem to be strong enough offset the negative effect of her absence.

While the absence of a mother due to migration increases a child’s risk of death by around 50%, her absence due to death increases the risk more than tenfold (Bocquier et al. 2021). The effect of maternal death is strongest in the 15 days preceding her death and the three months following it. This pre-death effect is explained by prolonged illness, in particular due to HIV or tuberculosis; in the final stages of disease the mother is usually less able to care for her child(ren) (Houle et al. 2015).

The unexpected role of younger siblings

Birth spacing with an older sibling has consistently been found to affect child survival, with intervals shorter than 36 months increasing the probability of infant and under-five death (Molitoris et al. 2019). However, based on the analysis of HDSS data, where precise timing of births is possible, recent research has found that birth spacing with respect to a younger sibling is even more important (Bocquier et al. 2021). The risk of child mortality is highest when a birth interval with a younger sibling is less than 23 months. However, when a mother is pregnant with the younger sibling, the risk of child death is actually lower (Figure 1). This beneficial period during pregnancy could be related to the antenatal care received by the mother and her visits to health facilities with her child. The child may be examined on these occasions, or the mother may receive general advice about healthcare for her children. The presence of the father in the household during the pregnancy may also be beneficial, through his direct role in childcare or in looking after the expectant mother. Additional care provided by other family members and friends may also have spillover effects on a child’s health.

Once born, the presence of siblings close in age can increase a child’s exposure to life-threatening communicable diseases. However, if the older sibling does not co-reside with the youngest child, this risk should be reduced and there should also be less competition among the children. However, the absence of an older or younger sibling due to migration is actually associated with a higher risk of mortality. This is likely a reflection of a dispersed, unstable, family unit. Furthermore, the death of a sibling is detrimental to child survival. Siblings share a risk of infectious diseases by living in the same environment. They receive similar levels of care from their parents, and they share a genetic background. Clustering of deaths within families is therefore likely (van Dijk 2018). As after a mother’s death, the risk of a child’s death is elevated before and after a sibling’s death. 

Policy implications

In addition to the known proximate determinants of child mortality, including maternal factors, risk factors associated with siblings deserve attention from healthcare providers. In particular, birth intervals of at least 24 months are recommended as they increase the survival chances of both older and younger siblings. The mother’s pregnancy appears to be beneficial for the survival of already existing young children, but things tend to change after delivery: for various possible reasons, the presence of a younger, closely-spaced child tends to be detrimental for older (but still very young) siblings. Finally, caregivers should pay special attention to children whose siblings do not co-reside with them, are sick or have died. Increased awareness of these risk factors associated with siblings could help reduce child mortality in sub-Saharan Africa. 

References

Bocquier, P., Ginsburg, C., Menashe-Oren, A., Compaoré, Y., & Collinson, M. (2021). The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa. Demography. doi:10.1215/00703370-9429499

Houle, B., Clark, S. J., Kahn, K., Tollman, S., & Yamin, A. E. (2015). The impacts of maternal mortality and cause of death on children ’ s risk of dying in rural South Africa : evidence from a population based surveillance study ( 1992-2013 ). Reproductive Health, 12(Suppl 1), S7. doi:10.1186/1742-4755-12-S1-S7

Molitoris, J., Barclay, K., & Kolk, M. (2019). When and Where Birth Spacing Matters for Child Survival : An International Comparison Using the DHS. Demography, 56(4), 1349–1370. doi:doi:10.1007/s13524-019-00798-y

van Dijk, I. K. (2018). Early-life mortality clustering in families: A literature review. Population Studies, 73(1), 79–99. doi:10.1080/00324728.2018.1448434

The post Closely spaced births reduce survival chances of existing and future children appeared first on N-IUSSP.

Few people would question the saying that ‘no parent should have to bury a child.’ Child mortality has been low for so long in some parts of the world that the idea that children might die before their parents seems unnatural. Even in the Global North, however, things have not always been this way. For millennia, losing multiple children was the norm: in historical populations, parents usually lost about half of their children before they reached puberty (Volk and Atkinson 2013).

Conversely, in the Global South, despite remarkable progress in recent years, the death of a child, particularly a young one, continues to be a common life event for many parents.

A historic opportunity to reduce the gap between the Global South and North

In a recent study, my co-authors and I illustrate the huge differences in terms of child loss suffered by mothers depending on their place of birth, with the Global South being particularly affected (Alburez-Gutierrez, Kolk and Zagheni 2021). For example, women born in 1955 in Niger experienced 73 times more child deaths during their working ages than women of the same cohort in Sweden. Figure 1 exemplifies these differences on a world map by showing the number of children that an average woman aged 65 years in 2020 has lost over her life course. Recent studies on the prevalence of maternal bereavement have found a similar pattern, showing that 79% of mothers in Niger have lost at least one child, compared to less than 1% of mothers in Sweden (Smith-Greenaway and Trinitapoli 2020, Smith-Greenaway et al. 2021).

The risk that women in a population will lose a child at some point of their life depends on the prevailing levels of fertility and mortality. In general terms, high fertility increases the likelihood of losing a child because more women have several children and are thus exposed to a higher risk of losing at least one. The risks are even higher if mortality levels are also high. Knowledge of past, present, and future demographic developments is crucial for characterizing global trends in child loss.

An overall favourable trend

Some of our findings are encouraging. We anticipate that the experience of child death will be increasingly uncommon among younger cohorts of women all around the world. In addition, we project that the gaps between women in countries of the Global North and countries of the Global South, currently very large, will shrink in the coming decades. Yet, some inequalities will persist. For example, the death of a young child will continue to be a distressing reality for many women in sub-Saharan Africa.

Figure 2 exemplifies these trends by focusing on the related phenomenon of child survival. On average, women born in 1950 can expect four of their children to live longer than themselves, while for women born in 2000 the global average will be about two (left panel). These estimates are largely driven by fertility levels, which are expected to converge to about 2.1 children per woman by the end of the century. A complementary measure is the fraction of children who are expected to outlive their mothers. The right panel of Figure 2 shows a global convergence of this relative measure of child survival. The share of offspring who will outlive their mothers will increase globally from 89% for the 1950 cohort of women to almost 95% for the 2000 cohort. The difference between the region with the highest survival (Europe and North America) and the region with the lowest survival (sub-Saharan Africa) will decline over this period from 15 to just 5 percentage points.

These trends have an unexpected and previously unrecognized effect: women born in 1985 or later will be more likely to lose an adult child (when they themselves are aged 65 years or over) than to lose a young child (before their own 50th birthday), reversing a long-standing global trend. We anticipate that “child death” will increasingly come to mean the death of adult offspring.

A call for support to bereaved parents

The loss of a child is a traumatic event that affects the mental and physical health of parents in general and of mothers in particular. Studies have linked child loss to depression, poor self-rated health, increased alcohol consumption and intimate partner violence. These effects are particularly pronounced in countries where bereaved parents have no recourse to counselling or any other institutional form of support. Our finding that parents will increasingly face the death of an adult child requires particular attention. This trend is worrying if mothers (and fathers, even if they are not explicitly considered in our paper) plan their lives around the expectation that their adult children will survive to support them in their older years. The consequences may be especially severe following the death of an only child, a growing risk for women (and parents) in countries with very low fertility. The situation is particularly ominous in settings that lack adequate institutional systems of old-age support.

References

Alburez-Gutierrez D., Kolk M., Zagheni E. (2021). “Women’s experience of child death: A global demographic perspective.” Demography. Advanced Publication. DOI: 10.1215/00703370-9420770

Smith-Greenaway E., Alburez-Gutierrez D., Trinitapoli J., Zagheni E. (2021) “The Global Burden of Maternal Bereavement: Indicators of the Cumulative Prevalence of Child Loss.” BMJ Global Health, 6:e004837. DOI:bmjgh-2020-004837.

Smith-Greenaway E., Trinitapoli J. (2020). Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa. Proceedings of the National Academy of Sciences, 117, 4027–4033.

Volk A.A., Atkinson J.A. (2013). Infant and child death in the human environment of evolutionary adaptation. Evolution and Human Behavior, 34, 182–192.

The post Global trends in child loss: less and later appeared first on N-IUSSP.

The sex ratio at birth is lower in sub-Saharan Africa than in other regions of the world. That is, fewer sons are born than is naturally expected. There has been little research on these “missing boys” compared to the opposite phenomenon of “missing girls” in many Asian nations. In India and China, for example, fewer daughters are born than sons, which generally results from selective abortion of female foetuses. In contrast, foetal loss (spontaneous miscarriage) could be driving the pattern of “missing boys” and low sex ratios at birth in sub-Saharan Africa (Morse, Luke 2021). 

The sex ratio at birth is normally around 105-107 males born for every 100 females. In sub-Saharan Africa, however, it is around 103-104 males for every 100 females. Some populations dip even lower; in Rwanda, for example, the ratio is 101-102:100 (UNPD 2019). Although these differences may seem small, when applied to a sizeable population, they translate into large numbers. Given the number of births in sub-Saharan Africa each year, the difference between a sex ratio at birth of 103:100 and 106:100 is approximately 250,000 male births every year. 

Maternal stress and male foetal loss

Research from the biological sciences shows that—on average—male foetuses are more likely to be miscarried than female foetuses when the mother faces severe stress which could compromise the pregnancy. This research is compatible with an anthropological theory which explains that—from an evolutionary perspective—sons are high-risk-high-reward children while daughters are low-risk-low-reward: a highly successful son can result in many more grandchildren than a highly successful daughter. Yet, unsuccessful males are much more unsuccessful than unsuccessful females (they are more likely to die before producing any children at all). From an evolutionary perspective, when a mother’s health is on the margins, it is better to avoid giving birth to a high-risk boy child.

As such, studies have documented declines in male births following traumatic events, such as earthquakes or terrorist attacks (Fukuda et al. 2019; Catalano 2006), or resulting from longer-term distress, such as during famines or food shortages (Song, 2012).

Given the link to maternal stress, some scientists have labelled a low sex ratio at birth in a population as a “sentinel health indicator” (Grech and Masukume, 2016). We continue this line of work to see if low sex ratios at birth in sub-Saharan Africa could be explained by foetal loss.

Measuring foetal loss: time between births

To study the connection between foetal loss and the sex ratio at birth, data on women’s experience of foetal loss are needed. Measuring foetal loss at the individual level is extremely difficult, however. Surveys that ask women to report spontaneous miscarriage produce unreliable information, since many losses occur without the mother’s knowledge or before pregnancy has been recognized. Large-scale clinical studies that track the outcomes for pregnant women over time would be enormously expensive. 

Our idea is simple and inexpensive: we looked at the time between women’s first and second births (the second birth interval) as an indication of foetal loss. All else equal, a foetal loss adds time to a birth interval because a second conception must take place. As intentional spacing of births due to contraceptive use leads to longer birth intervals, we used data from women in 17 sub-Saharan African countries who were not using any method to limit or space their births. We assumed that longer second birth intervals indicated foetal loss, possibly due to stress, and hypothesized that they would be associated with a higher probability of subsequent female birth.

Our findings

The findings from our analysis support our hypothesis. Women with longer birth intervals (who were more likely to have had a foetal loss) were less likely to have a son. We then translated this finding to the population level and found low sex ratios at birth with longer birth intervals. 

Our findings support the view that foetal loss could be driving the pattern of “missing boys” and low sex ratios at birth in many sub-Saharan African countries. Although we did not study the precise types of maternal stress that produce such high levels of foetal loss, it is likely that chronic conditions (such as malnutrition or lack of adequate prenatal care) or shorter-term stressors (such as armed conflicts or forced migration) lead to widespread maternal stress in these countries. Policies and programmes should aim to improve maternal health before and during pregnancy to reduce high rates of foetal loss.

References

Catalano, Ralph, et al. 2006. “Exogenous shocks to the human sex ratio: the case of September 11, 2001 in New York City.” Human reproduction 21.12: 3127-3131.

Fukuda, Misao, Kiyomi Fukuda, Shawn Mason, Takashi Shimizu, and Claus Yding Andersen. 2019. Effects of earthquakes and other natural catastrophic events on the sex ratio of newborn infants, Early Human Development104859.

Grech, Victor, and Gwinyai Masukume. 2016. “The sex ratio at birth in South Africa may be a sentinel health indicator.” Early human development 103: 225-227.

Morse, Anne, and Nancy Luke. 2021. “Foetal loss and feminine sex ratios at birth in sub-Saharan Africa.” Population Studies: 1-16.

Song, Shige. 2012. “Does famine influence sex ratio at birth? Evidence from the 1959–1961 Great Leap Forward Famine in China.” Proceedings of the Royal Society B: Biological Sciences 279.1739: 2883-2890.

UNPD. 2019. World Population Prospects 2019, Online Edition. Rev. 1. United Nations, Department of Economic and Social Affairs, Population Division.

The post Missing boys in sub-Saharan Africa due to high rates of foetal loss appeared first on N-IUSSP.

Heterogeneity

Fertility is typically lower and has been declining more rapidly in urban than in rural areas. On average, the urban total fertility rate fell from just over 4.7 children per woman in the first survey to just under 3.9 in the last survey, a decline of 0.9 children or 19 percent. By contrast, in rural places the average TFR fell from just over 6.5 in the first survey to just under 6.0 in the last, a decline of 0.6 children or 9 percent. On average, the duration between the first and last survey was a little more than 16 years, but for individual countries it ranged from five to 27 years.

There was considerable heterogeneity in the experience of individual countries. Map 1 shows the average annual pace of decline of the urban total fertility rate, and Map 2 is the counterpart for rural places. Middle Africa typically displays slow declines or even increases in urban fertility. In rural areas, fertility declines are rare and slow, especially in Middle Africa. In Western and Eastern Africa there is more heterogeneity in rural fertility, with countries where it remains high, and others with relatively rapid declines.

Table 1 shows how educational attainment and infant and child mortality have changed in the countries analyzed; the table gives the average number of years of schooling and the percentage of women with no schooling, as well as the average infant and child mortality rate, as of the first and last DHS, for urban and rural places. Absolute and percentage changes in these indicators are also provided. Urban places had greater schooling and lower mortality as of the first survey, and absolute increases in years of schooling between the first and last survey were larger for urban places. By contrast, absolute declines in mortality were somewhat greater in rural areas.

The effect of female education and child mortality on fertility

Multivariate analyses reported in Shapiro and Tenikue (2017) show that in both urban and rural places, fertility declines with education, across six detailed categories that correspond roughly to no schooling, primary, low, medium, and upper secondary, and post-secondary. The declines are especially large for the two highest schooling groups. In addition, mortality at very young ages is positively related to fertility, presumably reflecting replacement fertility and insurance fertility.

For each country and place of residence, changes in educational attainment and in mortality are evaluated for their impact on fertility. These evaluations examine places in which fertility declined by more than a trivial amount, representing 26 of the 30 countries in the case of urban places, and – reflecting the lesser prevalence of rural fertility decline – only 15 of the rural places. As a consequence of differences between countries and by place of residence in rates of increase of schooling and rates of decrease of mortality, there was considerable variation among the countries in the results (Shapiro and Tenikue, 2017). In some cases, increased schooling was the major contributor to fertility decline, in others reduced mortality was distinctly more important, and in still others both factors were pertinent.

In urban places, increased women’s schooling accounted for an average of 57 percent of the observed declines in fertility, while reductions in infant and child mortality accounted for an average of 29 percent. In rural places where fertility declined, increased women’s schooling accounted for an average of 30 percent of the decline, while declining mortality accounted for an average of 36 percent. In both cases, the estimated contribution of schooling is a lower bound, since there is also an indirect effect of greater schooling in reducing infant and child mortality. In all cases, this analysis of individual data thus confirms earlier analyses of aggregate data, indicating that both increased women’s schooling and reduced infant and child mortality are important factors contributing to fertility decline in sub-Saharan Africa.

Policy implications

There are a few implications of interest in our findings. The longer-term trends toward increased schooling and reduced infant and child mortality suggest that fertility decline in the region will be ongoing; accelerating the increase of women’s schooling and improving delivery of public health services to reduce mortality more rapidly would presumably accelerate fertility decline. Continuing urbanization will also contribute to the ongoing decrease.

The United Nations (2015) estimate of fertility in sub-Saharan Africa by mid-century is approximately three children per woman. While this is well below the current level, it is expected to be associated with population growth of close to two percent annually. Challenges in educating growing populations and promoting economic growth and development will thus persist through much of this century. At the same time, improved opportunities for schooling and greater access to modern contraception, especially in rural places, have the potential to accelerate fertility decline in the coming decades.

References

Barro, Robert J. and Jhong Wa Lee. 2013. “A new data set of educational attainment in the world, 1950-2010.” Journal of Development Economics, (104): 184-198.

Bundervoet, Tom. 2014. “What explains Rwanda’s drop in fertility between 2005 and 2010?” Policy Research Working Paper no. WPS 6741. Washington, D.C.: World Bank Group.

Oaxaca, Ronald. 1973. “Male-female Wage Differentials in Urban Labor Markets.” International Economic Review, 14(3): 693-709.

Shapiro, David. 2012. “Women’s Education and Fertility Transition in Sub-Saharan Africa.” Vienna Yearbook of Population Research 2012, vol. 10: 9-30.

Shapiro, David and Tesfayi Gebreselassie. 2008. “Fertility Transition in Sub-Saharan Africa: Falling and Stalling.” African Population Studies, 23(1): 3-23.

Shapiro, David and Michel Tenikue. 2017. “Women’s Education, Infant and Child Mortality, and Fertility Decline in Urban and Rural Sub-Saharan Africa.” Demographic Research 37(21).

United Nations, Department of Economic and Social Affairs, Population Division. 2015. World Population Prospects: The 2015 Revision, DVD edition.

The post Women’s schooling, child mortality, and fertility in Sub-Saharan Africa appeared first on N-IUSSP.