Parental Divorce and Child Mortality in Sub-Saharan Africa ... · Parental Divorce and Child Mortality in Sub-Saharan Africa: ... Paper first prepared for presentation in session

Parental Divorce and Child Mortality in Sub-Saharan Africa: Does Context Matter?

Emily Smith-Greenaway University of Michigan

University of Southern California mailto:[email protected]

Shelley Clark McGill University

[email protected]

Population Studies Center Research Report 15-843 July 2015

Paper first prepared for presentation in session 178 at the 2015 Population Association of America’s annual meeting in San Diego, California. Emily Smith-Greenaway gratefully acknowledges use of the services and facilities of the Population Studies Center at the University of Michigan, funded by NICHD Center Grant R24 HD041028 and the support of an NICHD training grant to the Population Studies Center at the University of Michigan (T32 HD007339).

mailto:[email protected]

mailto:[email protected]

Parental Divorce and Child Mortality in Sub-Saharan Africa: Does Context Matter? 2

Abstract Parental divorce is known to be associated with poor child health in sub-Saharan Africa. However, the great diversity in social and cultural practices, including marital ones, across the subcontinent likely yields substantial variation in the prevalence of divorce, which in turn could moderate its consequences for children. In this paper, we use Demographic and Health Survey data from 31 African countries to estimate variation in the prevalence of divorce across 290 subnational regions. We find that the prevalence of divorce varies significantly, ranging from less than 1 percent of women in some subnational regions to nearly 20 percent in others. We then estimate a series of multilevel discrete-time hazard models to analyze the association between parental divorce and child mortality, and to test whether the mortality risk associated with divorce varies significantly in subnational regions where divorce is rare compared to those where it is common. We find that children with divorced parents experience significantly amplified mortality risk where divorce is rare, even though their mothers are positively selected on socioeconomic traits. We argue that the stigmatization and discrimination associated with divorce in subnational regions where it is rare, and the lack of social and cultural support, leave divorced mothers and their children particularly vulnerable to poor health outcomes in these settings.


INTRODUCTION

Extensive evidence shows that children with divorced parents have worse outcomes

compared to their peers whose parents stay married (Amato, 2010). The vast majority of

evidence comes from studies on North American and European families; however, recent

research on African families has linked divorce to especially severe childhood disadvantages.

African children with divorced parents are more likely to be malnourished (Gage, 1997),

miss out on vaccinations (Gage, 1997), attend less school (Chen, 2012; Thiombiano,

LeGrand, & Kobiané, 2013), and die before age five (Clark & Hamplová, 2013;

Thiombiano et al., 2013) than their peers whose parents remain married.

Like most research on the consequences of family processes for children’s wellbeing,

studies on the implications of parental divorce in Africa have focused exclusively on the

family-level, giving no recognition to the broader cultural, social, and marital context in

which divorce unfolds. Nonetheless, recent research suggests that one contextual feature that

can powerfully moderate the consequences of non-traditional family forms for children is the

extent to which they are prevalent (Amato & Keith, 1991; Kalmijn, 2009; Liefbroer &

Dourleijn, 2006; Pong, Dronkers, & Hampden‐Thompson, 2003; Smith-Greenaway &

Trinitapoli, 2014). Based on this research, we hypothesize that having divorced parents in a

setting where divorce is rare could bear distinct consequences for children than having

divorced parents in a setting where divorce is more prevalent.

Although demographers often characterize African marriages as having high divorce

rates (Caldwell, Caldwell, & Quiggin, 1989; Therborn, 2004), in reality, the subcontinent’s

diverse nuptial, cultural, and kinship practices—matched with socioeconomic disparities

across contexts—produce considerable variation in the prevalence and corresponding social

acceptability of divorce. For instance, a recent country-level study shows that whereas as few

as 6.5 percent of women ever divorced (by age 50) in Lesotho, nearly 40 percent of women

divorce in Liberia (Clark & Brauner-Otto, 2015). Evidence from a handful of country-

specific studies suggest that there may be further variation at the subnational-level due to

the ethnic, kinship, and socioeconomic diversity within African countries. For instance,

research from Malawi concludes that first marriages are more than twice as likely to end in

divorce in the southern district compared to marriages in the central and northern districts

(Reniers, 2003, 2008). Similarly, ethnographic work in Nigeria confirms divorce is

extraordinarily common in the northern Hausa region (Solivetti, 1994) but virtually non-

existent in the country’s southeastern region (Smith, 2009).


This substantial variation in the prevalence of divorce could alter the impact of

divorce on children’s wellbeing. On the one hand, the childhood health disadvantages

associated with divorce could be dampened where divorce is less common and exacerbated

where divorce is more prevalent. Multiple studies have shown that individuals who select

into divorce in contexts (or historical periods) where it is rare tend to be positively selected

on socioeconomic traits (Chen, 2012; Goode, 1963; Park & Raymo, 2013; Raymo,

Iwasawa, & Bumpass, 2004). Because socioeconomic resources are known to be protective

of child mortality (Boyle et al., 2006), if divorced women are socioeconomically advantaged

in settings where divorce is less common, divorce may be unassociated—or only weakly

associated—with poor child health in these settings.

On the other hand, the opposite could be true: the child health disadvantages

associated with divorce may be amplified in settings where divorce is rare versus those where

it is more prevalent. Despite evidence of pronounced positive selection of the

socioeconomically advantaged into divorce in low divorce settings, there is evidence that

divorce in these contexts tend to be negatively selected in terms of marital conflict. That is,

marriages that end in divorce where the barriers to getting divorced are greater tend to have

worse marital problems compared to those who opt for divorce in settings where divorce is

more common and accessible (De Graaf & Kalmijn, 2006). Because high-conflict, violent

home environments are known to be associated with worse child health outcomes (Åsling-

Monemi, Pena, Ellsberg, & Persson, 2003), the selection of high-conflict situations into

divorce where it is uncommon could drive the association between divorce and poor child

health to be larger in these settings. The unique social and psychological challenges divorcées

face in settings where it is rare versus widespread could also operate to more directly elevate

its negative consequences for children. Individuals—particularly women—who are divorced

where it remains uncommon are likely to face considerable social stigma and to lack

institutional, cultural, and social support when navigating the divorce process, thereby

leaving them and their children particularly vulnerable to social isolation, psychological

distress, and ultimately poor health.

In this paper, we extend the literature on divorce and child health through three

objectives. First, building on evidence of variation in the prevalence of divorce both between

(Clark & Brauner-Otto, 2015) and within (Reniers, 2003, 2008; Smith, 2009; Solivetti, 1994)

countries, we use Demographic and Health Survey (DHS) data from 31 countries to provide

the first comprehensive estimates of divorce prevalence across 290 of Africa’s subnational

regions. Second, leveraging variation in the prevalence of divorce, we estimate a series of

multilevel discrete-time hazard models among 357,474 children to assess whether the child

mortality risk associated with divorce varies by the prevalence of divorce in the subnational

region. Our modeling approach is guided by competing hypotheses of whether (1) children


with divorced parents fare better in settings where divorce is rare due to the pronounced,

positive selection of socioeconomically advantaged women into divorce in these settings or if

(2) children with divorced parents fare worse where divorce is rare due to either (a) negative

selection of high-conflict, violent relationships into divorce in these settings or (b) the distinct

social and psychological challenges divorced women face where it is uncommon and taboo.

Divorce in sub-Saharan Africa and its Consequences for Children

A rich literature from diverse contexts concludes that parental divorce produces

negative consequences for children across multiple domains of wellbeing, and that these

disadvantages persist over their life course (for a review, see Amato 2010). Historically, the

literature has focused heavily on North American and European families, with little known

about the consequences of divorce for children in low-income regions of the world.

More recently, a handful of studies have confirmed that the consequences of divorce

for African children are even more severe than those documented in high-income world

regions. Research on Kenyan families shows that children of formerly married mothers are

significantly more likely to be malnourished and to miss out on key vaccinations compared to

their peers with married mothers (Gage, 1997). In Burkina Faso, having divorced parents is

associated with significantly higher risk of under-five mortality compared to having married

parents (Thiombiano et al., 2013). A recent multinational study corroborates these country-

specific findings: children with divorced parents have a 36 percent increase in the risk of

dying in the Democratic Republic of the Congo, a 52 percent increase in Liberia, a 57 percent

increase in Nigeria, and an almost two-fold increase in Sierra Leone compared to their peers

with married parents (Clark & Hamplová, 2013). African children with divorced parents who

survive early childhood go on to face sizeable educational setbacks, including delayed school

entry (Thiombiano et al., 2013) and lower educational attainment compared to their peers

with married parents (Chae, 2013).

Variation in the Consequences of Parental Divorce for Child Wellbeing

These studies provide strong evidence that divorce is associated with significant

health and educational disadvantages in Africa. The severity and size of the childhood

disadvantages associated with divorce raises the question of whether the magnitude of the

divorce penalty is uniform across Africa’s diverse social, cultural, and marital contexts: do

children with divorced parents living in African settings where divorce is prevalent

experience the same health risks as children with divorced parents living in contexts divorce

is exceptionally rare?


Dampened Childhood Consequences of Divorce in Low vs High Divorce Settings

Children with divorced parents may be less disadvantaged in places where divorce is

rare (versus more common) namely due to the pronounced positive selection of

socioeconomically advantaged women into divorce in these settings. Multiple studies from

diverse contexts have shown that individuals who select into divorce in contexts (or historical

periods) where it is rare tend to be positively selected on several socioeconomic traits (Chen,

2012; Goode, 1963; Park & Raymo, 2013; Raymo et al., 2004). Researchers hypothesize

that socioeconomically privileged individuals—especially women—are more likely to opt for

divorce where it is uncommon (Bernardi & Martínez-Pastor, 2011; Chen, 2012; Martin,

2006; Park & Raymo, 2013; Raymo et al., 2004) because they have sufficient resources to

independently support themselves and their children, thereby making divorce a viable option.

Moreover, because divorce is socially “innovative” in these settings(Goode 1963), it is likely

to be more readily adopted by those who are more educated and have been exposed to new

ideas and perspectives on the traditional family form. Conversely, in settings and historical

periods where there are few legal, social, and cultural barriers to divorce, the patterns of

selection have been shown to “cross-over”, resulting in divorce being concentrated among the

socioeconomically disadvantaged (Chen 2012).

Combining extensive evidence that the socioeconomic profiles of divorced

individuals are advantaged in low divorce settings (versus high divorce ones) with evidence

that socioeconomic factors drive most of the child health disparities associated with single

motherhood (Thomson, Hanson, & McLanahan, 1994), if divorced women are

socioeconomically advantaged in low-divorce settings, their children’s health experiences

may be comparable to—or even superior than—their peers with married parents. Put

differently, if divorced women in high divorce settings in Africa socioeconomically

disadvantaged, their children will have considerably worse health profiles than their peers

with married parents. Together, this leads to the following hypothesis:

Hypothesis 1: The selection of socioeconomically advantaged women into divorce in settings where it is rare will drive children with divorced parents to have minimal (or no) health disadvantages (compared to their married peers) in these settings compared to contexts where divorce is more common and either less-selective or concentrated among socioeconomically disadvantaged women.

Amplified Childhood Consequences of Divorce in Low vs High Divorce Settings

Despite the pronounced, positive selection of socioeconomically advantaged women

into divorce in settings where it is rare, some evidence suggests that children with divorced

parents may fare worse in these settings. Amato and Keith’s (1991) meta-analysis shows that

the consequences of parental divorce on a host of psychological, social, economic,

educational, and relational factors were far greater when divorce was less common in the


United States and lessened as it became more prevalent. Using a cross-contextual framework,

Kalmijn’s (2009) multinational study similarly found that the negative consequences of

divorce on individuals’ wellbeing are amplified in European settings where divorce is less

common and muted in settings where it is more prevalent.

Why would the child health disadvantage associated with divorce be greater in

settings where it is rare? One explanation is negative selection: despite positive selection on

socioeconomic factors, other evidence suggests marriages that end in divorce in low divorce

contexts highlight negative selection in terms of marital factors. A low divorce rate in a

society is, at least in part, the result of high legal, social, and cultural barriers to divorce

(González & Viitanen, 2009; Goode, 1963). As a result, the threshold for leaving a bad

marriage is higher, meaning that only the most conflict-ridden, violent marriages end in

divorce. As a result, marriages that end in divorce where divorce is uncommon tend to have

higher levels of severe marital conflict compared to marriages that dissolve under high

divorce conditions (De Graaf & Kalmijn, 2006). In Africa, marital conflict often takes the

form of physical and sexual violence, as evidenced by some of the world’s highest rates of

intimate partner violence (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006; Jewkes,

Levin, & Penn-Kekana, 2002; Koenig et al., 2003). Based on the fact that mothers’ exposure

to intimate partner violence is strongly correlated with poor health among their children

(Åsling-Monemi et al., 2003), if divorce is concentrated among a select group of violent

relationships, especially where divorce is uncommon, children with divorced parents in these

settings may experience worse health simply because of the corresponding exposure to

violence. This perspective leads to the following hypothesis:

Hypothesis 2a: Children with divorced parents will experience the greatest disadvantage where divorce is less common due to the selection of especially violent marriages into divorce in these settings.

Even after accounting for marital conflict, another explanation is that divorce bears

higher social and psychological costs where it is rare, which may operate through multiple

pathways to more directly exacerbate the disadvantages children with divorced parents

experience in these settings. Family sociologists agree that the diffusion of a family

process—like divorce—in a society is closely associated with its level of social acceptability

and institutionalization (Cherlin, 2004). In other words, the social acceptability of divorce

and its prevalence tend to go hand-in-hand. For instance, the historical rise in divorce in the

United States and Europe was accompanied by a parallel increase in its social acceptability

(DiFonzo, 1997; Spanier & Thompson, 1987; Thornton, 1985; Thornton & Young‐

DeMarco, 2001; White & Booth, 1991).


Although we are not aware of any studies that have tracked the association between

the prevalence and social acceptability of divorce in Africa, a handful of ethnographies and

community studies suggest the two are as closely related. For instance, divorce is generally

seen as a socially acceptable outcome where it is common among the Hausa in northern

Nigeria (Solivetti, 1994) and matrilineal groups in central and southern Malawi (Kaler,

2001). In fact, in central Malawi, even religious leaders support divorce as a response to

particular marital issues, such as sexual infidelity (Trinitapoli, 2011). Conversely,

ethnographers have noted that divorce remains culturally, religiously, and socially

unacceptable in contemporary African societies where it is rare. For example, Smith (2009)

reports that divorce is viewed as immoral behavior in southeastern Nigeria, regardless of

the circumstances surrounding it.

In settings where divorce is rare and taboo, ethnographic research confirms that

divorcées, particularly women, experience intense stigma (Al-Krenawi & Graham, 1998).

For instance, divorced women in Israeli communities are perceived as distrustful, sexually

seductive, and a mortal threat to family life (Al-Krenawi & Graham, 1998). Qualitative

evidence from Kenya confirms that the stigma associated with divorce drives community

members to sever relationships, socially isolating divorced mothers and their children (Clark,

Beguy, Boco, and Cotton 2013). Cross-contextual research from Europe corroborates this

qualitative evidence, demonstrating that divorcées experience steeper declines in social

contacts after divorce in European regions where divorce is socially disapproved versus their

peers who divorce in European regions where it has greater acceptance (Kalmijn & Uunk,

2007).1 Because children of mothers with smaller, weaker social networks are known to have

worse health outcomes (Adams, Madhavan, & Simon, 2002), this suggests that if divorced

mothers have the least social support in African settings where divorce is rare, their children

may especially vulnerable to adverse health.

Related to the more dramatic social fallout associated with divorce where it is

uncommon, the psychological cost of divorce may also be more severe in these

contexts. Qualitative evidence from Kenya suggests that divorced women internalize the

social ostracizing that they encounter, with one woman stating: “I am disrespected

because I don’t have a husband. The women around here feel that since I am not

married then I am not a good member of the community” (Clark, Beguy, & Cotton,

1 Of course, even where divorce is relatively common and socially acceptable, divorced women likely experience some social losses after the dissolution of their marriage. However, in these contexts divorcées can turn to other divorced persons as experienced “veterans” (Gerstel, 1987). Thus, in settings where divorce is more prevalent, divorcées will have a naturally larger support system of other divorced women available in their community.


2013). Based on large literatures showing that internalizing negative self-perceptions

interferes with psychological well-being (Yang et al., 2007), which in turn, is closely

linked to a host of child health outcomes (Engle et al., 2007; Patel, Rahman, Jacob, &

Hughes, 2004), children with divorced mothers may have especially poor health

outcomes where divorce is uncommon and imposes the greatest psychological stress.

Together, this perspective leads to the following hypothesis:

Hypothesis 2b: Even after accounting for selection, the social and psychological challenges that accompany divorce in settings where it is uncommon will lead children to have worse health outcomes (compared to their married peers) than in settings where divorce is more prevalent.

DATA

Data for this study come from 31 Demographic and Health Surveys (DHS)

administered in sub-Saharan Africa since 2000. We use the most recent survey for the

following countries: Burkina Faso, Benin, Burundi, Cameroon, Chad, Congo (Brazzaville),

Democratic Republic of the Congo, Ethiopia, Gabon, Ghana, Guinea, Ivory Coast, Kenya,

Liberia, Lesotho, Madagascar, Malawi, Mali, Mozambique, Namibia, Niger, Nigeria,

Rwanda, Sao Tome Principe, Sierra Leone, Senegal, Swaziland, Tanzania, Uganda, Zambia,

and Zimbabwe.2

The DHS program is a nationally representative, cross-sectional survey fielded in

participating countries, typically every five years. The DHS uses a stratified random

sampling approach, with clusters providing the primary sampling unit. Within each selected

cluster, the DHS randomly samples families. Household heads complete a full roster of

members, from which the DHS identifies eligible men and women. Women are asked

whether they have children and, if so, to provide detailed information on each live birth (e.g.,

date of birth, whether the child is still alive, and the month and year of death for all deceased

children) from which the DHS generates the child datasets that we use here.

Analytic Sample

We focus our analysis on births that occurred within seven years of the survey. This

restriction reduces recall error and ensures that current family characteristics correspond

2 In ancillary analyses, we used the preceding round of each survey to ensure the stability of our findings in terms of the levels of divorce and multivariate results. In all instances, our results were consistent regardless of the year of survey, with the exception of Mozambique. In Mozambique, women’s reports of divorce/separation are significantly lower in 2011 versus 2003/04 and 1997. Because southern African countries contiguous to Mozambique show no downward trends in the prevalence of women who are currently divorced, we use the 2003/04 DHS survey in Mozambique.


reasonably well with children’s environment since birth, but also reduces excessive censoring

by ensuring the majority of the sample has reached their fifth birthday.3 In ancillary analyses,

we loosened the restriction to children born in the last ten years and reproduced the study’s

key findings. We further restricted the sample to children whose mothers have been married

no more than once because we cannot determine whether the first union of a remarried

mother ended in divorce or widowhood. Appendix A demonstrates that the profiles of

children whose mothers have been married more than once and are thus excluded from the

study differ from their peers, including higher levels of mortality and greater family

instability. Despite these differences, ancillary analyses (not shown but available upon

request) confirm that including these children in our hazard analysis and categorizing their

mothers as “remarried” produces results that are consistent with those shown in the main

analyses. Finally, we exclude approximately one percent of children from our analyses due to

missing data. Our final analytic sample consists of 357,474 births. Appendix B shows the

survey years and sample sizes for children in each of the 31 countries.

To better capture the within country variance in the prevalence of divorce, our

aggregate units of focus are subnational regions. Subnational regions have been used in

previous research to approximate cultural, ethnic, geographic, and political boundaries in

Africa (Smith-Greenaway & Heckert, 2013; Smith-Greenaway & Trinitapoli, 2014).

Because the DHS does not collect contextual data, to characterize the 290 subnational regions

in our sample, we aggregate data from interviews with household heads and reproductive-age

women. In some instances, the household head or mother of the children in our study are

included in the samples from which we create our aggregate measures. However, because

there are an average of 1,894 children in each subnational region, and because excluding

them does not alter our results, we include the index-family when creating the contextual-

level measures.

MEASURES

Child Mortality

The outcome variable is the hazard of mortality before age five. Children born less

than five years prior to the survey are censored at the time of the survey, which we

appropriately address through our multilevel discrete-time hazard modeling approach.

3 The DHS collects additional health related data for children born in the last five years. The additional survey items lead respondents to omit or displace young children’s birth dates (Schoumaker 2011), encouraging us to deliberately sample children older than five years to avoid this displacement (see Clark and Hamplová 2013).


Family Structure

The DHS asks all mothers their marital status at the time of the survey, including

whether they are never married, married, widowed, or divorced. For the purposes of our

analysis, we modify this measure in several ways. First, as we described in the analytic

sample section, because we limited our sample to children whose mothers have never

remarried, all married mothers in our sample have been continuously married. Similarly,

divorced and widowed mothers have been continuously divorced or widowed since their first

marriage ended. Second, we use information on the timing of mothers’ first marriage and

their child’s birth— precise to the month—to classify women who were married long after

their child’s birth as “never married” in order to reflect their marital status at the time of

birth. Recognizing that entry into marriage is a prolonged process in Africa, if married within

six months of their child’s birth, we classify women as having been “married”. Thus, our

“never married” category includes women who never married and those not married at (or

soon after) their child’s birth. In detailed ancillary analyses, we eliminated this “grace period”

and confirmed that it does not significantly influence the results shown here. Third, we

leverage data on whether there are co-wives present in the union. Based on the extensive

literature linking polygynous marriage to poor child health outcomes (Omariba & Boyle,

2007; Smith- Greenaway & Trinitapoli, 2014), we use this information to differentiate

between mothers who are in a monogamous versus polygynous union.

Our ultimate measure is a five categorical variable: divorced, widowed, never

married, married monogamously (reference group), and married polygynously.4 A limitation

of our measurement is that we do not have data on the timing of mothers’ divorce (or

widowhood), making it possible that some children died prior to divorce or widowhood.

However, our estimates of the association between parental divorce and child mortality are

strikingly similar to those produced by other studies that had more detailed data on the timing

of divorce (see, for example, Thiombiano et al 2013 and Clark and Hamplová 2013).

Prevalence of Divorce

We use data from all reproductive-age women interviewed—including women without

children—in each subnational region to calculate the percentage of women who are currently

divorced. We specifically estimate the prevalence of reproductive-age women who are currently

divorced in each subnational region, not the prevalence of women who have ever divorced,

because it provides a valuable snapshot of the subnational region’s marital landscape and offers a

4 In line with existing research, given the high number of informal and unregistered unions in sub-Saharan Africa, we use the term “married” to refer to both married and cohabiting unions and “divorce” to refer to women who are both divorced or separated (see, for example, Porter et al 2004).


better sense of the extent to which divorced women in a community remain single versus

remarry. Because stigma acts as a powerful motivation for divorced women to quickly remarry

(Grover, 2011), which keeps the prevalence of divorce low at any given time, the percentage of

currently divorced arguably offers a better sense of the extent of its social acceptability

compared to the percentage of women who have ever divorced.

Cross-level Interaction between Prevalence of Divorce and Family Structure

To assess whether the child mortality risk associated with divorce varies across low

versus high divorce settings, we interact the subnational region-level prevalence of currently

divorced women with the marital status of individual mothers. A negative coefficient for the

cross-level interaction term will confirm that the child mortality risk associated with divorce

is larger in settings where divorce is more prevalent (and thus smaller where divorce is rare)

(hypothesis 1), whereas a positive coefficient will confirm that the child mortality risk

associated with divorce is significantly smaller in settings where divorce is more prevalent

(and thus larger where divorce is rare) (hypothesis 2a and 2b).

Socioeconomic Resources

Because prior research has suggested that the socioeconomic profiles of divorced

women may differ by the prevalence of divorce, we account for two aspects of mothers’

socioeconomic profiles. First, we include a continuous measure of the mothers’ highest level

of formal schooling. Second, we make use of the DHS-constructed wealth index to account

for inequality in material resources. The DHS collects information on household’s ownership

of various assets (e.g., radio, television, refrigerator, bicycle, car) and about the

characteristics of the house (e.g., availability of electricity, source of drinking water, type of

toilet facility, number of rooms) and aggregates these variables into a principal component

factor analysis. The factor scores are used to categorize households into the five quintiles that

we make use of here: poorest, poor, middle, rich, or richest (see Bollen, Glanville and

Stecklov 2007; Houweling, Kunst and Mackenbach 2003; Filmer and Pritchett 1998 for more

detailed discussion).

Marital Violence

In order to assess whether selection into divorce is concentrated among high-conflict

marriage in low divorce settings, we make use of data on women’s experience with both

physical and sexual intimate-partner violence. The DHS recently incorporated a special

module into select country surveys to track women’s experience with violence. The DHS


asks women whether their current or— in the instance that she is divorced or widowed—

most recent partner ever (1) pushed, shook, threw something at them, (2) slapped, (3)

punched with fist or something hard, (4) kicked or dragged, (5) tried to strangle or burn, (6)

threatened with a knife/gun or other weapon, (7) ever attacked with a knife/gun or other

weapon, (8) physically forced sex when not wanted, or (9) ever forced sexual acts when not

wanted. From these nine items, we create a binary indicator of whether children’s mother

ever experienced physical or sexual violence (no=0, yes=1).5

These data afford a rare opportunity to compare the prevalence of physical and sexual

violence among women by marital status and marital context; however, the data are available

in only 17 of the 31 countries in our study: Burkina Faso, DRC, Cameroon, Gabon, Ghana,

Kenya, Ivory Coast, Liberia, Mali, Malawi, Nigeria, Rwanda, Sao Tome Principe, Tanzania,

Uganda, Zambia, and Zimbabwe. Narrowing our sample to these countries would

compromise the extent of our study’s representation of African families and subnational

regions. Thus, in our multivariate results we include a category representing “no data” (=2)

(not shown in tables) in order to maintain the full sample while exploring whether divorce is

more closely associated with violent relationships in low divorce settings, and if this selection

drives divorce to be associated with especially poor child health in these settings.

Child Controls

In all models, we include a set of demographic variables known to influence child

survival: maternal age at the time of the child’s birth, birth order, birth spacing (first born,

fewer than 36 months, 36 months or more), child’s sex, and whether the child is from a

singleton or multiple birth. To accommodate our modeling strategy, we restructured our data

to a time-based dataset in which observations refer to time (i.e., months) and each birth

contributes the number of months the child was observed. In addition to explicitly handling

time through our event-history modeling approach, all models control for the child’s age (0 to

11 months, 12 to 23 months, 24 to 35 months, and 36+ months).

Subnational Region-level Controls

Although little is known about the contextual correlates of divorce in Africa,

extrapolating from individual-level findings and from contextual research in the United

States, we anticipate that a subnational region’s prevalence of divorce will be correlated with

the socioeconomic profile of its residence. It is important to account for these factors to

5 See the World Health Organization Report for a similar approach of estimating physical and sexual violence, and for country comparisons ( http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1).

http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1

http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1


ensure that they do not drive any observed difference in the child health consequences of

divorce by its prevalence. In general, more highly-educated African women are more likely

to divorce (DeRose, Garcia, Salazar, & Tarud, 2014; Takyi & Broughton, 2006), which

means that divorce may be concentrated in settings with the highest female education.

Because the children living among more highly-educated women are known to have lower

mortality (Kravdal, 2004), we include an aggregate measure of the highest level of education

of the average woman in each subnational region. In addition to female education, extending

evidence from the United States that the extent of female employment is highly correlated

with the prevalence of divorce (Ruggles, 1997), we include a continuous measure of the

prevalence of women in the subnational region who have been employed in the prior year.

Third, because of evidence that urbanization is also associated with higher divorce rates

(Clark & Brauner-Otto, 2015), and because of known disparities in child mortality in rural

versus urban settings (Van de Poel, O'donnell, & Van Doorslaer, 2009), we use the DHS’s

classification of households as “rural” versus “urban” to generate a continuous measure of the

percentage of households that are classified as rural in each subnational region.

Country-level Controls

A country’s political, cultural, and economic climate is likely associated with both the

level of divorce and child mortality across its subnational regions. To address the possible

confounding nature of these factors in our multinational study design, our multilevel discrete-

time hazard models conservatively account for country-level factors by taking a fixed-effects

approach that includes a set of dummy variables representing each of the 31 countries in our

sample. This modeling strategy enables us to conservatively account for constant, unobserved

country-level factors that may confound the associations of interest. See Smith-Greenaway

and Trinitapoli 2014 and Liefbroer and Dourleijn 2006 for examples of multinational studies

that take comparable approaches.

ANALYTIC PLAN

We begin the results with descriptive statistics in order to characterize our sample.

We then provide subnational region-level estimates of the prevalence of divorce to highlight

its variability across the 290 regions in our sample. Next, because we are interested in the

distinct selection patterns of women into divorce in low versus high divorce settings, we

show bivariate analyses that compare divorced and married mothers (1) socioeconomic

resources (education, household wealth) and (2) experience with intimate partner violence

(physical or sexual violence) by the prevalence of divorce in their subnational region. For the


purposes of these analyses, we categorize our continuous measure of the prevalence of

divorce in each subnational region according to whether the level of divorce falls within one

standard deviation (3.74 percent) below, around, or above the mean value of 6.37 percent.

Next, we estimate a series of multilevel discrete-time hazard models to test whether

the mortality risk of having a divorced mother varies in contexts where divorce is rare versus

those where it is more prevalent. This modeling strategy allows us to handle two complexities

of our data: censoring and its hierarchical structure. In terms of the former, our hazard

modeling approach addresses the fact that children who are still alive at the time of the

observation period (i.e., at the survey), or who have not yet reached their 5th birthday, are

right-censored. The multilevel nature of our models appropriately estimates standard errors to

address the fact that children (level-1) are nested within subnational regions (level-2), which

are in turn nested within countries (level-3).6

We present a series of four multilevel hazard models:

(1) logit(htijk) = αt + ß1FamStructureijk + ß2Xijk + ß3Ck + uj (2) logit(htijk) = αt + ß1FamStructureijk + ß2PrevDivorcejk + ß3SocioeconomicContextjk +

ß4Xijk + ß5Ck + uj (3) logit(htijk) = αt + ß1FamStructureijk + ß2(PrevDivorcejk*FamStructureijk) +

ß3PrevDivorcejk + ß4SocioeconomicContextjk + ß5Xijk + ß6Ck + uj (4) logit(htijk) = αt + ß1FamStructureijk + ß2FamilySocioeconomicijk +

ß3IntimatePartnerViolenceijk + ß4(PrevDivorcejk*FamStructureijk) + ß5PrevDivorcejk + ß6SocioeconomicContextjk + ß7Xijk + ß8Ck + uj

We begin with a base model (1) that aims to replicate the association between

parental divorce and child mortality that has been documented in previous research on

specific countries (Clark & Hamplová, 2013; Thiombiano et al., 2013). In this model, and

all subsequent models, we include controls for child i in subnational region j in country k;

where Xijk is a vector of standard demographic controls that are known to influence child

survival; Ck are country dummy variables; uj is the subnational region-level random effect;

and the ßs represent the corresponding coefficients. In Model (2) we include the subnational-

region level indicator of the prevalence of currently divorced women, as well as indicators of

the socioeconomic context (average level of women’s education, women’s employment, and

urbanization). In model (3) we interact the prevalence of divorce at the subnational region-

level with family structure to test our competing hypotheses of whether the child mortality 6 We use the clustering feature in Stata to account for the fact that some children share the same mothers in our sample. In supplementary analyses, we randomly sampled one child per mother among women with multiple children in the dataset and re-estimated each model. Results from these analyses confirm that the findings are consistent with those shown here, suggesting the presence of siblings is not influencing the findings.


risk associated with divorce is either muted (hypothesis 1) or exacerbated (hypothesis 2a/2b)

in low divorce settings. In the final model (4), we include measures of both women’s

socioeconomic status (education and household wealth) and marital conflict (physical or

sexual violence) in order to test whether the differential selection into divorce across low

versus high divorce settings drives children to have distinct mortality risks. We also graph

Kaplan-Meier hazard functions in order to depict the study’s central findings.

RESULTS

Descriptive Findings

Table 1 provides descriptive statistics to characterize the sample of children and the

subnational regions in which they live. As shown, over nine percent of the children in our

sample have died either before their fifth birthday or the time of the survey (whichever came

first). The results also highlight that African children experience diverse family structures.

Although the vast majority of children (63%) have mothers who have been continuously

married (monogamously) since their birth, approximately one-fourth have polygynously

married mothers, nearly five percent have divorced mothers,7 and small percentages have

widowed mothers or mothers who have remain unmarried since their birth (1.7% and 7.1%

respectively). Turning to the subnational regional prevalence of divorce, the results show that

the average child in our sample lives in a context where more than six percent of mothers are

currently divorced. However, as shown by the standard deviation, the prevalence of divorce

varies considerable across subnational regions—motivating our investigation of the potential

cross-contextual variability in its implications for children.

The descriptive results further show that nearly 20 percent of women report having

been the victim of physical or sexual violence perpetrated by either their current or previous

partner (among women in the 17 countries where data on violence were collected). In

general, children’s mothers have fewer than three years of school. Furthermore, the sample

varies according to key proximate determinants of mortality, making it important to account

for these factors. The subnational estimates align with the characteristics of the mothers in

our sample. On average, nearly 70% of households in the average subnational region are

rural, about 65% of women living in these areas worked in the prior year, and the average

education is only a bit over 4 years; however, the large standard deviations point to the

diverse socioeconomic contexts across the subnational regions.

7 It is important to bear in mind that our estimates of divorce pertain to children whose mothers are currently divorced and have not remarried, and thus are lower than the prevalence of children whose mothers have ever divorced.


Variation in Prevalence of Divorce across Africa’s Subnational Regions

To provide a better sense of the variation in the prevalence of divorce across the 290

subnational regions in our sample, and how it varies both between and within the 31

countries in our study, Figure 1 plots each of the 290 subnational regions according to its

prevalence of divorce, by country.8 For reference, the black line indicates the mean

prevalence of divorce for the entire sample and the gray lines show one standard deviation

below/above the mean. The figure demonstrates two important findings. First, there are clear

country and regional patterns in the level of divorce across subnational regions. In general,

subnational regions in West African countries have some of the lowest levels of divorce (e.g.,

Burkina Faso, Guinea, Mali, Benin, Nigeria, Niger) whereas subnational regions in Southern

African countries tend to have notably higher levels (e.g., Mozambique, Malawi, Zambia).

Despite these overall trends, there are important exceptions. For example, Liberia, a West

African country, has generally high levels of divorce across its subnational regions whereas

some regions in Namibia, a Southern African country, have exceptionally low levels of

divorce.

Aside from patterns across countries, the figure shows remarkable within-country

variation in the prevalence of currently divorced women. For instance, in several countries—

Ethiopia, Madagascar, Mozambique, Tanzania, and Uganda—the prevalence of currently

divorced women varies by approximately a ten percentage point difference across subnational

regions. In total, we capture a nearly 20-point percentage difference in the prevalence of

divorce—a range comparable to the change in divorce rates that unfolded in the United States

over an entire century (Cruz, 2013).

Differential Selection into Divorce in Low versus High Divorce Settings

As prior research suggests, it is possible that women who divorce in low divorce

settings have distinct socioeconomic and marital profiles than those who divorce in high

divorce areas. In Table 2, we first explore the possibility that divorce is concentrated among

socioeconomically advantaged women in settings where it is rare. As shown, we find

evidence that it is: divorced women in low divorce settings have about one more year of

education compared to their married peers, but the difference is only 0.18 years in high

divorce settings. Furthermore, divorced women have a 0.21 advantage in their wealth ranking

in low divorce settings, but are slightly disadvantaged in settings where divorce is

8 Appendix C provides the full list of countries and its corresponding number of regions, and the average, standard deviation, minimum, and maximum values of divorce across subnational regions.


widespread. These descriptive statistics provide preliminary support for hypothesis 1, that the

pronounced socioeconomic advantage among divorced women where it is rare could

dampen—or even reverse—its negative consequences for children.

Despite socioeconomic advantage, however, the results also provide evidence of

pronounced negative selection in terms of marital conflict. The first column demonstrates

that, in general, divorced women are more likely to experience physical or sexual violence

compared to their married peers. But the subsequent columns confirm that the discrepancy in

exposure to violence is much larger in low divorce settings. In low divorce settings, 15

percent more divorced women report violence than do married women. In contrast, the size

of the disparity is halved in low divorce settings, with the prevalence of reported violence

only 7.8 percentage points higher among divorced mothers. This aligns with the possibility

that children with divorced parents may actually have the worst health outcomes where

divorce is rare, and that their greater exposure to violent environments could be why

(hypothesis 2a).

Cross-contextual Variation in Association between Parental Divorce and Child

Mortality

Table 3 shows estimates from multilevel discrete-time hazard models analyzing the

interrelationships between the prevalence of divorce, family structure, and children’s

likelihood of dying before age five. Corroborating previous research, the results in Model 1

demonstrate a strong association between parental divorce and children’s risk of death

(before age five) in sub-Saharan Africa. A child whose mother is divorced has 37 percent

higher odds of dying compared to a peer child whose mother is monogamously married. The

results further show children’s whose mothers are single either because they have never

married or are currently widowed have similarly high risk of mortality, experiencing a 22 and

46 percent higher odds of mortality, respectively. The results further confirm that children

whose mothers are in a polygynous union experience a higher likelihood of death compared

to their peers whose mothers are in a monogamous union.

In addition to distinct mortality risk by family structure, the results show that several

of the known proximate determinants of mortality are associated with children’s risk of death

as anticipated. Most notably, the results show that a lengthier birth interval preceding the

child’s birth lowers their risk of mortality and that female children experience lower mortality

than males. Furthermore, the results show that children of multiples (rather than from

singleton births) experience substantially higher mortality (odds ratio: 3.81).


To characterize the subnational regions in which children live, model 2 includes an

indicator for the prevalence of currently divorced women as well as socioeconomic indicators

that are likely to be correlated with both the level of divorce and child mortality. The results

show that the prevalence of currently divorced women in the subnational region is not

directly associated with child mortality, suggesting that for the average child, there is no

direct disadvantage associated with living among greater family instability. Moreover, as we

would expect, living in a subnational region wherein the average woman has more education

is associated with lower mortality risk: a one unit increase in the average schooling for

women is associated with a six percent lower odd of child death. Interestingly, the results

show that children living in settings wherein more women are employed have higher

mortality. Although this merits additional analysis, because most female employment

consists of agricultural labor in rural settings, it is likely that this association is in part a

reflection of the general lack of infrastructural provisions in settings wherein most women are

engaged in agricultural work. Net of these indicators of socioeconomic status, we find no

significant differences in the risk of mortality by level of urbanization.

Model 3 includes a cross-level interaction between the prevalence of divorce in the

subnational region with the child’s individual family structure to test our study’s central

hypotheses: whether (and if so, why) the magnitude of the mortality risk associated with

divorce varies systematically by its prevalence. The significant, positive interaction term

refutes Hypothesis 1 and instead confirms that the child health disadvantage associated with

divorce is significantly smaller in settings where divorce is more prevalent and thus larger in

settings where divorce is rare. In fact, a 10 percent higher prevalence of divorce corresponds

with a 10 percent decrease in the likelihood of child mortality for children with divorced

mothers (compared to children with married mothers). Furthermore the magnitude of the

odds ratio for having a divorced mother increases (from 1.38 in model 2 to 1.53 in model 3),

suggesting that failure to account for these cross-level interactions underestimates the true

size of the child mortality risk associated with divorce. Put differently, although the odds of

dying are 50 percent higher for children with divorced parents, this negative effect of divorce

is at least partially offset if the child is born in an area were divorce is common. Figure 2

illustrates this finding graphically with Kaplan-Meier survival estimates (holing all covariates

in model 3 at the mean value). In addition to differences in the size of the magnitude of the

disadvantage associated with having a divorced mother versus a married one, the Kaplan-

Meier analysis also confirms that children with divorced mothers where divorce is rare have

significantly higher mortality compared to their peers with divorced mothers in settings

where divorce is more common (log rank test, p<.001).


Why is the child health disadvantage associated with divorce significantly greater in

settings where divorce is rare? Given that divorce is more concentrated among violent

marriages in these sub-national regions (Table 2), it is important to assess whether the

elevated mortality risk associated with divorce in low divorce settings is merely a function of

this pronounced negative selection (Hypothesis 2a). In Model 4 we include an indicator for

mothers’ exposure to physical and/or sexual violence as well as mother’s education and

wealth. As shown, we find no support that negative selection is driving the finding: the cross-

level interaction remains significant net of selection in terms of marital violence. Although

the results show that children’s risk of mortality is increased by three percent if their mother

has experienced physical or sexual violence, accounting for exposure to violence, as well as

the socioeconomic factors, actually increases the size of the cross-level interaction: each unit

increase in the prevalence of divorce corresponds with a two percentage point reduction in

the risk associated with divorce.

The fact that the subnational regional effect of divorce persists even after controlling

for selection lends indirect support to our theoretical argument that the greater social and

psychological cost of divorce in low divorce settings drive the finding (hypothesis 2b). In

particular, in settings were divorce is uncommon, divorced mothers are likely to experience

social isolation and significant psychological strain which likely compromises their health-

seeking behaviors, children’s receipt of care, and ultimately their children’s health and

survival.

Before discussing the results, another finding in Table 3 merits further explanation:

the child mortality risk associated with having a widowed mother also varies by the

prevalence of divorce. Why do African children with widowed mothers have a higher

likelihood of dying in settings where divorce is more prevalent? Our supplemental

investigation suggests it is due to the confounding effect of HIV/AIDS prevalence and

concentration of AIDS-related widowhood in more urbanized, socioeconomically advantaged

settings (which also have higher levels of divorce). Because HIV/AIDS prevalence data are

not available for all countries/subnational regions, in supplementary analyses (not shown) we

attempt to reduce its confounding effect by excluding countries where HIV/AIDS prevalence

exceeds 10 percent in at least one subnational region (Cameroon, Namibia, Kenya, Malawi,

Mozambique, Swaziland, Tanzania, Zambia, and Zimbabwe). In these analyses, the

coefficient on the cross-level interaction between widowhood and divorce prevalence

becomes non-significant.


DISCUSSION

In this paper, we extend the literature on parental divorce and child wellbeing in

Africa in three unique ways. First, we leverage data from 290 subnational regions in Africa to

highlight the variability in the prevalence of currently divorced women, and as a result, the

distinct conditions under which African families experience divorce. Corroborating emerging

research documenting the variability in the level of divorce across African countries (Clark

and Brauner-Otto 2015), we find important differences in the level of divorce across

subnational regions. In general, subnational regions in West African countries have the

lowest levels of divorce whereas those in Southern Africa have markedly higher levels of

divorce. However, we find important within-country variation in the prevalence of currently

divorced women across subnational regions. For instance, in several countries—Ethiopia,

Madagascar, Mozambique, Tanzania, and Uganda—the prevalence of divorced women varies

by approximately a ten percentage point difference between subnational regions. In total, we

capture a nearly 20-point percentage difference in the number of women who are currently

divorced—a range comparable to the change in divorce rates that unfolded in the United

States over an entire century (Cruz, 2013).

Second, building on recent evidence that the prevalence of a family form can

powerfully moderate its consequences for individuals and their children (Amato & Keith,

1991; Kalmijn, 2009; Liefbroer & Dourleijn, 2006; Pong et al., 2003; Smith-Greenaway &

Trinitapoli, 2014), we show that context matters a great deal for understanding the child

health consequences of divorce in sub-Saharan Africa. Despite the more pronounced positive

selection of the socioeconomically advantaged into divorce in settings where it is rare,

children with divorced parents in these settings experience exceptionally high mortality risk.

Although their peers with divorced parents in settings where it is more common are still at

higher risk of mortality compared to their peers with married mothers, a one percentage

increase in the prevalence of divorce corresponds with an approximately two percentage

point reduction in the size of the divorce penalty. Although the size of the association is

small, multiplying the coefficient by the nearly 20 percentage point difference in the

prevalence of divorce across subnational regions corresponds to a 40 percent difference in the

odds of child mortality associated with divorce.

Third, building on past research, we test whether the pronounced selection of high-

conflict, violent marriages into divorce in settings where it is rare drives the additional

mortality risk associated with divorce in these settings (hypothesis 2a). Although we find

evidence that divorce is, in fact, more tightly connected to violence in low divorce settings,

this does not explain the observed mortality differentials. Therefore, we contend that at least


part of the explanation lies in the distinctly harsh experience of being a divorced mother in

settings where divorce is uncommon. Building on evidence that divorcées —particularly

women—experience intense stigma and social penalties in cultural context where divorce is

rare and socially unacceptable, we argue that divorced women’s social isolation,

psychological challenges, and general lack of support are what drive their children’s

especially poor health in these settings.

The study findings confirm the importance of ensuring that children with divorced

parents have equal access to health, nutrition, and educational services, especially in

resource-scarce settings like Africa. However, our results suggest that doing so successfully,

at least in settings where divorce is rare, will require community-wide initiatives to

destigmatize divorce and reach divorced women who, despite their socioeconomic advantage,

face steep social and psychological barriers to good health. More generally, the study adds to

the growing evidence that it is imperative to consider the broader social, cultural, marital, and

socioeconomic context in which families live order to develop a more nuanced understanding

of how family processes like divorce influence adults and their children.


Appendix A. Sample characteristics of children excluded because mother has been in more than one union *

Mean/% (SD) Key variables Child mortality (% ever died) 14.12*

Family structure Divorced mother 9.08* Never married mother NA Widowed mother 2.39* Polygynously married mother 33.73* Monogamously married (ref) 54.8*

Subnational region-level prevalence of divorced women (%) 6.92 (4.15)*

Selection indicators Socioeconomic resources Mother's years of formal schooling 2.78 (3.42)* Household wealth

Poorest 28.50* Poor 23.60* Average 20.00 Rich 16.86* Richest 11.04*

Mother experienced violence1 19.96*

Child-level controls Female 49.50 Multiple birth 3.87 Maternal age at birth 27.92 (6.95)* Birth order 4.27 (2.46)* Length of preceding birth interval

First born 12.38* Short interval 47.97* Long interval 39.65*

Subnational region-level controls Average years of schooling among adult women 4.02 (2.28)* Adult women's employment (%) 66.43 (16.43)* Rural (% households rural) 71.75 (21.31)* N=94,209 children *Indicates that the value is significantly different from value in Table 1 1Among subsample of countries with intimate-partner violence module


Appendix B. List of Countries, Survey Year, and Sample Size Survey year N

Benin 2011/12 17,187 Burkina Faso 2010 20,868 Burundi 2010/2011 10,230 Cameroon 2011 13,663 Chad 2004 7,177 Congo (Brazzaville) 2011/12 10,314 Democratic Republic of the Congo 2007 10,683 Ethiopia 2003 14,846 Gabon 2012 6,602 Ghana 2008 3,560 Guinea 2012 9,680 Ivory Coast 2011/12 9,508 Kenya 2008/09 8,308 Lesotho 2009/10 5,783 Liberia 2006/07 6,165 Madagascar 2008/09 13,901 Malawi 2010 23,386 Mali 2006 18,931 Mozambique 2003 12,220 Namibia 2006/07 6,868 Niger 2012 16,064 Nigeria 2008 37,659 Rwanda 2010/11 11,873 Sao Tome Principe 2008/09 1,725 Sierra Leone 2008 6,934 Senegal 2010/11 15,651 Swaziland 2006/07 3,992 Tanzania 2009/10 9,284 Uganda 2011 9,836 Zambia 2007 7,763 Zimbabwe 2010/11 6,813

N 357,474 Source: Demographic and Health Survey


Appendix C. Variation in Prevalence of Divorce within and across African Countries Average % divorced Number women of across Regions regions SD Min. Max.

Benin 12 3.40 1.59 0.98 5.75 Burkina Faso 13 1.41 0.89 0.17 3.05 Burundi 5 4.64 1.07 3.57 6.30 Cameroon 12 5.69 1.91 3.31 9.84 Chad 9 6.42 2.22 4.11 10.93 Congo (Brazzaville) 12 12.51 1.97 10.07 16.01 Democratic Republic of the Congo 11 7.20 1.97 4.50 11.52 Ethiopia 11 7.96 2.75 3.93 13.02 Gabon 10 9.42 2.48 4.55 11.71 Ghana 10 6.21 2.67 2.41 9.43 Guinea 8 2.08 1.08 0.49 4.10 Ivory Coast 11 4.19 1.99 1.41 8.57 Kenya 8 6.10 1.53 3.50 8.74 Lesotho 10 4.43 1.17 2.62 6.28 Liberia 6 7.20 1.33 5.31 8.50 Madagascar 6 11.72 3.09 6.69 15.10 Malawi 3 9.14 1.30 8.07 10.59 Mali 9 2.56 1.89 0.58 5.88 Mozambique 11 13.31 3.10 9.42 18.31 Namibia 13 4.49 2.24 1.36 9.00 Niger 8 3.18 2.05 1.34 7.18 Nigeria 6 1.96 0.71 1.31 3.23 Rwanda 5 5.41 1.18 4.07 7.12 Sao Tome Principe 4 11.78 2.12 9.90 14.59 Senegal 14 3.28 1.16 1.98 5.90 Sierra Leone 4 3.70 0.70 2.95 4.64 Swaziland 4 3.15 0.43 2.57 3.66 Tanzania 26 8.51 2.99 4.86 17.69 Uganda 10 8.92 3.23 2.12 12.65 Zambia 9 8.13 1.52 6.69 10.94 Zimbabwe 10 7.33 0.88 6.12 8.95

Full Sample 290 6.37 3.74 0.17 18.31 Source: Demographic and Health Survey


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Parental Divorce and Child Mortality in Sub-Saharan Africa: Does Context Matter? 29 Table 1. Descriptive Statistics Mean/% Key variables Child mortality (% ever died) 9.41

Family structure Divorced mother 4.39 Widowed mother 1.73 Never married mother 7.07 Monogamously married (ref) 63.07 Polygynously married mother 23.74

Subnational region-level prevalence of divorced women (%) 6.36 (3.75)

Selection indicators Socioeconomic resources Mother's years of formal schooling 3.49 (4.09) Household wealth

Poorest 24.43 Poor 21.15 Average 19.64 Rich 18.35 Richest 16.43

Marital conflict Mother experienced violence1 18.43 Controls Child-level Maternal age at birth 25.91 (6.76) Birth order 3.57 (2.43) Length of preceding birth interval

First born 23.28 Short interval 45.48 Long interval 31.24

Female 49.33 Multiple birth 3.32 Subnational region-level Average years of schooling among adult women 4.15 (2.54) Adult women's employment (%) 64.82 (17.51) Rural (% households rural) 69.89 (22.19) N=357,474 children 1Among subsample of countries with intimate-partner violence module

Parental Divorce and Child Mortality in Sub-Saharan Africa: Does Context Matter? 30 Table 2. Selection into divorce: Comparison of divorced versus married mothers among full sample and stratified by prevalence of divorce Full Sample Low Divorce Medium Divorce High Divorce

Divorced Married Divorced Married Divorced Married Divorced Married %/Mean %/Mean Difference %/Mean %/Mean Difference %/Mean %/Mean Difference %/Mean %/Mean Difference Socioeconomic Factors Mothers' Education 4.89 4.03 0.86 * 3.97 2.99 0.98 * 4.98 4.15 0.83 * 4.83 4.65 0.18 * Wealth index (1-5 scale) 2.98 2.97 0.01 3.14 2.93 0.21 * 3.04 3.02 0.02 * 2.77 2.85 -0.08 *

Marital Conflict Physical or sexual violence1 26.41 19.17 7.24 * 28.89 13.80 15.09 * 27.09 21.86 5.23 * 23.76 15.98 7.78 * Source: Demographic and Health Survey 1Among subsample of countries with intimate-partner violence module

Parental Divorce and Child Mortality in Sub-Saharan Africa: Does Context Matter? 31 Table 3. Multilevel discrete time hazard models analyzing whether the child mortality risk associated with divorce vary by its subnational regional prevalence in sub-Saharan Africa Model 1 Model 2 Model 3 Model 4 OR Coeff S.E. Sig OR Coeff S.E. Sig OR Coeff S.E. Sig OR Coeff S.E. Sig Key Variables Cross-level Interaction % Divorce * Divorced 0.99 -0.01 0.01 * 0.98 -0.02 0.01 * % Divorce * Widowed 1.03 0.03 0.01 * 1.03 0.03 0.01 * % Divorce * Never married 1.01 0.01 0.01 1.01 0.01 0.01 % Divorce * Married (ref) -- -- % Divorce *Polygynously married 0.99 -0.01 0.00 0.99 -0.01 0.00

Family structure Divorced Mother 1.37 0.32 0.03 *** 1.38 0.32 0.03 *** 1.52 0.42 0.06 *** 1.54 0.43 0.06 *** Widowed mother 1.46 0.38 0.04 *** 1.46 0.38 0.04 *** 1.25 0.23 0.07 ** 1.22 0.20 0.07 ** Never married mother 1.22 0.20 0.03 *** 1.22 0.20 0.03 *** 1.12 0.11 0.05 * 1.18 0.16 0.05 *** Monogamously married (ref) -- -- -- -- Polygynously married mother 1.17 0.16 0.01 *** 1.17 0.16 0.01 *** 1.19 0.18 0.02 *** 1.17 0.16 0.02 ***

Subnational region % divorce 0.99 -0.01 0.01 0.99 -0.02 0.01 0.98 -0.02 0.01

Selection indicators Socioeconomic resources Mother's years of schooling 0.97 -0.03 0.00 *** Household wealth

Poorest Poor 1.03 0.02 0.02 Average 0.96 -0.04 0.02 ** Rich 0.91 -0.10 0.02 *** Richest 0.78 -0.25 0.02 ***

Marital conflict Physical/sexual violence1 1.03 0.03 0.02

Controls Child-level Maternal age at birth 0.98 -0.02 0.00 *** 0.98 -0.02 0.00 *** 0.98 -0.02 0.00 *** 0.98 -0.02 0.00 *** Birth order 1.09 0.09 0.00 *** 1.09 0.09 0.00 *** 1.09 0.09 0.00 *** 1.08 0.07 0.00 *** Length of preceding birth interval


First born Short interval 0.91 -0.10 0.02 *** 0.91 -0.10 0.02 *** 0.91 -0.10 0.02 *** 0.89 -0.12 0.02 *** Long interval 0.55 -0.60 0.02 *** 0.55 -0.60 0.02 *** 0.55 -0.60 0.02 *** 0.54 -0.61 0.02 ***

Female 0.86 -0.16 0.01 *** 0.86 -0.16 0.01 *** 0.86 -0.16 0.01 *** 0.86 -0.16 0.01 *** Multiple birth 3.81 1.34 0.02 *** 3.82 1.34 0.02 *** 3.82 1.34 0.02 *** 3.86 1.35 0.02 *** Age dummies (not shown) Subnational region-level controls Average female schooling 0.94 -0.06 0.02 *** 0.94 -0.06 0.02 *** 0.98 -0.02 0.02 Adult women's employment (%) 1.65 0.50 0.13 *** 1.64 0.50 0.13 *** 1.62 0.48 0.14 *** Rural (% households rural) 1.05 0.05 0.10 1.05 0.05 0.10 0.92 -0.08 0.11 Country-level Country dummies (not shown)

Variance components Between subnational region variance 0.02 0.01 0.01 0.01

Model Fit Likelihood-ratio test 1146.49*** 752.82*** 755.03*** 768.30*** †p<.1 ; *p<.05 ; **p<.01 ; ***p<.001 Source: Demographic and Health Survey


Figure 1. Variation in the prevalence of currently divorced women across 290 subnational-regions in Africa, by country

Congo (Brazzaville) Sao Tome Principe

Mozambique Malawi Zambia

Madagascar Zimbabwe

Liberia Tanzania

Gabon DRC Chad

Rwanda Ethiopia Burundi

Kenya Cameroon

Sierra Leone Lesotho

Swaziland Ghana

Uganda Senegal

Ivory Coast Namibia

Niger Nigeria

Benin Mali

Guinea Burkina Faso

0 5 10 15 20

% Women Divorced in Subnational Region


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