Barcelona 2013
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| Abstract #378 - Pregnancy and Childbearing | ||||
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Session: 34.1: Pregnancy and Childbearing (Parallel) on Tuesday @ 14.30-16.00 in Raval Chaired by Victorio Torres, Malega Kganakga Authors: Presenting Author: Dr Rachel Kidman - Tulane School of Public Health and Tropical Medicine, United States |
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| Additional Authors: Dr. Jordi Casabona, | ||||
| Aim: Millions of youth experience parental bereavement due to the AIDS epidemic. Critically, research demonstrates earlier sexual debut, higher pregnancy rates and a two-fold risk of contracting HIV among orphans. Studies testing modifiable pathways largely focus on the mitigating role of structural vulnerability (e.g., educational attainment and economic insecurity) and related risk behaviors, with mixed results. We explore an alternative hypothesis: heightened risk may stem from orphans? desire for normalcy through family formation, a phenomenon reported among HIV-positive women. Orphans may perceive childbearing as a way to replace loving parental relationships and create a more positive future. We explore these two competing pathways. If sexual behavior and pregnancy are linked to structural vulnerability, we expect: 1a) recent orphans will demonstrate economic and educational deficits; 1b) orphans will be more likely to report sexual partnerships. If sexual activity is linked to family formation, we expect: 2a) orphans will report higher fertility desires; 2b) higher fertility desire will be associated with realized childbearing among orphans. | ||||
| Method / Issue: We present preliminary findings from the Malawi Longitudinal Study of Families and Health, which has collected longitudinal panel data in rural Malawi since 1998. We use data on approximately 1,000 youth aged 15-24 collected in 2006. Orphanhood is stratified by time since parental death (recent = <5 years ago, greater duration = >5 years ago). We run bivariate tests of total fertility between orphans and non-orphans and regressions to examine differences in economic status, educational attainment, HIV risk behavior, and desired fertility. Regressions control for age, household economic status, region of residence, marital status, and number of living children; and are stratified by gender. Further analyses will be conducted using longitudinal data. | ||||
| Results / Comments: Bivariate results show that orphans have significantly more living children than youth with both parents still alive (1.55 for orphans, 1.03 for non-orphans; p<0.01). There is little evidence for systematic socioeconomic disadvantage: no significant relationships emerge for women, and relationships were inconsistent for men (e.g., male orphans of greater duration have higher economic status (p<0.01) but lower educational attainment (p<0.04)). There are no significant differences (at p<0.05) in the number of sexual partners by orphanhood. Both male and female recent orphans have higher fertility desires than those surviving mothers (approximately 0.5 more children desired by female orphans and 1 more by male orphans; p<0.03). Longitudinal data will be used to test casual relationships and whether fertility desires are significantly associated with future childbearing among orphans. | ||||
| Discussion: We find that orphans consistently report both higher fertility desires and actualized childbearing, but not higher sexual risk behaviors. This suggests that orphaned youth may be actively choosing to start families. Interventions to reduce early childbearing and HIV risk will likely need to address 1) normative pressure to have children and 2) psychological pathways between parental bereavement and fertility desire. Malawi is characterized by high rates of HIV, early marriage, and early childbearing; further investigations should examine the generalizability of these associations in other contexts and collect qualitative data to better understand motivations underlying fertility desire. | ||||
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