Academic journal article International Perspectives on Sexual and Reproductive Health

Fertility among Orphans in Rural Malawi: Challenging Common Assumptions about Risk and Mechanisms

Academic journal article International Perspectives on Sexual and Reproductive Health

Fertility among Orphans in Rural Malawi: Challenging Common Assumptions about Risk and Mechanisms

Article excerpt

In Sub-Saharan Africa, millions of youth have lost one or both parents to the HIV epidemic. A parental death can have a profound impact on children and young adults, and practitioners and researchers alike have emphasized the adverse consequences of orphanhood. Indeed, a substantial body of literature has identified disparities in health, education and economic outcomes between orphaned and nonorphaned children, (1) and concern is growing about the reproductive health of orphaned adolescents and youth. One area of concern is fertility, as early childbearing is associated with substantial mortality for both mothers and infants in developing countries. (2)

The relationship between orphanhood and pregnancy has not been decisively established. In the past decade, six studies have assessed this relationship in Sub-Saharan Africa, and four demonstrated higher rates of pregnancy among orphans than among nonorphans. (3-6) However, the geographic scope of these studies was limited to Zimbabwe and South Africa, and the relationship between orphanhood and pregnancy may be different in other settings. In addition, these findings are contradicted by those from two more recent studies, which also included data from Zimbabwe and South Africa. (7,8) In particular, Palermo and Peterman examined this issue using data from 10 countries in Sub-Saharan Africa, and found differences in only three. (7) Extending analyses to other countries could yield important information about how orphanhood affects fertility in different social contexts.

Potential Mechanisms

When differences in fertility by orphan status do emerge in the literature, they are implicitly ascribed to increased structural vulnerability (e.g., poverty) and related sexual risk-taking among orphans. However, as we shall see, the exact mechanisms through which orphanhood may affect risk behavior have not been clearly established, and may differ across settings. This is a critical oversight, as the success of programs to identify and assist at-risk youth likely hinges on a clear understanding of the mechanisms.

* Structural vulnerability and sexual risk. According to this pathway, the adverse impacts of orphanhood, such as impoverishment and educational curtailment, reduce sexual power. As a result, orphans may be more easily exploited or coerced into having high-risk sex than nonorphans, and unwanted pregnancies may result. For example, Gregson and colleagues noted that female orphans had a lower likelihood than nonorphans of completing secondary school, which in turn was associated with adverse reproductive outcomes. They concluded: "High proportions of HIV infections, STIs and pregnancies among teenage girls in eastern Zimbabwe can be attributed to maternal orphanhood and parental HIV. Many of these could be averted through further female secondary school education." (3) (p.785)

To examine the supporting evidence, we have broken the structural vulnerability pathway into three components: Orphans experience greater socioeconomic disadvantage; orphans engage in higher levels of sexual risk behavior; and socioeconomic disadvantage drives sexual risk-taking among orphans. We find the evidence for all three to be inconclusive.

An extensive body of research has examined economic insecurity and educational disadvantage among orphans, (9) and evidence has been mixed. Longitudinal studies in South Africa and Kenya have documented lower rates of school enrollment among orphans than among nonorphans, (10,11) but studies in Malawi, Tanzania and Burkina Faso have found no disadvantage among orphans. (12,13) Where educational disparities do appear, they are largely associated with maternal orphanhood. (9) The picture that emerges concerning economic disadvantage is equally varied, with regard to both country context and type of orphan. (14,15) Unlike schooling, poverty is more common among paternal than maternal orphans. (15) Taken together, the evidence suggests that disparities between orphans and nonorphans in human capital accumulation are not always present, and that they depend on the context, orphan type and specific outcome under study. …

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