SOCIAL DYNAMICS OF ADOLESCENT FERTILITY IN SUB-SAHARAN AFRICA

POPULATION DYNAMICS OF SUB-SAHARAN AFRICA

Caroline H. Bledsoe and Barney Cohen, Editors

Working Group on the Social Dynamics of Adolescent Fertility

Panel on the Population Dynamics of Sub-Saharan Africa

Committee on Population

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1993



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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa SOCIAL DYNAMICS OF ADOLESCENT FERTILITY IN SUB-SAHARAN AFRICA POPULATION DYNAMICS OF SUB-SAHARAN AFRICA Caroline H. Bledsoe and Barney Cohen, Editors Working Group on the Social Dynamics of Adolescent Fertility Panel on the Population Dynamics of Sub-Saharan Africa Committee on Population Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1993

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa POPULATION DYNAMICS OF SUB-SAHARAN AFRICA DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA DEMOGRAPHIC EFFECT OF ECONOMIC REVERSALS IN SUB-SAHARAN AFRICA EFFECTS OF HEALTH PROGRAMS IN CHILD MORTALITY IN SUB-SAHARAN AFRICA FACTOR AFFECTING CONTRACEPTIVE USE IN SUB-SAHARAN AFRICA POPULATION DYNAMICS OF KENYA POPULATION DYNAMICS OF SENEGAL SOCIAL DYNAMICS OF ADOLESCENT FERTILITY IN SUB-SAHARAN AFRICA

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa NOTE: This map, which has been prepared sorely for the convenience of readers, does not purport to express political boundaries or relationships. The scale is a composite of several forms of projection.

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council. Library of Congress Catalog Card No. 93-84260 International Standard Book Number 0-309-04897-4 Additional copies of this report are available from: National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20418. Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). B147 Copyright 1993 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa WORKING GROUP ON THE SOCIAL DYNAMICS OF ADOLESCENT FERTILITY CAROLINE H. BLEDSOE (Chair), Department of Anthropology, Northwestern University ANDREW J. CHERLIN, Department of Sociology, Johns Hopkins University ANASTASIA J. GAGE-BRANDON, Demographic and Health Surveys, Institute for Resource Development/Macro International, Columbia, Maryland JANE I. GUYER, Department of Anthropology, Boston University DANIEL M. SALA-DIAKANDA, Institut de Formation et de Recherche Démographiques (IFORD), Yaoundé, Cameroon BARNEY COHEN, Staff Officer DOMINIQUE MEEKERS, Staff Officer* JOAN M. MONTGOMERY HALFORD, Senior Project Assistant** PAULA J. MELVILLE, Senior Project Assistant *   through December 1991 **   through July 1992

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa PANEL ON THE POPULATION DYNAMICS OF SUB-SAHARAN AFRICA KENNETH H. HILL (Chair), Department of Population Dynamics, Johns Hopkins University ADERANTI ADEPOJU, Institut de Développement Economique et de la Planification (IDEP), Dakar, Senegal JANE T. BERTRAND, School of Public Health and Tropical Medicine, Tulane University CAROLINE H. BLEDSOE, Department of Anthropology, Northwestern University WILLIAM BRASS, Centre for Population Studies, London School of Hygiene and Tropical Medicine, England DOUGLAS C. EWBANK, Population Studies Center, University of Pennsylvania PHILIPPE FARGUES, Centre d'Etudes et de Documentation Economique, Sociale et Juridique (CEDEJ), Cairo, Egypt RON J. LESTHAEGHE, Faculteit van de Economische, Sociale en Politieke Wetenschappen, Vrije Universiteit Brussel, Belgium PATRICK O. OHADIKE, Regional Institute for Population Studies (RIPS), Accra, Ghana ANNE R. PEBLEY, The RAND Corporation, Santa Monica, California DANIEL M. SALA-DIAKANDA, Institut de Formation et de Recherche Démographiques (IFORD), Yaoundé, Cameroon

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa COMMITTEE ON POPULATION SAMUEL H. PRESTON (Chair), Population Studies Center, University of Pennsylvania JOSE-LUIS BOBADILLA, World Bank, Washington, D.C. JOHN B. CASTERLINE, Department of Sociology, Brown University KENNETH H. HILL, Department of Population Dynamics, Johns Hopkins University DEAN T. JAMISON, School of Public Health, University of California, Los Angeles ANNE R. PEBLEY, The RAND Corporation, Santa Monica, California RONALD R. RINDFUSS, Department of Sociology, University of North Carolina, Chapel Hill T. PAUL SCHULTZ, Department of Economics, Yale University SUSAN C.M. SCRIMSHAW, School of Public Health, University of California, Los Angeles BETH J. SOLDO, Department of Demography, Georgetown University MARTA TIENDA, Population Research Center, University of Chicago BARBARA BOYLE TORREY, Population Reference Bureau, Washington, D.C. JAMES TRUSSELL, Office of Population Research, Princeton University AMY O. TSUI, Carolina Population Center, University of North Carolina, Chapel Hill LINDA G. MARTIN, Director BARNEY COHEN, Research Associate SUSAN M. COKE, Senior Project Assistant KAREN A. FOOTE, Research Associate DIANE L. GOLDMAN, Administrative Assistant* JAMES N. GRIBBLE, Program Officer JOAN M. MONTGOMERY HALFORD, Senior Project Assistant** CAROLE L. JOLLY, Program Officer DOMINIQUE MEEKERS, Research Associate* PAULA J. MELVILLE, Senior Project Assistant *   through December 1991 **   through July 1992

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa Preface This report is one in a series of studies that have been carried out under the auspices of the Panel on the Population Dynamics of Sub-Saharan Africa of the National Research Council's Committee on Population. The Research Council has a long history of examining population issues in developing countries. In 1971 it issued the report Rapid Population Growth: Consequences and Policy Implications . In 1977, the predecessor Committee on Population and Demography began a major study of levels and trends of fertility and mortality in the developing world that resulted in 13 country reports and 6 reports on demographic methods. Then, in the early 1980s, it undertook a study of the determinants of fertility in the developing world, which resulted in 10 reports. In the mid-and late-1980s, the Committee on Population assessed the economic consequences of population growth and the health consequences of contraceptive use and controlled fertility, among many other activities. No publication on the demography of sub-Saharan Africa emerged from the early work of the committee, largely because of the paucity of data and the poor quality of what was available. However, censuses, ethnographic studies, and surveys of recent years, such as those under the auspices of the World Fertility Survey and the Demographic and Health Survey programs, have made available data on the demography of sub-Saharan Africa. The data collection has no doubt been stimulated by the increasing interest of both scholars and policymakers in the demographic development of Africa and the relations between demographic change and socioeconomic develop-

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa ments. In response to this interest, the Committee on Population held a meeting in 1989 to ascertain the feasibility and desirability of a major study of the demography of Africa, and decided to set up a Panel on the Population Dynamics of Sub-Saharan Africa. The panel, which is chaired by Kenneth Hill and includes members from Africa, Europe, and the United States, met for the first time in February 1990 in Washington, D.C. At that meeting the panel decided to set up six working groups, composed of its own members and other experts on the demography of Africa, to carry out specific studies. Four working groups focused on cross-national studies of substantive issues: the social dynamics of adolescent fertility, factors affecting contraceptive use, the effects on mortality of child survival and general health programs, and the demographic effects of economic reversals. The two other working groups were charged with in-depth studies of Kenya and Senegal, with the objective of studying linkages between demographic variables and between those variables and socioeconomic changes. The panel also decided to commission papers reviewing levels and trends of fertility, the proximate determinants of fertility, nuptiality, child mortality, adult mortality, internal migration, and international migration, as well as the demographic consequences of the AIDS epidemic. This report, one of the four cross-national studies, is concerned with the social dynamics of adolescent fertility in sub-Saharan Africa. It uses data from recent national surveys, conducted under the auspices of the Demographic and Health Surveys (DHS), to examine, among other things, contemporary trends in marriage, sexuality, contraceptive use, and fertility. It describes in some depth the changing social context within which adolescents are having children in sub-Saharan Africa, and the effects of these changing circumstances on the benefits and risks of early childbearing. The report draws extensively on ethnographic and historical literature to demonstrate the enormous heterogeneity in economic and social regimes within sub-Saharan Africa. This heterogeneity is used to explain why adolescent fertility has very different meanings and outcomes for different groups. This report results from the joint efforts of the working group members and staff and represents a consensus of the members' views on the issues addressed. The Committee on Population and the Panel on the Population Dynamics of Sub-Saharan Africa appreciate the time and energy that all the working group members devoted to the study. Caroline H. Bledsoe wrote the first drafts of Chapters 1 and 8, and she and Barney Cohen served as the principal editors and coordinators for the manuscript. Andrew J. Cherlin and Dominique Meekers collaborated on the first draft of Chapter 2, and Anastasia Gage-Brandon wrote the first draft of Chapter 3. Jane I. Guyer wrote the first draft of Chapters 4 and 6. Dominique Meekers wrote, and Daniel M. Sala-Diakanda contributed to, the first draft of Chapter 5. Barney

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa Cohen wrote the first draft of Chapter 7, relying heavily on a commissioned paper by Laurie Zabin and Karungari Kiragu. As noted above, however, this report represents the views of the group as a whole, and considerable effort by all the members and staff went into the refinement of the early drafts. The working group would like to acknowledge the help of Katherine Abu, A.A. Adejo, Aderanti Adepoju, Odette Ba, Gary Barker, Ann Blanc, Reed Boland, Judith Bruce, Kabir Cham, Gracia Clark, Francine Coeytaux, Sidiki Coulibaly, Allan Ferguson, Karen Foote, Christina Fowler, Samantha Garbers, Adrienne Germaine, Muhiuddin Haider, Karen Tranberg Hansen, Sarah Harbison, Kenneth Hill, Nikki Jones, Karungari Kiragu, Anke Kleiner-Bossaller, Mary Kay Larson, V.K. Lema, Thérèse Locoh, Carolyn Makinson, Linda G. Martin, Dominique Meekers, Asha Mohamud, Leo Morris, Pierre Ngom, Wangui Njau, Mojisola Olaneyan, John Paxman, Sam Preston, Paul Richards, K.O. Rogo, Harshadkumar C. Sanghvi, Krista Stewart, John M. Whiting, Nancy Williamson, and Laurie Zabin. As is the case for all of the panel's work, this report would not have been possible without the cooperation and assistance of the Demographic and Health Surveys Program of the Institute for Resource Development/Macro Systems. We are grateful to the DHS staff for responding to our inquiries and facilitating our early access to the survey data. We are also most grateful to the organizations that provided financial support for the work of the Africa panel: the Office of Population and the Africa Bureau of the Agency for International Development, the Andrew W. Mellon Foundation, the William and Flora Hewlett Foundation, and the Rockefeller Foundation. Besides providing funding, the representatives of these organizations were a source of information and advice in the development of the panel's overall work plan. Special thanks are also due to Joan Montgomery Halford and Paula J. Melville for providing superb administrative and logistical support to the working group, to Mendelle T. Berenson and Florence Poillon for skillful editing of the report, to Elaine McGarraugh for meticulous production assistance, and to Eugenia Grohman for valuable guidance and extraordinary patience through the review and production processes. SAMUEL H. PRESTON, Chair Committee on Population

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   5     Changes in Two Configurations of Adolescent Fertility   7     Analytical Frameworks for Explaining Change in Adolescent Fertility   9     Our Approach: Social Influences on the Outcomes of Adolescent Fertility   11     Plan of the Report   13 2   LEVELS AND TRENDS IN ADOLESCENT FERTILITY   16     Levels of Education, Sexual Experience, Marriage, Fertility, and Contraceptive Use Among Adolescents   16     Trends in Education, Marriage, and Fertility Among Adolescents   23     Putting the Indicators Together   32     Conclusion   36 3   MARRIAGE: NEW FORMS, NEW AMBIGUITIES   37     ''Customary'' Marriage in Africa   38     Effects of Ambiguous Marital Status on Legitimate Reproduction   47     Changes in Marriage in Contemporary Africa   49

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa     Effect of These Changes on Marriage   65     Effects of Marital Changes on Premarital Sexuality and Reproduction   67 4   REPRODUCTIVE ENTITLEMENT: THE SOCIAL CONTEXT OF FERTILITY AND PARENTHOOD   69     The Political Economy of Marriage and Reproduction   70     The Value of Children   71     Reproduction Within the Sequence of Life Events   73     Earning Reproductive Entitlement   74     The Boundaries of Adolescent Sexuality   77     The Regulation of Paternity   79     Changes in Adolescent Sexuality and Reproduction   83     Changes in Unsanctioned Births   87 5   EDUCATION AND ADOLESCENT FERTILITY   89     The "Culture" of Formal Education: An Example from Sierra Leone   91     Levels and Trends in Formal Education   95     Educational Influences on Adolescent Fertility   99     Why Do Schoolgirls Become Pregnant?   107     Effects of Adolescent Fertility on Education   109     Conclusion   114 6   EARLY WORK, TRAINING, AND PREPARATION FOR ADULTHOOD   116     Adolescent Labor Force Participation   117     Patterns of Female Employment   123     Discussion   131     Fertility and Training Outside Schooling   132     Conclusion   140 7   CONSEQUENCES OF ADOLESCENT SEXUALITY AND CHILDBEARING FOR MOTHERS AND CHILDREN   142     Health Consequences of Adolescent Fertility   147     Socioeconomic Consequences of Adolescent Fertility   161     Discussion   166

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Social Dynamics of Adolescent Fertility in Sub-Saharan Africa 8   CONCLUSIONS   168     Future Research Needs   173     Summary   176 APPENDIX:   DIFFICULTIES IN ANALYZING ADOLESCENT FERTILITY   178     Definition of Adolescent   178     Definition of Marriage   179     The Data: Definitions and Deficiencies   180     Integration of Data Sources   182     Dating of Change   183     REFERENCES   185

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