Patriarchal norms, partner pronatalism, and women's fertility intentions in Ghana.

Social norms influence many dimensions of women's lives and women's assumptions about male partners' pronatalism can have important associations with fertility behaviours. Using data on married/cohabiting women from the 2018/19 Ghana Socioeconomic Panel Survey and a series of robust descriptive analyses and logistic regression models, the links between women's internalization of patriarchal norms, presumed male partner pronatalism and fertility intentions are explored. The characteristics of conservative and liberal women are also examined. Logistic regressions show that greater internalization of patriarchal norms is associated with higher odds of women wanting more children- male children, particularly. Additionally, women's perceptions of their partners' fertility preferences were important- women who assumed that their male partners wanted more children tended to have stronger immediate pronatalist intentions themselves. Descriptive analyses show that conservative women, with greater internalized patriarchal norms, are more pronatalist, less educated, resident in rural parts of the country and more likely to be from poorer households, compared to their more liberal counterparts. Findings encourage the tailoring and targeting of family planning messages along cultural lines, to influence women's fertility intentions. Additionally, the importance of effective spousal communication is highlighted. Findings also emphasise the importance of involving men in the implementation of family planning programs.

Mixed methods exploration of Ghanaian women's domestic work, childcare and effects on their mental health.

This research paper aims to understand the effects of time spent in domestic work, including childcare, on women's mental health in Ghana. The paper adopted a triangulation convergence mixed methods approach. The quantitative information was sourced from two waves (2009/ 2014) of the Ghana Socioeconomic Panel Survey (GSEPS) while qualitative information was obtained from in-depth interviews with couples and key informants from five (5) regions, representing diverse ethnic backgrounds, in Ghana. Employing fixed effects regressions and a multinomial logistic regression model with fixed effects, we find that domestic work contributes to poorer mental health outcomes among women. These results are consistent, even when we correct for potential self-selectivity of women into domestic work. We also examine whether the relationship is differentiated between women of higher and lower socioeconomic status. We find that women from wealthier households who spend increasing time in domestic work have higher odds of mental distress. These results are supported by the qualitative data- women indicate increasing stress levels from domestic work and while some husbands acknowledge the situation of their overburdened wives and make attempts, however minor, to help, others cite social norms and cultural expectations that act as a deterrent to men's assistance with domestic work. Efforts should be made to lessen the effects of social and cultural norms which continue to encourage gendered distributions of domestic work. This may be done through increased education, sensitization and general re-socialization of both men and women about the need for more egalitarian divisions of household work.

Revisiting the polygyny and intimate partner violence connection: The role of religion and wife's rank in Nigeria.

Objective: The study examines the association between polygyny and intimate partner violence (IPV) by focusing on the Muslim-vs.-Christian context of polygyny and on co-wives' rank. Background: Although prior research points to a higher incidence of IPV in polygynous unions, the association between polygyny and IPV are not well understood. In particular, the role of broader cultural and religious context of marriage and its connection with intra-marital dynamics have not been examined. Method: The study uses pooled data on over 42,000 women from the 2008, 2013 and 2018 rounds of the Nigeria Demographic and Health Survey to examine the association of polygynous versus monogamous status of marriage, of Muslim versus Christian religious affiliation, and of co-wife rank within polygynous unions in both religions with women's reported experience of physical, emotional, and sexual IPV. Multivariate logit and propensity score models (PSM) are fitted, and the Rosenbaum bounds test is used to gauge the robustness of PSM results. Results: Results show a clear disadvantage of polygynously married women, compared to monogamously married ones; IPV experience is more common among Christians than Muslims. Among women in polygynous marriages, senior wives are more likely to experience IPV than junior wives, but this difference is more pronounced among Christians. Results of a Rosenbaum bounds analysis indicate that unobserved selectivity does not present a challenge to causality between polygyny/wife rank and IPV, particularly when analyses are disaggregated by religion. Conclusion: Findings reflect multi-dimensional gender inequalities embedded in the institution of polygynous marriage and their harmful consequences for women's health and well-being.

Food insecurity and family structure in Nigeria.

The article explores a series of questions and hypotheses related to polygynous family structures and both household and individual-level food security outcomes, using the World Bank Living Standards Measurement Survey data from Nigeria, collected in 2011, 2013 and 2015. A Correlated Random Effects (CRE) model is used to examine the relationship between polygyny and household-level food security, and the degree to which it is mediated by household wealth, size, and livelihood. A Household Fixed Effect model is employed to explore whether a mother's status as monogamous versus polygynous relates systematically to her child's health, and also whether child outcomes of senior wives are better than outcomes of junior wives within polygynous households. At the household level, polygynous households are found to have better food security outcomes than monogamous households with differences in household composition and agricultural livelihood as potential explanatory mechanisms. At the individual level, however, children of polygynous mothers have worse nutrition outcomes than children of monogamous mothers in the long run. Within polygynous households, children of junior wives appear to have better nutritional outcomes in the long run, compared to children of more senior wives.

Economic evaluation of 2014 cholera outbreak in Ghana: a household cost analysis.

INTRODUCTION: Ghana experienced its worst cholera outbreak in three decades in 2014. Evidence of cholera economic costs on affected households has been limited. This study aimed at determining economic costs on households affected by the  cholera outbreak in a Coastal Region of Ghana. METHODS: Two districts; High and Low Incidence Areas (HIA and LIA) were selected in comparative cost analysis and disease impact on affected households assessed based on scientifically documented economic indicators. A total of 418 (282 HIA and 136 LIA) households that experienced at least one case of cholera infection were interviewed. Direct and indirect costs were estimated. Correlates of household's cholera infection were estimated using Tobit Regression model in STATA 13. RESULTS: Average direct cost to households in HIA amounted to USD 106.88, almost 2 folds higher than LIA (USD 62.02). Potential cost saving of an episode of cholera is USD 99,201.28 in LIA and raises almost 8 folds in HIA (USD 782,611.60). Households in lowest income category had the highest incidence of cholera (0.073) compared to other categories plus other factors were significant in explaining cholera incidence. CONCLUSIONS: The study showed considerable differences in HIA and LIA costs with higher household economic impact of cholera on the lowest income category. Results underscore the need for pragmatic policy interventions  to avert recurrent outbreaks and emphasis huge potential  cost saving with reducing  cholera cases.

Determinants and the impact of the National Health Insurance on neonatal mortality in Ghana.

The national health insurance was established to increase access to health care services and the maternal component was later introduced to improve the health outcomes of both mother and child. The main objectives of this study are to investigate the factors that affect neonatal deaths as well as examine the effect of the Ghana Health Insurance on neonatal deaths in Ghana. Using the most recent round of the Ghana Demographic and Health Survey, the study estimates the probit model with interaction effects to account for the heterogeneity in outcomes. Additionally, the study employs the propensity score matching approach to account for the possible endogeneity in the insurance enrolment decision. Results from the estimations, after controlling for relevant individual and household characteristics suggest that the national health insurance significantly reduces the likelihood of neonatal deaths. Estimates remain consistent even after more robust estimators are employed. Estimates from the interaction between place of residence and health insurance indicate that health insurance beneficiaries who reside in urban areas are at a higher risk of neonatal deaths compared to other women. Access to medical facilities proxied by distance to the nearest health post emerged as an important predictor of neonatal death. The study also suggests significant regional differences in neonatal deaths. We, therefore, conclude that the national health insurance may have the potential to substantially improve the health outcomes of neonates and have policy implications for increasing coverage to more mothers and their neonates, as well as coverage in critical neonatal services and drugs.

The effect of neighbourhood mortality shocks on fertility preferences: a spatial econometric approach.

According to the demographic transition theory, fertility rates fall in response to declines in child mortality rates. Although national statistics indicate that child mortality rates have been declining over time, Ghana's fertility rates appear to have stalled. This paper hypothesises that women's fertility behaviours may be more responsive to child mortality experiences at more localised levels. Using all rounds of the Ghana Demographic and Health Surveys (1988-2008) and employing a variety of spatial and empirical estimation techniques, results indicate that in addition to own-child mortality, neighbourhood child mortality shocks are also a determinant of women's fertility in Ghana. Women in neighbourhoods with large child mortality shocks may desire more children as an "insurance" against future losses, as a result of their increased perceptions of own-child mortality risks.

Examining the influence of antenatal care visits and skilled delivery on neonatal deaths in Ghana.

BACKGROUND: Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60% of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality. OBJECTIVE: This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana. METHODS: Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits. RESULTS: Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2%, while older women have an approximately 0.2% higher risk of losing their neonates than do younger women. CONCLUSION: Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women's age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.

National health insurance, social influence and antenatal care use in Ghana.

The study explores the importance of social influence and the availability of health insurance on maternal care utilization in Ghana through the use of antenatal care services. A number of studies have found that access to health insurance plays a critical role in women's decision to utilize antenatal care services. However, little is known about the role that social forces play in this decision. This study uses village-level data from the 2008 Ghana Demographic and Health Survey to investigate the effects of health insurance and social influences on the intensity of antenatal care utilization by Ghanaian women. Using GIS information at the village level, we employ a spatial lag regression model in this study. Results indicate that, controlling for a host of socioeconomic and geographical factors, women who have health insurance appear to use more antenatal services than women who do not. In addition, the intensity of antenatal visits appears to be spatially correlated among the survey villages, implying that there may be some social influences that affect a woman's decision to utilize antenatal care. A reason for this may be that women who benefit from antenatal care through positive pregnancy outcomes may pass this information along to their peers who also increase their use of these services in response. Traditional/Cultural leaders as "gate-keepers" may be useful in the dissemination of maternal health care information. Public health officials may also explore the possibility of disseminating information relating to maternal care services via the mass media.