The stall in fertility decline in rural, northeast, South Africa: the contribution of a self-settled, Mozambican, refugee sub-population

Ibisomi, Latifat; Williams, Jill; Collinson, Mark; Tollman, Stephen

doi:10.11564/28-0-517

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…The stall in fertility decline in this population from 2004–2007 has been documented by Ibisomi et al [ 5 ] who found that this stall was most prominent in the South African population, who saw an increase in fertility. Our study corroborates their findings and further extends them, showing that the South African population’s fertility remained largely stable through 2013, with some decline in the last period, while Mozambican fertility continued to decline.…”

Section: Discussionsupporting

confidence: 52%

“…In Agincourt, a rural area in Mpumalanga province, South Africa, earlier work by Garenne et al [ 4 ] has found that fertility decline stalled in the 1980s with the influx of Mozambican refugees who arrived in large numbers and had higher fertility than the resident South Africans. Another stall in fertility decline was also detected in the early 2000s and had again been thought to be attributable to the higher fertility of Mozambican immigrants, though Ibisomi et al [ 5 ] find that during this period it was South African fertility that increased while Mozambican fertility declined.…”

Section: Introductionmentioning

confidence: 99%

“…Literature investigating these relationships has largely been limited to short periods of follow-up or cross-sectional analyses and thus unable to observe how these effects behave over time within a community. Second, previous methods used from Agincourt on fertility were direct calculation of rates (or decomposition of those rates) and did not supply confidence intervals [ 4 , 5 ]. Using discrete time event history analysis, we are able to quantify uncertainty around our estimates as well as incorporate multiple covariates for fertility and test their interactions.…”

Section: Introductionmentioning

confidence: 99%

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Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013

Houle

Pantazis

Kabudula

et al. 2016

Popul Health Metrics

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BackgroundLiterature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change.MethodsWe use data for females aged 15–49 from the Agincourt health and socio-demographic surveillance system (1993–2013). We use discrete time event history analysis to summarize patterns in the probability of any birth.ResultsOverall fertility declined in 2001–2003, increased in 2004–2011, and then declined in 2012–2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004–2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality.ConclusionsThe fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013

Houle

Pantazis

Kabudula

et al. 2016

Popul Health Metrics

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“…It includes a sizeable community of Mozambicans from the same ethnic group, who came in the 1980s as refugees during the civil war and settled in South Africa; they now account for about 30% of the population in the HDSS area. The Mozambican refugees became better and better integrated over the years in terms of income, education, and demographic behavior, but they still have distinctive features, as shown in this study (32–35). …”

Section: Methodsmentioning

confidence: 54%

Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992–2014

Garenne

Collinson

Kabudula

et al. 2016

Global Health Action

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BackgroundCompleteness of vital registration remains very low in sub-Saharan Africa, especially in rural areas.ObjectivesTo investigate trends and factors in completeness of birth and death registration in Agincourt, a rural area of South Africa covering a population of about 110,000 persons, under demographic surveillance since 1992. The population belongs to the Shangaan ethnic group and hosts a sizeable community of Mozambican refugees.DesignStatistical analysis of birth and death registration over time in a 22-year perspective (1992–2014). Over this period, major efforts were made by the government of South Africa to improve vital registration. Factors associated with completeness of registration were investigated using univariate and multivariate analysis.ResultsBirth registration was very incomplete at onset (7.8% in 1992) and reached high values at end point (90.5% in 2014). Likewise, death registration was low at onset (51.4% in 1992), also reaching high values at end point (97.1% in 2014). For births, the main factors were mother's age (much lower completeness among births to adolescent mothers), refugee status, and household wealth. For deaths, the major factors were age at death (lower completeness among under-five children), refugee status, and household wealth. Completeness increased for all demographic and socioeconomic categories studied and is likely to approach 100% in the future if trends continue at this speed.ConclusionReaching high values in the completeness of birth and death registration was achieved by excellent organization of the civil registration and vital statistics, a variety of financial incentives, strong involvement of health personnel, and wide-scale information and advocacy campaigns by the South African government.

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“…6 14 36 There seems to be an increase in the intention to use/ current postpartum contraceptive use across the study period, particularly due to increased injectable contraceptive uptake, which also aligns with decreased fertility rates in this population. [37][38][39] While this follows WHO best practices and the South African strategic plan, 5 40 it is essential to consider these findings in the context of South Africa's contraceptive history. During apartheid, the government's contraceptive priorities were motivated by the racist desire to limit reproduction in Black South Africans.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers

et al. 2021

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IntroductionPregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition.MethodsWe included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic).ResultsBetween 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents.ConclusionPregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions.

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The stall in fertility decline in rural, northeast, South Africa: the contribution of a self-settled, Mozambican, refugee sub-population

Abstract: The stall in fertility decline in rural, northeast, South Africa: the contribution of a self-settled, Mozambican, refugee sub-population.

Cited by 7 publications

References 27 publications

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013

Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013

Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992–2014

Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers

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