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Impact of Migration on Fertility and Abortion: Evidence From the Household and Welfare Study of Accra

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Demography

Abstract

Over the last few decades, total fertility rates, child morbidity, and child mortality rates have declined in most parts of sub-Saharan Africa. Among the most striking trends observed are the rapid rate of urbanization and the often remarkably large gaps in fertility between rural and urban areas. Although a large literature has highlighted the importance of migration and urbanization within countries’ demographic transitions, relatively little is known regarding the impact of migration on migrants’ reproductive health outcomes in general and abortion in particular. In this article, we use detailed pregnancy and migration histories collected as part of the Household and Welfare Study of Accra (HAWS) to examine the association between migration and pregnancy outcomes among women residing in the urban slums of Accra, Ghana. We find that the completed fertility patterns of lifetime Accra residents are remarkably similar to those of residents who migrated. Our results suggest that recent migrants have an increased risk of pregnancy but not an increased risk of live birth in the first years post-move compared with those who had never moved. This gap seems to be largely explained by an increased risk of miscarriage or abortion among recent migrants. Increasing access to contraceptives for recent migrants has the potential to reduce the incidence of unwanted pregnancies, lower the prevalence of unsafe abortion, and contribute to improved maternal health outcomes.

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Notes

  1. Returned migrants are defined as individuals who were away from the household for some time in the last five years but have since returned to the household (Ackah and Medvedev 2012).

  2. Measures of variables across data sets were not obtained in the same way for every variable. For example, the DHS asked, “Have you ever had a pregnancy that was terminated?” For the HAWS data, the participant was asked to list every pregnancy and identify the outcome as live, stillbirth, or lost. Reporting bias can act on these measures differently, which makes these rough rather than exact comparisons. Individual sample weights were used to calculate summary statistics of DHS variables.

  3. For consistency in both descriptive statistics and analysis, we regard a move to be a “true” move only if it was out of the neighborhood in which the woman was residing. This constituted 85 % of all moves; see Online Resource 1 for the distribution of all types of moves.

  4. This could be possible if a woman has multiple stillbirths in the same year, for example. It could also be due to measurement error. However, whether the stillbirth happened once or twice in a person-year doesn’t affect our analysis because the binary indicator of stillbirth for that person-year is 1, regardless. It is also rare, occurring in only 3.2 % of observations.

  5. Results were robust to including year fixed effects instead of period fixed effects.

  6. The distribution of the outcome of total children ever born by each migration status group is shown in Online Resource 1.

  7. The process for how we obtained the sample size is described in the Online Resource 1.

  8. Month of move is missing for 84 % of all moves that happen in the same year as the current person-year. Birth month is missing for 25 % of all births. Death month is missing for 56 % of those who died since birth.

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Acknowledgments

We are grateful to Allan Hill for the support of the project, as well as to Mark McGovern for his useful feedback and comments. This project was supported by Grant No. T32HS000055 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. We would also like to thank Matthias Schündeln as well as the William and Flora Hewlett Foundation for the financial support for the HAWS project.

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Authors and Affiliations

  1. Department of Health Policy, Evaluative Sciences and Statistics, Harvard University, 14 Story Street, 4th floor, Cambridge, MA, 02138, USA

    Slawa Rokicki

  2. Center for Population and Development Studies, Harvard School of Public Health, 9 Bow Street, Cambridge, MA, 02138, USA

    Livia Montana

  3. Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Building 1, Room 1110, Boston, MA, 02115, USA

    Günther Fink

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  1. Slawa Rokicki
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  2. Livia Montana
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Correspondence to Slawa Rokicki.

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Rokicki, S., Montana, L. & Fink, G. Impact of Migration on Fertility and Abortion: Evidence From the Household and Welfare Study of Accra. Demography 51, 2229–2254 (2014). https://doi.org/10.1007/s13524-014-0339-0

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