Household Structure and Childhood Mortality in Ghana Winfred Avogo Victor Agadjanian

1. Household Structure and Childhood Mortality in Ghana Winfred Avogo Victor Agadjanian Department of Sociology/ Center for Population Dynamics, Arizona State University

2. Introduction • Child mortality public health priority in Africa • Analysis show mortality decline has stalled • Focus on socio-economic & biological factors • Little known about influence of living arrangements of children on child mortality • Examine household structure within cultural and socio-economic context children live

3. Objectives • Chart trends in childhood mortality from 1993- 2003 • Estimate effect of household structure on child survival • Examine variations of household structure and child survival across rural and urban areas

4. Setting • Ghana; population of 20 million in West Africa • Economy stable; estimated poverty rate at 35%of population • 25% Urban and 75% rural • Young population with 46.9% 0-14 • Overall life expectancy of 59.6 for females and 55.4 for males

5. Theoretical framework Three major theoretical perspectives: • ‘New household economic models’ Becker, 1981; Schultz, 1974 • Critically examine household as a single entity • Resource pooling within the family • Household boundaries and resource availability • Literature on socioeconomic influences on child survival • Biological proximate determinants of child survival

6. Hypotheses • Children in nuclear households have health advantage if constraints to resource pooling exist • Effects of nuclear households depend on mother’s education and socio-economic status • Effects mediated by bio-demographics of mother and utilization of maternal services • Effects of household structure stronger in rural than in urban areas

7. Data and Methods • Ghana Demographic Health Surveys (GDHS), cross-sectional; 1993, 1998 & 2003 • Sample size: 6351 last born children Statistical Model • Discrete-time logistics models • 5 Age intervals specified • Each child contributes 1-5 observations depending on age at death or censoring

8. Data and Methods • Outcome Variable: • Childhood mortality: probability of dying from • birth to age 5 • Main predictor: Household structure: two broad forms: • (1) Elementary: nuclear & single-parent Households • (2) Extended:three generational & lateral households • Control variables: person months lived, socio-economic, bio-demographic, maternal health factors

9. Analytical Strategies • Model 1: Household structure, 2: socio-economic, 3: biological and maternal utilization • Urban and Rural Areas: Same model specification

13. Figure 4: Child Survival Estimates by Household Structure

14. Multivariate Results *= <.05, ** = <.01 + = <.1

15. Summary of findings • Extended households seem to have negative impact on child mortality • Household structure important for rural areas does not appear so in urban areas • Cost of health care, social inequalities may explain effects of household structure in rural and urban areas • Education and standard of living more important in urban areas

16. Conclusion and Implications • Community level health interventions need to adjust to specific needs of household forms • More research is needed to identify vulnerable children in changing household situations • Comprehensive sociological models needed to account for household effects

17. THANK YOU