Browsing by Author "Moultrie, Thomas"

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    An investigation into the progression of premarital fertility since the onset of Zimbabwe's fertility transition
    (2021) Ngwenya, Chantelle Linda; Moultrie, Thomas
    Premarital fertility, that is, childbearing before first marriage, is an important yet under researched demographic topic in sub-Saharan Africa. In Zimbabwe, the distinction by marital status in fertility research is hardly drawn. Hence, a gap exists in the knowledge of premarital fertility levels. This research aims to investigate levels of, and factors associated with, premarital fertility since the onset of Zimbabwe's fertility transition in the mid-1980s. The research employed direct fertility estimation techniques to effectively compare premarital, marital, and overall fertility trends between 1988 and 2015. Cox proportional-hazards regression and forest plot analyses were then used to explain changes in factors associated with the timing of premarital first births over the same period. Data quality assessments were carried out using the method of cohortperiod fertility rates to provide explanations for any erratic results. The results showed that premarital fertility was constant and moderate, with an average of 0.7 children per woman, between 1988 and 2015. While most premarital first births consistently occurred to younger women, from 2005 onwards, they increased among women aged above 24 years and decreased among adolescents. An increase in age, commencing sexual activity after adolescence, and improved socio-economic status including level of education decreased the relative risk of having a premarital first birth. However, delaying marriage past young womanhood, history of contraceptive use, Ndebele ethnicity, and residence in regions other than Manicaland and Masvingo, especially Ndebele dominated regions, increased the same risk by 465.0%, 45.5%, 136.0% and up to 135.0% respectively. The stagnation of premarital fertility between 1988 and 2015 while both marital and overall fertility first declined and then stalled indicates that there is insufficient evidence to suggest that premarital fertility had contributed to the stall of fertility decline in Zimbabwe from the mid-1990s. The timing of premarital first births since the start of the fertility transition in the 1980s has had a strong ethnic and cultural bias. Due to evidence of the effect of migrancy and tourism on premarital fertility in border and tourism towns, an extension into the theory of migrant premarital sexual behaviour to detail the risk of premarital fertility among border town residents who interact with but are neither migrants nor tourists is recommended.
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    Assessment of subnational level birth registration data in South Africa
    (2021) Madamombe, Tawanda; Moultrie, Thomas
    Birth registration data forms part of vital statistics. It is the right of the child to be registered immediately after birth and to acquire an identity and a nationality as stipulated by the Convention on the Rights of the Child (UNICEF 1989). The assessment of birth registration is important to help authorities in the processes of planning and decision making. This study investigates birth registration data at a district level with the aim to establish the data's usefulness in determining reliable completeness of births and estimating total fertility rate (TFR). The study further analyses the spatial relationships between respective districts to each other based on levels of birth completeness and total fertility rate. The Geographical Information Systems (GIS) technique of the Global Moran's Index spatial autocorrelation is used to examine the spatial distribution of completeness and TFR. The Indirect method of relational Gompertz model is used to calculate robust estimates of actual births that occurred in the twelve-month period before 2011 Census and 2016 Community Survey, respectively. Then, the Hauer and Schmertmann (2020) method of determining fertility was used to validate results from the Gompertz model. The study establishes that there was an improvement in the promptness of birth registration between 2011 and 2016, highlighted by an 82% completeness in 2011 that increased to 85% in 2016 for births that were registered within the same year of occurrence. This is evidence that mothers are registering births at younger ages than before. The TFR decreased from 2.55 in 2011 to 2.28 in 2016. Apart from that, the study illustrated that districts with higher completeness levels tend to be in major urban agglomerations. However, no spatial relationship could be established meaning that the neighbouring districts do not follow any pattern when compared to each other. It was also noted that districts with low fertility are clustered near major cities. Although there are issues with data at lower levels of disaggregation such as districts, it has been shown that the use of robust methods produces results that help to give meaningful insights of birth registration data.
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    Contraceptive histories: a comparative analysis of switching behaviour in five East African countries
    (2019) Kisaakye, Peter; Moultrie, Thomas
    Since the inception of family planning programmes in developing countries in the 1960s, crosssectional data show remarkable progress in the adoption of modern methods of contraception. Despite the positive contribution contraception plays in preventing unwanted pregnancies, sexually active women from sub-Saharan Africa continue to grapple with unintended pregnancies, which in some instances, results in unsafe induced abortion, with its attendant risks to maternal health. This thesis uses the most recent (as of January 2017) reproductive calendar data from the Demographic and Health Survey (DHS) programme from five East African countries; Ethiopia (2011), Kenya (2014), Rwanda (2014/15), Tanzania (2015/16), and Uganda (2011), to examine how women use contraception over time. The reproductive calendar data that are collected retrospectively provides a better mechanism to understand the trajectory of how women adopt, and immediately switch, contraception than if current-status data were utilised. Three important findings emerge from the analyses: First, contraceptive use being the most important driver of fertility decline, the slow fertility transition that is evident in the five countries can be largely attributable to limited immediate switching of contraception following discontinuation. Despite this universal observation, the key indicators of immediate switching are largely country-specific, which suggests differences in the way family planning programmes are implemented in these countries. Second, all five countries follow a similar pattern of adopting modern contraception – where the majority of users adopt short-term methods compared to long-acting reversible contraceptives (LARCs). However, the duration of use of short-term methods is observed to be shorter compared to LARCs, implying that LARCs facilitate contraceptive continuation. Last, the analysis of current-status data point to improvements in quality of contraceptive provision, and availability – facilitating increased adoption of modern contraception. However, the results indicate that method information exchange is a key predictor of contraceptive use in all countries, with users of LARCs receiving more information than users of short-term methods. Although family planning programmes have made big strides in recruiting new users, this thesis argues that unintended pregnancy, which often leads to a slow fertility transition, can be prevented once family planning programmes emphasise the benefits of immediately switching, or consistent use of contraception among existing users. Sub-optimal switching of contraception among already existing users is likely to attenuate fertility transition.
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    Ethnic migration patterns in South Africa: A case of Zimbabwean immigrants
    (2018) Zhou, Siyanai; Moultrie, Thomas
    Zimbabwean-born migrants form the largest proportion of the foreign-born population in South Africa; however, relatively little is known about both the international and internal migration behaviour of this population group. This study reviews several migration theories, and existing evidence on Zimbabwean-born migration to South Africa and uses the 2011 Census and 2016 Community Survey data for South Africa to explore both provincial and metropolitan migration patterns of Zimbabwean migrants. The study also seeks to identify characteristics of migrant internal movers and how these are associated with their propensity to migrate. To accomplish this, two modelling approaches are used, namely: the multiplicative component model (TODA) and the logistic regression model. The first modelling approach describes the origin-destination specific migration patterns of this group of migrants. The results from this analytic model show that Zimbabwean migrants are concentrated in three provinces, namely, Gauteng, Western Cape, and Limpopo; particularly in respective metropolitan areas. Also, post-arrival migration is largely focused on these major receiving provinces. The findings suggest that this pattern of concentration is likely to continue. The second modelling approach examines the inter-provincial migration of Zimbabwean migrants. At the aggregate level, the study results show a degree of selectivity of Zimbabwean immigration by factors such as age, sex, marital status, and education. Also, the results show that post-immigration migration is not necessarily significant to migrants’ redistribution. However, for those who move, the logistic regression analysis reveals that province of residence, age, marital status, and sex significantly impact on migrants’ propensity to move from “pioneer settlements” and their effects are consistent over time. Finally, despite concerns about the quality of the data collected in the 2011 census and 2016 Community Survey, our results show that there is general consistency of migration 'patterns’ between the two datasets.
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    Projecting fertility by educational attainment: proof of concept of a new approach
    (2018) Ncube, Presley; Moultrie, Thomas
    The United Nations Population Division publishes fertility projections for all countries in the World Population Prospects (WPP). These are the most widely used projections for planning and policy implementation. Despite a substantial body of literature that suggests education has a significant impact on fertility, these projections do not incorporate changes in the composition of the population by level of education. We therefore propose and implement a method that incorporates education composition change in projecting fertility. We investigate fertility differentials by level of education, then evaluate how education influences fertility independently; and finally, a model is fitted to project fertility rates by education levels. In both cases, the fertility rates by education level are then weighted by the IIASA educational attainment distributions to get the national fertility rates. These national fertility rates are in turn validated against the WPP fertility rates to evaluate how good the proposed method works. Fertility is high among the less educated relative to educated women. Education proves to be an important driver of fertility decline in Southern Africa. The proposed model is a good fit for countries with sufficient DHS data. However, there are other sources of data that are available, for example, the census data but we could not rely on them since they only give summary information. Validation was done to evaluate how good the model is working. This exercise produced consistent results with the observed fertility estimates. The percentage difference between the projected and WPP fertility estimates varied from 1 to 5 percent in Lesotho, Namibia and Zimbabwe. In conclusion, the model can also be used for other countries. Furthermore, education composition change should be considered when projecting fertility since it has proven to be a significant driver of fertility change. Data quality and availability issues were a major limitation to our study and in future should be improved.
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    The influence of maternal HIV status on mortality in children under the age of five years
    (University of Cape Town, 2020) Makala, Lukuni; Moultrie, Thomas
    Child mortality can be used to measure the level of social development as well as the health status of children (Hill 1991). By world regions, sub-Saharan Africa maintains the highest rates of under-five mortality. Current under-five mortality is estimated at 76 deaths per 1,000 live births (Hug, Sharrow, Zhong et al. 2018). In Zambia, under-five mortality reached a peak of 197 in 1996 and is currently estimated at 60 (Hug, Sharrow, Zhong et al. 2018). On the world health agenda, reducing child mortality has been made a priority, especially for low income countries that remain the most affected. Among the targets of the Sustainable Development Goals (SDGs) is reduction of neonatal mortality to at least 12 deaths per 1,000 live births and under-five mortality to 25 deaths by 2030 (United Nations 2015). HIV/AIDS is one of the leading causes of mortality in Zambia and has contributed to the slow decline of under-five mortality (Garenne and Gakusi 2006). Children under the age of five years get infected with HIV mainly through vertical transmission (Fishel, Ren, Barrère et al. 2014). In the absence of treatment, vertical transmission of HIV is high and can range between 15 and 45 per cent, reducing below 5 per cent with effective interventions (Barral, Oliveira, Lobato et al. 2014). Despite vertical transmission being the main pathway through which children get infected with HIV, little research has been done to determine the significance of maternal HIV status on under-five mortality in Zambia. The aim of the study was, therefore, to determine the extent to which mortality of children with HIV-positive mothers differs from that of children with HIV-negative mothers. The Zambia Demographic and Health Survey (ZDHS) data for 2007 and 2014 which contain HIV serotesting data were used. Survival analysis using Poisson regression was used to model the influence of maternal HIV status taking into account confounding factors. The results of the study indicate that maternal HIV status was significantly associated with child mortality in both survey periods but by 2013/14 the influence of maternal HIV status had reduced and was insignificant for children born within one year of the 2013/14 survey. The reduction in the risk of dying between the inter-survey period may be as a result of increased coverage of prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) services over the years. In order to reach universal coverage, there is need for increased provision of PMTCT and ART treatments and support for HIV strategies such as the 90 90 90 target.
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    Trends and determinants of contraceptive use and method choice among young Zimbabwean women from 1988 to 2015
    (2022) Moyo, Audrey; Moultrie, Thomas
    Fertility decline in Zimbabwe has been driven by an increase in the contraceptive prevalence rate (CPR). However, adolescent childbearing remains a challenge. Adolescent fertility increased from 103 births per 1 000 women in 1988 to 110 births per 1 000 women in 2015. The study aims to examine the trends in contraceptive use, unmet need, method choice, and determinants of contraceptive use and method choice among young women aged 15-24 in Zimbabwe from 1988 to 2015. The study utilises six cross-sectional data sets obtained from the Zimbabwe Demographic and Health Survey (ZDHS) for the years 1988, 1994, 1999, 2005-06, 2010-11, and 2015. Descriptive statistics and multivariate logistic regression were used to achieve the objectives of the study. Results showed that young women are sexually active and mostly outside of marital union. The use of modern contraceptives among sexually active young women increased from 39.7% in 1988 to 58.2% in 2015. Unmet need for modern contraceptives declined from 54.1% in 1994 to 41.6% in 2015. The pill remains the most common method used, and the use of injections and implants has also increased over time. The results show that young women aged 22-24, residing in urban areas, better educated, employed, married or cohabitating, with one or more living children, and those with a desire to have more children after 2 years are more likely to use modern contraceptives compared to other groups. Whereas, widowed, divorced, or separated, and women with a desire to have more children within 2 years are less likely to use modern contraceptives. Young women who are married (OR=2.265), better educated (OR=1.590), and have one or more living children (OR=18.411) are more likely to use injections compared to other groups. Women with secondary or higher education (OR = 2.748) and one or more living children (OR= 22.673) are more likely to use Norplant/Implants compared to other groups. In conclusion, the study demonstrates that young women are sexually active and the unmet need for modern contraceptives remains a challenge. The use of contraceptives is associated with age group, residence, education level, employment status, marital status, parity, and desire for more children. There is need to strengthen young women's universal access to family planning information and services.