ANNALS OF IBADAN POSTGRADUATE MEDICINE
T.A. Obembe1, K.O Odebunmi2 and A.D Olalemi3
Background: Fertility, particularly as it pertains to the role of men as decision makers is important with respect to demographic transition theory. Studies have explored fertility preferences of men but very little has been done with regard to fertility preferences amongst men from the slums. The aim of this study was to investigate drivers of family sizes among the urban slum households in Ibadan of South-West Nigeria.
Methods: A cross-sectional survey design was conducted among 362 men in selected urban slum communities in Ibadan, Oyo State using multi-stage sampling. Data was collected using pre-tested, semi-structured, interviewer-administered questionnaires. Data were analysed using descriptive statistics, Chi square test and binary logistic regression with level of significance set at 5%.
Results: Age of respondents was 41.1 ± 7.56 years. Over a third have completed tertiary education (35.9%) and were civil servants (47.0%). Ethnicity, educational status, sex distribution of children and number of children were significantly associated with desire for more children (p<0.05). Marginally over half (54.4%) of respondents with 2 or less children wanted to continue child bearing compared to other respondents (p<0.001). Men with female only children were almost 3 times more likely to desire more children than men with male only children (p<0.001; OR= 2.798; 95% CI = 1.53 – 5.13). Igbos also were 52.8% less likely to desire more children compared to Yorubas (p=0.047; OR = 0.472; 95% CI = 0.225 - 0.991).
Conclusion: Programmes targeted at slum dwellers to improve their education on childbearing and family planning are required to assist the country progress through the stages of demographic transition.
Keywords: Slum dwellers, Health disparities, Urban slum, Urban poor, Demographic transition
Dr. T.A. Obembe
Dept. of Health Policy and Mgt,
Faculty of Public Health,
College of Medicine,
University of Ibadan,
The demographic transition theory states that for societies to experience modernization, there must be progress from a pre-modern regime of high fertility and high mortality to a post-modern one in which fertility and mortality are both low.1 It postulates a progression through 4 stages with the last stage comprised of low birth rates and low death rates. The three main components driving this transition “fertility, mortality and migration”, have consequences on one another and on the overall size and/or structure of the population.2 Bloom et al opined that the age structure, a key indicator of the stage of demographic transition possesses a critical influence on the economic performance of any nation.3 In his stance, nations with a high proportion of children are likely to devote a high proportion of resources to their care that invariably influences the pace of economic growth and ultimately the health status of a society. Thus, policy makers try to ensure that countries attain quickly the uptimum stage of low natality and low mortality, a stage believed to bring about modest amount of health and economic benefits to any society.
However, the situation in most developing countries especially in Africa is that most are fixed in the second stage of the transition (high birth rates and a drop in mortality) instead of progressing to the next stage of demographic transition.4,5 The stagnancy of most African countries in the second stage of transition (i.e. high natality and a drop in mortality) has been perpetuated by the patriarchal dominance6,7 rooted in most African cultures and their desire for male children.8
Evidence towards this is observed in the fact that although decline in fertility rates have been noticed in some metropolitan areas and selected communities in the sub-continent, a drop in fertility is not yet witnessed in the many parts of sub-Saharan Africa.9 While initial efforts revolved mainly around the woman and understanding her role in reproduction, researchers’ interests in male issues has been recently aroused on how it influences the dynamics of fertility. For instance, it has been observed that couples may not have the same opinions about fertility and due to the cultural and socio-demographic characteristics peculiar to Africa, the decision of whether to bear more children or not in most instances lies with the man and not the woman.10
Research on the role of men in deciding the fertility rates of their partners, has shown that the desire for the male child proves to be one of the main factors behind the desire for continued childbirth among Nigerian women.11,12 Even though, the importance of demographic transitions in societies, especially on the socio-economic status of the population has been documented in varying conditions, studies have not explored the influence of birth and fertility preferences among men from slums within the Nigerian context. This becomes vital, as research has shown that fertility rates differ in different segments of the society. For instance, studies in some African countries have demonstrated that a lack of education as well as poorer socioeconomic status are linked with increased fertility rates.13,14 Furthermore, Stewart et al. observed that the populations in low and middle income countries (LMICs) are becoming rapidly urbanized, with the urbanization accompanied by increasing poverty levels among such migrants. The importance of examining this effect within the context of urban slums is of vital importance as the population of slums from increasing urbanization is on the increase daily.15,16 “United Nations (UN) projections estimate that by 2030, Nigeria’s urban population will reach 162 million whereas the rural population will be only about half the number of urban residents”.17 Urban slums, that arise in the process, account for 43.0% of the population in the developing world as compared to 32.0% of total world’s population.18 These slums in spite of their significant proportion are disadvantaged in terms of access to proper health care, good water supply, and proper sanitation.19 This study thus sought to investigate drivers of family sizes among the urban poor households in slums of Ibadan capital in South-west Nigeria.
A cross sectional study design was utilized to sample 362 residents from 5 urban areas in Ibadan, the capital of Oyo State, Nigeria. Nigeria is located in West Africa with an estimated population size of 170,000,000 (2.04% of the world population) and a total of 774 local government areas.21 Oyo State is in the southwest geo-political zone of Nigeria and lies within longitude 3.933o East and latitude 7.85o north. It has a landmass of 28,246.264 km2 and a population of about 6,182,172.21 At present, the slums in Ibadan are situated in 5 local government areas namely, Ibadan North, Ibadan North-East, Ibadan North-West, Ibadan South-West, and Ibadan South East in Ibadan municipality where the study was conducted.22 Within these area, the largest slums are located in Ibadan North-East, Ibadan South-East and Ibadan South-west Local government areas.23 These local government areas are further sub-divided into wards. Wards housing major slums within Ibadan North-East Local government area include Beere, Olorunsogo, Oje, Oke-Irefin while wards within Ibadan South East Local government include Esu Awele, Eleta, Agbongbon, Bode and part of Oke Ado. The wards with slums within Ibadan Southwest include Oja Oba, Orita Merin, part of Idi-Arere.21,23
Study population comprised entirely of males between 18–60 years who met our inclusion criteria24 while we excluded unmarried males, those below the age of 18 years or above 60 years from participating in our study. Participants were included only if household head had lived in an identified slum for a minimum of 1 year to avoid mis-classification of visitors as residents of the slums. A selected community was identified and labelled as an “urban slum” if, ‘it was situated in an urban colony that had not been authorized by the government and that lacked basic amenities such as durable housing sufficient living area for inhabitants, access to improved water and sanitation facilities’.25,26
After a pre-test was conducted in a similar slum, it was found out that 63.6% of men desired for more children. Thus, a minimum sample size of 355 respondents was estimated using the Leslie Kish formula27 for survey sampling assuming that the estimated proportion of men that desired more children is 63.6% at a degree of precision of 5%. A multistage sampling technique was used to recruit participants for the study.
Stage 1: Urban local government areas: A sampling frame of all 5 urban local government areas containing the urban slums was obtained State (i.e. Ibadan North, Ibadan Northeast, Ibadan Northwest, Ibadan Southeast and Ibadan Southwest).17 One urban local government area was selected randomly by balloting.
Stage 2: Urban slum community: A complete list of all the communities (wards) within the selected urban local government area was obtained and an urban slum community was selected randomly also using computer generated numbers.
Stage 3: Participants: All eligible men that met the inclusion criteria within the selected community were invited to participate in the study. All participants within the selected community who consented to participate in the study were recruited. Overall, 422 men met the inclusion criteria, however three hundred and sixty-two participants agreed to participate in the study (Response rate of 85.8%).