Family Changes and Their Implications for Child Health Outcomes in Sub-Saharan Africa: A Multivariate Decomposition Analysis

Abstract

Demographic literature on family changes and their health consequences is dominated by evidence from developed countries. Family norms, values and practices are deeply rooted in the sociocultural beliefs of societies. Therefore, findings from the developed and western nations cannot adequately represent the experiences of sub-Saharan African nations. This book chapter is aimed at providing evidence to bridge this knowledge gap. Family changes and their implication for childhood survivorship in sub-Saharan Africa were investigated using reproductive history data collected for demographic and health surveys in seven countries (Cameroon, Ghana, Kenya, Namibia, Senegal, Uganda and Zimbabwe). Descriptive analysis was performed to describe changes in selected indicators of family characteristics. Relative contributions of changes in these characteristics to childhood mortality decline were estimated using multivariate decomposition techniques. The findings indicate that though family changes in the seven countries are diverse, some patterns still emerged. Prominent among these patterns is the declining proportion of women in marital unions. While the pace was fastest in Ghana and Namibia, the case was different in the other five countries. Contraceptive use increased, while family size followed a downward trend. Nonmarital childbearing increased only in Namibia and Ghana. Furthermore, the results showed that the proportion of changes in childhood death that could be attributed to family changes is less than 25% in all countries. The complex nature of the relationship between selected family indicators and childhood mortality precludes a conclusive statement on the implications of changes in family structure for child survival.