Effects of Paternal Socioeconomic and Demographic Status on Child ...

Effects of Paternal Socioeconomic and Demographic Status on Child Survival in Nigeria: A Mediation Analysis Phillips Edomwonyi Obasohan Department of Liberal Studies, College of Business and Administrative Studies (CABS), Niger State Polytechnic, Bida Campus, Nigeria [email protected] Introduction In the recent years, researchers have become more interested in the topics of men in reproductive health. There are beliefs that Men’s behaviour influences the reproductive health of both men and women and the health of their children.(1,2) There are many family planning and other reproductive health programs recognising that men especially involving them have a positive impact on women and children’s health in a number of ways, including improving Maternal and Child Healthcare, apart from a distinct reproductive health needs of their own.(3) For instance, the 1994 International Conference on Population and Development in Cairo has program of action to include a statement on “Male Responsibilities and Participation” thus: "Special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; prenatal, maternal and child health; prevention of STDs, including HIV; prevention of unwanted and high-risk pregnancies; shared control and contribution to family income, children's education, health and nutrition; and recognition and promotion of the equal value of children of both sexes." (3) More than 20 years after, mechanism for a workable framework is still been worked out. During the development of operational guidance on gender analysis and programming on the focus area of young child survival and development, it emerged that there is limited data on the impact of gender on child survival outcomes and that more tools would be needed to conduct quality gender analyses.(4) Any intervention on child health and survival that must be effective, equitable and sustainable 1

must be design based on gender sensitive information and continually evaluated from a gender perspective.(5) In reproductive health design, childhood mortality or child survival has become a major health burden for most sub-Saharan African countries, especially in Nigeria. It is said that Children in developed countries are 10 times as more likely to survive through their 5th birthday compared to those in developing nations. (6) To measure the efficiency of a nation’s health system for instance, the states of maternal health care as well as that of child mortality/survival rate have become the major indices. And in response to the burden of child survival status in sub-Saharan African countries, United Nations (UN) and World Health Organisation (WHO) at the turn into this millennium, incorporated reduction of childhood mortality rates by two-third by the year 2015 as part of their Millennium Development Goals (MDGs).(6) Nigeria situation showed that by the end of 2015 mortality rate for under-5 stood at 108.8 deaths per 1000 live births (). This figure could not achieve MDGs which was clearly below global average of 47.8% and 53% sub-Saharan African average (7). Beyond MDGs is the post-2015 Sustainable Development Goals (SDGs) to end preventable newborn and children death by 2030 with under-5 going down as low as 25 deaths per 1000 live births (7). Several models in existence focused on women and household effects on child survival, but those that included men are very few due to lack of information about men’s perspectives that could be used to design appropriate programs.(3) However, the picture of how by involving men in their parenting can directly contribute to better health outcomes for themselves, their children and their partner has been very vague.(1) Very little is known about how various factors affect the relationship between fatherhood and health.(1) There remains argument as to whether the association between father’s characteristics and child survival is direct, or is mediated by pathways related to mother’s characteristics. This has been an ongoing challenge to the reproductive health framework of how best to involve and characterise men’s possible influences and to assess their impact on women’s and children’s health.(3,8) In addition, most research on fatherhood and health outcomes comprises qualitative research with relatively few samples and attendant few quantitative studies that can give a wider view of the patterns.(1) Research on links between fathers’ roles and child health are urgently needed to establish 2

an evidence-based argument for social programs and policy reformers to act on, so as to explore the pathways that fathers influences their children’s health, the potential strength of these relationships, and factors that can moderate and confound these relationships.(9) This is the focus of this research work. Though the Cairo conference of 1994 was held in Africa, but very few research works have been carried out in understanding the nature of men’s involvement in reproductive health in this region. However, the candidate is unaware of any study that has investigated the net or combine effects of paternal socioeconomic and demographic linkages with some other maternal characteristics (especially, her schooling status and decision making power) on child survival in Nigeria. In some African countries, there are factors considered as maternal and perhaps some as household factors which have significant impact on child’s health outcomes but are directly father’s characteristics determined. So, men are important actors whose factors influence both positively and negatively, both directly and indirectly the reproductive health outcome of women and their children.(8) The Aim The aim of this study is to determine the indirect effects of some paternal variables on under-5 mortality in Nigeria through mediation effects of maternal characteristics using 2013 Nigeria Demographic and Health Survey (NDHS) dataset. Study Questions Specifically, this study is designed to answer the following questions: i.

ii.

iii.

Are there significant independent effects of the selected paternal socioeconomic and demographic characteristics on child survival in Nigeria? To what extent are the significant paternal socioeconomic characteristics mediated by maternal education status on the survival of a child in Nigeria To what extent are the significant paternal socioeconomic characteristics mediated by maternal autonomy status on the survival of a child? 3

Data and Methods Variables of Interest The outcome variable of interest is childhood survival status measured as the risk of death from birth before the age of five years (takes a binary scale: alive and not alive). The exposure variables are paternal socioeconomic (define on educational attainment level (takes a binary scale: Attainment of not more than primary school and more than primary school) and occupational status (also take on a binary scale: Not working and working) and demographic status (to include, age and place of residence). The maternal characteristics of interest that serve as mediation are maternal education (takes a binary scale: Attainment of not more than primary school and more than primary school) and decision making power (autonomy-defined on binary scale: low autonomy and more autonomy), Source of Data In this study, we used data from 2013 population-based cross-sectional secondary data of Nigeria Demographic and Health Survey (NDHS). Relevant information were collected for children considered for this study and born in the last 60 months before the survey was carried out, and also information for men and women of reproductive age were collected. Specifically we used data for couple to include 8925 males and 9016 females. The procedure regarding the sample design and data collection methods can be found in Nigeria’s reports (10). Method of Data Analysis With respect to the questions raised above, appropriate univariate, bivariate, and mediation techniques were used: (i) (ii)

Percentage Frequency Counts for some selected background variables of couples used in this study were stated. To address the first question, bi-variable analysis was conducted to determine the relationship between selected Paternal socioeconomic and demographic and maternal variables with child survival status in Nigeria using chi-square test and p-value less than 0.05 for significant 4

(iii)

With respect to questions 2 and 3, to determine mediation effect of maternal education and autonomy on the effects of the selected paternal socioeconomic status and child survival status, product of the coefficient method (11), and computations were done using Stata14SE (12)

Results and Discussions Table 1 displayed the frequency and percentage counts of the variables for both male and female respondents used in this study. The average age of male respondents was 36.8 years and for female was 28.6 years. More than 8900 males and 9000 females were captured in the survey responded. Table 1: Frequency and Percentage Count for Background Variables of Respondents Paternal Variables Age Group 15 – 24 years 25 – 34 years 35 + years Work Status Not Working Working Region North Central North East North West South East South South South West Place of Residence Urban Rural Age at 1st Marriage 15 – 24 years 25 – 34 years 35 + years Educational Status No Education Education

No

%

406 2806 5713

4.5 32.2 63.3

406 8616

4.4 95.6

1345 1524 3542 533 851 1219

15 17 39 6 9 13

3069 5947

34 66

4636 3918 461

51 43 6

5043 3971

56 44

5

Maternal Variables Education Status No Education Education Autonomy Level Low Autonomy More Autonomy Work Status Not Working Working Age in Group 15 – 24 years 25 – 34 years 35 + years Age at 1st Marriage 15 – 24 years 25 – 34 years 35 + years

6094 2922

68 32

4951 3128

61.3 38.7

3047 5968

34 66

2791 4139 2085

31 46 23

8257 738 21

91.5 8.2 0.3

The out of job rate for male partners was below 5%. 2 out of every 3 males resides in the rural areas and more than half of the total number of males married at first before the age of 25 years. The pattern of education status for men and women was almost the same. Those who have no education (ie not more than Primary School education) were more than those who had secondary education and above for both gender. In the female category, more than 90% of them entered into first marriage before the age of 25 years. Table 2: Relationship between some selected Paternal and Maternal Background Variables with Under-5 Mortality Paternal Variables Age Group 15 – 24 years 25 – 34 years 35 + years Work Status Not Working Working Region

Not Alive (N)

Alive (N)

Chi Sq

P-Value

15 136 354

192 2309 5072

3.0041

0.2746(NS)

38 472

337 5.26 7246

6

0.0436(S)

North Central North East North West South East South South South West Place of Residence Urban Rural Age at 1st Marriage 15 – 24 years 25 – 34 years 35 + years Educational Status No Education Education Maternal Variables Education Status No Education Education Autonomy Level Low Autonomy More Autonomy Work Status Not Working Working Age in Group 15 – 24 years 25 – 34 years 35 + years Age at 1st Marriage 15 – 24 years 25 – 34 years 35 + years

63 75 250 34 35 47

1146 31.3061 1243 2881 458 741 1104

0.0001(S)

130 376

2671 18.3261 4906

0.0000 (S)

269 206 30

3907 2.4912 3309 361

0.397(NS)

304 190

4195 8.900 3379

0.0119(S)

405 101

5043 38.102 2531

0.000(S)

347 157

4603 12.4964 2971

0.0025(S)

148 537

2393 1.108 5180

0.327(NS)

132 209 164

1930 17.0749 375 1880

0.0012(S)

472 33 1

6969 1.5358 594 10

0.554(NS)

Considering the relationship of respondents’ characteristics with under-5 mortality, from table 2 we observed that paternal age (in groups) was not significantly associated with under-5 mortality (p-value=0.2746), while maternal age (in groups) was significant (p-value=0.0012). However, paternal work status, region, place of residence (whether urban or rural) and education status were found to be significantly associated with 7

under-5 mortality. On the other hand, maternal education status and age group in 5 years were significantly associated to under-5 mortality in Nigeria Mediation Analysis Our focus here was to determine the indirect effect of Paternal Socioeconomic and Demographic variables represented by educational level attainment, work status and place of residence on under-5 mortality in Nigeria through some maternal variables (educational level attainment and decision making status) as mediators. In view of this, six mediation models were established. Model 1: Mediation effect of maternal education on the effect of paternal education on under-5 mortality Using the product of coefficient method, the indirect effect of paternal education status on under-5 mortality through the mediation of maternal education was 0.0173 with p-value (0.000) and the coefficient of the direct effect was 0.0032 with p-value (0.623)-though not significant. This translated into a ratio of indirect to direct effect of 5.41 and the proportion of the total effect that was mediated by maternal education status was 0.844. This result showed that about 84.4% of the effect paternal educational status has on under-5 mortality is mediated via maternal education status Model 2: Mediation effect of maternal autonomy status on the effect of paternal education status on under-5 mortality Model 2 analyses shown that, the indirect effect of paternal education status on under-5 mortality through the mediation of maternal autonomy status was 0.0032371 with p-value (0.017) and the coefficient of the direct effect was 0.0178 with p-value (0.002). This translated into a ratio of indirect to direct effect of 0.187 and the proportion of the total effect that was mediated by maternal autonomy status was 0.1538. This result showed that about 15.4% of the effect paternal educational status has on under-5 mortality is actually mediated via maternal decision making power

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Model 3: Mediation effect of maternal education status on the effect of paternal work status on under-5 mortality Using the product of coefficient method, the indirect effect of paternal work status on under-5 mortality through the mediation of maternal education status was 0.0066869 with p-value (0.000) and the coefficient of the direct effect was 0.0247219 with p-value (0.064). This translated into a ratio of indirect to direct effect of 0.270 and the proportion of the total effect that was mediated by maternal education status was 0.2129. This result showed that about 21.3% of the effect paternal work status has on under-5 mortality is actually mediated via maternal education status Model 4: Mediation effect of maternal autonomy status on the effect of paternal Work status on under-5 mortality The indirect effect of work status on under-5 mortality through the mediation of maternal autonomy status was 0.0028408 with p-value (0.006) and the coefficient of the direct effect was 0.0285601 with pvalue (0.033). This translated into a ratio of indirect to direct effect of 0.09946 and the proportion of the total effect that was mediated by maternal autonomy status was 0.0904. Indicating that about 9.04% of the effect paternal work status has on under-5 mortality is actually mediated via maternal decision making power Conclusion The findings from this study have established that paternal socioeconomic and demographic variables are associated with under-5 mortality in Nigeria. Furthermore, maternal level of educational attainment and autonomy status played significant role in explaining paternal disparities in under-5 mortality. However, the findings that more than a quarter of the effect paternal education has on under-5 mortality was mediated by the inequalities experienced in maternal education level, testified to the relevance of maternal education in child survival

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References 1. World Health Organization: Fatherhood and health outcomes in Europe: A summary report. WHO Regional Office for Europe, 2007. 2 Jessica Davis, Stanley Luchters, Wendy Holmes (2012) Men and maternal and newborn health: benefits, harms, challenges and potential strategies for engaging men, Compass: Women's and Children's Health Knowledge Hub. Melbourne, Australia. 3 Reproductive Health Outlooks: Men and Reproductive Health. www.fho.org accessed 23rd Feb, 2015. 4 United Nation Children’s Funds: Gender Influences on Child Survival, Health and Nutrition. Unicef, New York, December 2011. 5 United Nation Children’s Funds: Guidance on Methodologies for Researching Gender Influences on Child Survival, Health and Nutrition. Unicef, New York, December 2011. 6 Kayode Gbenga A, Adekambi Victor T. and Uthman Olalekan A. Risk factors and a predictive model for under-five mortality in Nigeria: Evidence from Nigeria demographic and health survey. BMC pregnancy and Children 2012; 12: 10 7 World Health Organization (WHO). Children: Reducing Mortality. http://www.who.int/mediacentre/factsheets/fs178/en/ October, 2017. Accessed on 5th March, 2018 8 Boco Adébiyi Germain. Individual and Community Level Effects on Child Mortality: An Analysis of 28 Demographic and Health Surveys in Sub-Saharan Africa. DHS Working Papers No. 73. 2010 Calverton, Maryland, USA: ICF Macro. 9. Dudgeon MR and Inborn M: Men’s Influence on Women’s Reproductive Health: Medical Anthropological Perspectives. Social Science and Medicine 2004; 59, 1379 -1395. 10 Ball J, Moselle and Pedersen: Father’s Involvement as a Determinant of Child Health, Public Health Agency of Canada, 2007 11 National Population Commission and ICF Macro (2014): Nigeria Demographic and Health Survey 2013. Abuja, Nigeria: National Population Commission and ICF Macro. 12 StataCorporation, Stata Statistical Software, College Station, TX, 2014.

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