Long-term Consequences of Men's Migration for Women's Well-being in a Rural African Setting.

Labor migration is a massive global reality, and its effects on the well-being of nonmigrating household members vary considerably. However, much existing research is limited to cross-sectional or short-term assessments of these effects. This study uses unique longitudinal panel data collected over 12 years in rural Mozambique to examine long-term connections of women's exposure to husband's labor migration with women's material security, their perception of their households' relative economic standing in the community, their overall life satisfaction, and their expectations of future improvements in household conditions. To capture the cumulative quality of such exposure, we use two approaches: one based on migrant remittances ("objective") and the other based on woman's own assessment of migration's impact on the household ("subjective"). The multivariable analyses detect a significant positive association between "objective" migration quality and household assets, regardless of women's current marital status and other characteristics. However, net of household assets, "objective" quality shows a positive association with life satisfaction, but not with perceived relative standing of the household or future expectations. In comparison, "subjective" quality is positively associated with all the outcomes even after controlling for other characteristics. These findings illustrate the gendered complexities of long-term migration impact on nonmigrants' well-being.

Gender norms and health: insights from global survey data.

Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.

Educational Selectivity of Migrants and Current School Enrollment of Children Left-Behind: Analyses in Three African Countries.

Migration of household members is often undertaken to improve the well-being of individuals remaining in the household. Despite this, research has demonstrated inconsistent associations between migration and children's well-being across sending areas and types of migration. To understand the degree to which different types of migration and migrants are associated with schooling, we analyze comparable data across three African countries differing in prevalence, type, and selectivity of migration. Results suggest that recent migration is differentially associated with left-behind children's school enrollment across settings. When analyses are restricted to migrant-sending households, however, migrant selectivity is positively associated with school enrollment.

Adults' Conceptualisations of Children's Social Competence in Nepal and Malawi.

Adults in Nepal (N = 14) and Malawi (N = 12) were interviewed about their views regarding social competence of 5- to 17-year-old children in their societies. Both Nepali and Malawian adults discussed themes consistent with those expected in collectivistic societies with economic challenges (e.g., respect and obedience, family responsibilities, social relationships). There were also unique themes emphasized in each country, which may correspond with country-specific religious beliefs or social problems (e.g., rules and self-control, sexual restraint). Nepali adults described a wider variety of socialization strategies compared with Malawian adults. Results provide novel information regarding adults' perceptions of children's social competence in Nepal and Malawi and may help guide the development of measures of social competence.

Physical attractiveness and women's HIV risk in rural Malawi.

BACKGROUND: Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. OBJECTIVE: We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. METHODS: We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15-35. RESULTS: Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. CONCLUSIONS: These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. CONTRIBUTION: This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings.

Parental Divorce and Children's Schooling in Rural Malawi.

A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.

Forgotten marriages? Measuring the reliability of marriage histories.

BACKGROUND: Marriage histories are a valuable data source for investigating nuptiality. While researchers typically acknowledge the problems associated with their use, it is unknown to what extent these problems occur and how marriage analyses are affected. OBJECTIVE: This paper seeks to investigate the quality of marriage histories by measuring levels of misreporting, examining the characteristics associated with misreporting, and assessing whether misreporting biases marriage indicators. METHODS: Using data from the Malawi Longitudinal Study of Families and Health (MLSFH), I compare marriage histories reported by the same respondents at two different points in time. I investigate whether respondents consistently report their spouses (by name), status of marriage, and dates of marriage. I use multivariate regression models to investigate the characteristics associated with misreporting. Finally, I examine whether misreporting marriages and marriage dates affects marriage indicators. RESULTS: Results indicate that 28.3% of men and 17.9% of women omitted at least one marriage in one of the survey waves. Multivariate regression models show that misreporting is not random: marriage, individual, interviewer, and survey characteristics are associated with marriage omission and marriage date inconsistencies. Misreporting also affects marriage indicators. CONCLUSIONS: This is the first study of its kind to examine the reliability of marriage histories collected in the context of Sub-Saharan Africa. Although marriage histories are frequently used to study marriage dynamics, until now no knowledge has existed on the degree of misreporting. Misreporting in marriage histories is shown to be non-negligent and could potentially affect analyses.

The Transformation of Polygyny in Sub-Saharan Africa.

As the rest of the developing world, Sub-Saharan Africa has experienced profound transformations in the institution of marriage. Yet, unlike most other regions, polygyny has remained widespread across the subcontinent. There is, however, evidence to suggest that the practice of polygyny is declining and that selection into polygynous unions based on sociodemographic characteristics is increasing assub-Saharan Africa undergoes rapid sociocultural, demographic, and economic change. Using data from 111 Demographic and Health Surveys conducted in 27 countries since the 1990s, we study recent trends in the prevalence of polygyny among currently married women, examine sociodemographic characteristics of women in polygynous unions, and test whether selection on these characteristics into polygynous unions has increased over time. We find that, net of other factors, the likelihood of being in a polygynous union has declined in most countries. We show that women who are less educated, non-Christian, and living in rural areas are more likely to be in a polygynous union and that in many countries, selection into polygynous unions on these characteristics has been growing. These findings contribute to the broader literature on marital and family change by providing new insights into recent trends in and patterns of polygyny across the subcontinent.

Bridewealth Marriage in the 21st Century: A Case Study from Rural Mozambique.

OBJECTIVE: This study examines trends over several decades in bridewealth marriage and analyzes the association of bridewealth with women's experiences in marriage in a rural sub-Saharan setting. BACKGROUND: Bridewealth - payments from the groom's to the bride's family as part of the marriage process - has long been a central element of kinship and marriage systems in patrilineal sub-Saharan Africa. This payment, which symbolizes the transfer of sexual and reproductive rights from the wife's to the husband's family, is grounded in a collectivist-oriented family system that closely ties women's status and value to their reproductive capacity. METHOD: The study draws on population-based longitudinal survey data collected in 2006, 2009, and 2011 from 1,552 women in rural Mozambique. We use multivariable regression to investigate whether year of marriage predicts being in a bridewealth marriage and whether bridewealth status predicts marital dissolution, women's decision-making autonomy, women's work outside of subsistence agriculture, or modern contraceptive use. RESULTS: The proportion of marriages involving bridewealth payment has declined over time. While no difference by bridewealth status exists in women's autonomy levels or modern contraceptive use, women in bridewealth marriages are less likely to divorce over a five-year period and less likely to work outside of subsistence agriculture, net of other factors. CONCLUSION: These findings reflect the complexity of a modernizing marriage system. With the decline of bridewealth marriage, its meaning has evolved, becoming increasingly indicative of individual wealth and status rather than family control.

The Influence of Schooling on the Stability and Mutability of Gender Attitudes: Findings From a Longitudinal Study of Adolescent Girls in Zambia.

PURPOSE: Inequitable gender norms are thought to harm lifelong health and well-being. We explore the process of gender attitude change and the role of schooling in shifting or reinforcing gender norms among adolescent girls in Zambia. METHODS: We used longitudinal data collected from unmarried, vulnerable girls (aged 10-19 years) as part of the Adolescent Girls Empowerment Program. We conducted random effects multinomial logistic regression to determine whether schooling-related factors were associated with shifts in adolescent girls' gender attitudes across three survey rounds and explored whether these relationships varied by age. RESULTS: Mean gender attitude scores at the aggregate level remained stable over time among rural girls and improved slightly for urban girls. At the individual level, about half the girls had relatively unchanged scores, whereas the other half shifted to higher or lower scores between rounds. Rural and urban girls currently attending school were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable. Educational attainment was not associated with shifts in gender attitudes among rural girls. Urban girls with higher educational attainment were more likely to have relatively stable equitable attitudes than stable, inequitable attitudes, or attitudes that shifted to inequitable or more equitable. CONCLUSIONS: Patterns of gender attitude stability and change differed more for urban girls than rural girls and varied by age and schooling-related factors. In general, schooling appears to be an institutional lever that holds promise for shifting gender attitudes toward greater equality. Our study highlights the importance of looking longitudinally at the effects of social context and reinforces calls for targeted, context-specific interventions for this age group.

The Severity and Management of Complications Among Postabortion Patients Treated in Kinshasa Health Facilities.

CONTEXT: Unsafe abortion is common in Kinshasa, which contributes to high rates of maternal morbidity and mortality. Little is known about the complications and treatment experienced by women seeking postabortion care at health facilities in the city. METHODS: Data from 867 women admitted to a sample of health facilities providing postabortion care in Kinshasa in 2016 were drawn from a Prospective Morbidity Survey. A measure of severity of postabortion complications was developed on the basis of information from these women and their primary care provider. Generalized ordered logistic regression analyses were used to examine associations between the characteristics of postabortion care patients and complication severity. RESULTS: Nearly three-fourths (72%) of postabortion care patients were classified as certainly having had an induced abortion, and another 16% as probably having had one. Sixteen percent of postabortion care patients experienced severe complications, 46% moderate complications and 33% mild complications; 5% had no evidence of complications. Severity of complications was associated with certain patient characteristics: For example, poor patients and those who had never been married had elevated odds of having experienced severe or moderate complications rather than mild or no complications (odds ratios, 1.8-1.9). Patients' complications were most commonly treated with such outdated methods as dilation and curettage and digital curettage (49% and 23%, respectively); only 11% of patients received medication for pain. CONCLUSIONS: Policies and programs promoting contraceptive use and safe legal abortion are needed in Kinshasa to reduce women's recourse to unsafe abortion. Improved quality postabortion care provision is also needed, including World Health Organization-recommended methods.

Reasons why women have induced abortions: a synthesis of findings from 14 countries.

OBJECTIVE: Many reasons inform women's reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. STUDY DESIGN: We examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women's sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. RESULTS: In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women's sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. CONCLUSION: This study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women's decisions to have abortions. IMPLICATIONS: Future research should examine in greater depth the personal, social, economic, and health factors that inform a woman's decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women's lives.

Correction: Characteristics of women obtaining induced abortions in selected low- and middle-income countries.

[This corrects the article DOI: 10.1371/journal.pone.0172976.].

Characteristics of women obtaining induced abortions in selected low- and middle-income countries.

BACKGROUND: In 2010-2014, approximately 86% of abortions took place in low- and middle-income countries (LMICs). Although abortion incidence varies minimally across geographical regions, it varies widely by subregion and within countries by subgroups of women. Differential abortion levels stem from variation in the level of unintended pregnancies and in the likelihood that women with unintended pregnancies obtain abortions. OBJECTIVES: To examine the characteristics of women obtaining induced abortions in LMICs. METHODS: We use data from official statistics, population-based surveys, and abortion patient surveys to examine variation in the percentage distribution of abortions and abortion rates by age at abortion, marital status, parity, wealth, education, and residence. We analyze data from five countries in Africa, 13 in Asia, eight in Europe, and two in Latin America and the Caribbean (LAC). RESULTS: Women across all sociodemographic subgroups obtain abortions. In most countries, women aged 20-29 obtained the highest proportion of abortions, and while adolescents obtained a substantial fraction of abortions, they do not make up a disproportionate share. Region-specific patterns were observed in the distribution of abortions by parity. In many countries, a higher fraction of abortions occurred among women of high socioeconomic status, as measured by wealth status, educational attainment, and urban residence. Due to limited data on marital status, it is unknown whether married or unmarried women make up a larger share of abortions. CONCLUSIONS: These findings help to identify subgroups of women with disproportionate levels of abortion, and can inform policies and programs to reduce the incidence of unintended pregnancies; and in LMICs that have restrictive abortion laws, these findings can also inform policies to minimize the consequences of unsafe abortion and motivate liberalization of abortion laws. Program planners, policymakers, and advocates can use this information to improve access to safe abortion services, postabortion care, and contraceptive services.

The incidence of induced abortion in Kinshasa, Democratic Republic of Congo, 2016.

BACKGROUND: In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. OBJECTIVES: Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. METHODS: We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. RESULTS: In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15-49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15-49. CONCLUSIONS: Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality.

Father's Migration and Leaving the Parental Home in Rural Mozambique.

Migration is an increasingly common demographic phenomenon and has important implications for the well-being of family members left behind. Although extensive research has examined the impact of parental labor migration on school-age children, less is known about its effect on adolescents. In this study, the authors used longitudinal survey data collected in rural Mozambique (N = 515) to assess the association between father's migration and adolescent children's leaving the parental home, an important component of the transition to adulthood. The results showed that father's migration delays home-leaving for adolescent girls and that these effects are not mediated by school enrollment. The results for boys were inconclusive. The authors also found that remittances and longer durations of paternal migration were negatively associated with the transition out of the home. On the basis of the findings, they argue that father's migration delays girls' marriage.

Barriers to contraceptive use among women in Benin.

The Republic of Benin has made it a national priority to promote family planning as part of its efforts to reduce maternal and child mortality rates. In addition to preventing deaths, increased contraceptive use would help women and families achieve their desired number of children and have greater control over timing births. It would also help Benin meet its development goals, including reducing poverty and increasing women's education and earning levels, children's schooling and GDP per capita. Key Points. (1) Although Benin's government promotes family planning, more needs to be done to meet the country's goal of increasing contraceptive prevalence to 20% by 2018. (2) As of 2012, modern contraceptive use remains low. Only 7% of married women and 23% of unmarried sexually active women use modern methods. (3) Unmet need has increased since 2006, from 27% to 33% among married women and from 35% to 50% among sexually active unmarried women. (4) Among married women with unmet need, the most commonly cited reasons for contraceptive nonuse are fear of side effects/health concerns (22%) and opposition to use (22%). In contrast, never-married women with unmet need cite not being married (42%), infrequent or no sex (21%) and fear of side effects/health concerns (17%). (5) Among women currently using sterilization, IUDs, implants, injectables or the pill, 57% report having been told about side effects when they received their method; 88% of those who were told about side effects were given instructions on how to deal with them. (6) Strategies to increase contraceptive use include improving the availability and quality of contraceptive services, increasing knowledge of family planning, and addressing social and cultural barriers to contraception.

Timing of orphanhood, early sexual debut, and early marriage in four sub-Saharan African countries.

According to a growing body of literature, some orphans are at heightened risk of early sexual debut and early marriage. This study examines a rarely explored aspect of orphanhood: the timing and type of parental death and their relationship to these outcomes. The study also explores whether education mediates orphans' risk of early sexual initiation and early marriage. The data are drawn from the 2004 National Survey of Adolescents, which includes interviews with 12-19-year-old adolescents in Burkina Faso, Ghana, Malawi, and Uganda. Results from discrete-time event history analysis indicate that female double orphans, regardless of timing of orphanhood, have greater odds of early sexual debut than do nonorphans. Education explains little of their increased risk. In contrast, male orphans of any type reveal no increased vulnerability to early sexual debut. Uganda is the only country where female orphans, specifically double orphans and those who are paternal orphans before age 10, have greater odds of early marriage, with education accounting for a small portion of the risk.