Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi.

While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.

Divorce, living arrangements, and material well-being during the transition to adulthood in rural Malawi.

In this paper, we use longitudinal data to investigate how parental death and divorce influence young women's own experience of divorce in Malawi, a setting where women marry relatively early and unions are fragile. We find that maternal death and parental divorce are positively associated with divorce for young women but, after controlling for socio-demographic and marital characteristics, only the association with maternal death remains statistically significant. Maternal and paternal death are both strongly associated with women's post-divorce living arrangements, which in turn affects their material well-being. This finding suggests that divorcing at a young age shapes the subsequent life chances of women; although some women return to their parental home and may have the opportunity to reset the transition to adulthood, other women begin their 20s as head of their own household and with considerable material disadvantage.

Trends in Modern Contraceptive Use among Young Adult Women in sub-Saharan Africa 1990 to 2014.

This article provides updated estimates of trends in modern contraceptive use among young adult women (aged 15-24) who have had sex, using Demographic and Health Survey data from 23 sub-Saharan African countries (1990-2014). In East/South Africa, parous women had higher modern contraceptive use than nulliparous women and larger increases in modern contraceptive use over time. In the West/Central region, nulliparous women had higher modern contraceptive use than parous women and larger increases in modern contraceptive use over time. Most of the increase in modern contraceptive use was driven by an increase in short-acting-rather than long-acting-methods across regions and parity groups. Although parous women had higher unmet need for family planning in both regions, nulliparous women had larger increases in unmet need for family planning over time in the East/South region. Decomposition analysis suggests that increases in use of modern contraceptives are largely driven by increases in the rate of contraceptive use rather than changes in the parity composition of women.

De facto Privatization and Inequalities in Educational Opportunity in the Transition to Secondary School in Rural Malawi.

There has been a recent, rapid de facto privatization of education in many African countries, as the number of private secondary schools operating in the region grew. The majority of these schools are "low-cost" private schools where tuition and fees are set as low as possible to cover operating costs and still generate profit. Proponents of low-cost private schools argue that these schools have proliferated in impoverished areas to meet unmet demand for access to education and where private schools may offer better quality than locally available public schools. Theories of inequality of educational opportunity suggest that if private schools offer better quality education, students from more advantaged families will be more likely to enroll at these institutions, potentially exacerbating educational inequality in the region. This analysis uses data from a school-based longitudinal survey, the Malawi Schooling and Adolescent Study, to examine socio-economic inequalities in the transition to secondary school and on-time enrollment in upper secondary. My findings indicate that youth from non-poor households are not only more likely to enroll in secondary school than poor youth, but they are also more likely to substitute enrollment in private schools for enrollment in second-tier government schools. Enrollment at private schools, however, does not yield schooling advantages; relative to both tiers of government secondary schooling, students who initially enrolled at private schools were the least likely to enroll on time in upper secondary school. These patterns suggest that these schooling circumstances may yield less segregation of opportunity than might otherwise be assumed.

Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents' understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers' knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018-1.802). When asked why vaccination rates may be low in their community, the two most common responses were "fearful of side effects" and "ignorance/disinterest/laziness" (44% each). The factors influencing caregivers' demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

The Demographic Promise of Expanded Female Education: Trends in the Age at First Birth in Malawi.

The expansion of female education has been promoted as a way to postpone the age of first birth. In sub-Saharan Africa, the first cohorts to benefit from policies that expanded access to education are now reaching adulthood and beginning childbearing. I investigate whether the expansion of education in Malawi, which implemented a free primary education policy in 1994 and subsequently expanded secondary schooling, has led to a later age at first birth and whether the education gradient in fertility timing has remained stable over time. Despite increases in female grade attainment over the past twenty years, the age at first birth has not changed. Using instrumental variables analysis, I find a significant negative association between grade attainment and age at first birth, suggesting that the deterioration of school quality and shift in the age pattern of enrollment that accompanied educational expansion may have compromised the transformative potential of education.

HIV Risk Perceptions, the Transition to Marriage, and Divorce in Southern Malawi.

Little is known about whether the timing of marriage is used as a strategy to avoid HIV infection among young people in sub-Saharan Africa. Analyzing five rounds of longitudinal data from the Malawi Schooling and Adolescent Survey, we do not find support for the hypothesis that young women's perceived chances of future HIV infection are associated with the transition to marriage, but we do find evidence that young married women who see themselves as at risk of future infection have a greater likelihood of divorcing than do women who perceive no chance of future infection. We also use individual-level fixed-effects regressions to examine how the transition to marriage affects respondents' expectations of future HIV infection. Respondents are consistently more likely to perceive any chance of future HIV infection in the years following marriage than in the years preceding it. Our findings suggest that young women revise their risk perceptions based on their marital experiences and that divorce may serve as a protective strategy for young married women concerned about their chance of future HIV infection.

Challenges in measuring the sequencing of life events among adolescents in Malawi: a cautionary note.

Using data from two rounds of the Malawi Schooling and Adolescent Survey, this research note examines consistency of retrospective reporting on the timing and sequencing of sexual initiation, school leaving, and marriage. The analysis, which compares reporting of events both within and between rounds, indicates substantial inconsistency in reporting of event sequences and highlights difficulties in measuring transitions to adulthood in sub-Saharan Africa with survey data.

The impact of family transitions on child fostering in rural Malawi.

Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.

The effect of school status and academic skills on the reporting of premarital sexual behavior: evidence from a longitudinal study in rural Malawi.

PURPOSE: Reliable data on sexual behavior are needed to identify adolescents at risk of acquiring human immunodeficiency virus or other sexually transmitted diseases, as well as unintended pregnancies. This study aimed to investigate whether schooling status and literacy and numeracy skills affect adolescents' reports of premarital sex, collected using audio computer-assisted self-interviews. METHODS: We analyzed data on 2,320 participants in the first three rounds of the Malawi Schooling and Adolescent Study to estimate the level of inconsistency in reporting premarital sex among rural Malawian adolescents. We used multivariate logistic regressions to examine the relationships between school status and academic skills and premarital sexual behavior reports. RESULTS: Males were more likely than females to report premarital sex at baseline, whereas females were more likely than males to report sex inconsistently within and across rounds. School-going females and males were more likely to report never having had sex at baseline and to retract reports of ever having sex across rounds than were their peers who had recently left school. School-going females were also more likely to report sex inconsistently at baseline. Literate and numerate respondents were less likely to report sex inconsistently at baseline; however, they were more likely to retract sex reports across rounds. CONCLUSIONS: The level of inconsistency both within a survey round and across rounds reflects the difficulties in collecting reliable sexual behavior data from young people in settings such as rural Malawi, where education levels are low and sex among school-going females is not socially accepted.

Menstruation and School Absenteeism: Evidence from Rural Malawi.

The provision of toilets and menstrual supplies has emerged as a promising programmatic strategy to support adolescent girls' school attendance and performance in less developed countries. We use the first round of the Malawi Schooling and Adolescent Survey (MSAS) to examine the individual- and school-level factors associated with menstruation-related school absenteeism. The MSAS is a school-based longitudinal survey of adolescent students enrolled in coed public primary schools in the southern districts of Machinga and Balaka who were aged 14-16 in 2007. Although one-third of female students report missing at least one day of school at their last menstrual period, our data suggest that menstruation only accounts for a small proportion of all female absenteeism and does not create a gender gap in absenteeism. We find no evidence for school-level variance in menstruation-related absenteeism, suggesting that absenteeism is not sensitive to school environments. Rather, co-residence with a grandmother and spending time on school work at home reduce the odds of absence during the last menstrual period.

The relationship between orphanhood and child fostering in sub-Saharan Africa, 1990s-2000s.

In countries most afflicted by HIV/AIDS in sub-Saharan Africa, orphanhood has increased dramatically, but the potential consequences of the increase have been mitigated by the ability of households to absorb orphans. This paper examines what the rising levels of orphanhood mean for the common practice of non-orphan child fostering in regions of high and low HIV prevalence in sub-Saharan Africa, which has a long history of child fostering. Using Demographic and Health Survey data from 135 regions within 14 sub-Saharan countries that undertake HIV testing and have had at least two surveys, we examine changes in fostering patterns. In most regions, we find a more accommodating relationship between orphan and non-orphan fostering: communities are able to absorb the demand for both orphans and non-orphans. Where HIV prevalence exceeds 10 per cent there is some evidence that the need to care for orphans is beginning to reduce opportunities for non-orphan fostering.

Girls' schooling and the perceived threat of adolescent sexual activity in rural Malawi.

Despite its relative infrequency, pregnancy is perceived by parents in rural Malawi as a leading cause of school dropout among female students. This paper explores parents' beliefs about adolescent sexual activity and schoolgirl pregnancy and how these perceptions frame parents' aspirations and expectations about girls' schooling. In-depth interviews were collected in rural Malawi from 60 adults aged 25-50 who were the parent of at least one school-aged child. Four themes emerged from the data: how expectations about sexual activity frame parental expectations about schooling duration and dropout, the loss of parental control, the negative influence of classmates and schools as unsafe environments. These concerns frame how parents consider a daughter's schooling prospects and are active even for parents whose daughters are not sexually active or who are not yet old enough to have gone through puberty. Although all parents aspire for their children to attend secondary school, these perceptions of daughters' relative risk weaken parents' motivation to encourage daughters to remain in school.

Pregnancy-related school dropout and prior school performance in KwaZulu-Natal, South Africa.

This study uses data from KwaZulu-Natal, South Africa, to examine the factors associated with schoolgirl pregnancy and subsequent educational pathways. We find that prior schooling discontinuities--defined as instances of non-pregnancy-related grade repetition or temporary withdrawals from school--are strongly associated with a young woman's likelihood of later becoming pregnant while enrolled in school, dropping out of school if she becomes pregnant, and not returning to school following a pregnancy-related dropout. Young women who are the primary caregivers to their children are also significantly more likely to leave school than are those who have help with their childcare responsibilities. Given the increasing importance of female school participation in sub-Saharan Africa, programs must be designed to reach girls and their families early to increase incentives for ensuring their timely progression through school and to increase their access to reproductive health information and services.