Volume 39 - Article 5 | Pages 136–176  

Urban–rural disparities in adult mortality in sub-Saharan Africa

By Ashira Menashe-Oren, Guy Stecklov

Abstract

Background: Empirical evidence showing higher survivorship in urban areas of sub-Saharan Africa (SSA) supports a theory of rural disadvantage. Yet this evidence mostly builds on infant or child mortality. There is practically no empirical evidence comparing adult mortality levels across urban and rural sectors.

Objective: This study explores adult mortality differences by urban–rural residence across SSA for men and women. It considers whether existing differences across sectors vary over the course of development.

Methods: The indirect orphanhood method is applied to 90 Demographic and Health Survey (DHS) datasets from 30 countries between 1991 and 2014. Conditional probabilities of dying between ages 15 and 60 (45q15) are separately estimated for rural and urban populations.

Results: Based on country averages over all time periods, the mean 45q15 is 0.274 and 0.265 among adult women and 0.307 and 0.292 among adult men in urban and rural populations, respectively. The average urban to rural probability of dying ratio from the most recent data between 2000 and 2010 is 1.08 for females and 1.11 for males in SSA as a whole, indicating an urban penalty. Multiple checks highlight the robustness of our findings to methodological limitations inherent in the method. Multivariate regression models suggest that as countries develop, excess adult mortality is likely to shift from the urban to the rural sector.

Contribution: We provide evidence that, unlike child mortality, adult mortality remains higher in the urban sector for many countries and for SSA as a whole. This finding has policy implications regarding the spatial provision of health services. Urban poor should be given more attention.

Author’s Affiliation

• Ashira Menashe-Oren - Université catholique de Louvain, Belgium EMAIL
• Guy Stecklov - University of British Columbia, Canada EMAIL

Other articles by the same author/authors in Demographic Research

The use of mobile phone surveys for rapid mortality monitoring: A national study in Burkina Faso
Volume 52 - Article 16

Improving old-age mortality estimation with parental survival histories in surveys
Volume 51 - Article 45

The dynamic role of household structure on under-5 mortality in southern and eastern sub-Saharan Africa
Volume 49 - Article 11

Migration’s contribution to the urban transition: Direct census estimates from Africa and Asia
Volume 48 - Article 24

Assimilation and ethnic marriage-squeeze in early 20th century America: A gender perspective
Volume 42 - Article 4

Migrant-based youth bulges and social conflict in urban sub-Saharan Africa
Volume 42 - Article 3

Social inequality and HIV-testing: Comparing home- and clinic-based testing in rural Malawi
Volume 21 - Article 21

Most recent similar articles in Demographic Research

Improving old-age mortality estimation with parental survival histories in surveys
Volume 51 - Article 45    | Keywords: adult mortality, microsimulation, parental survival, sample sizes, Senegal

Sample selection bias in adult mortality estimates from mobile phone surveys: Evidence from 25 low- and middle-income countries
Volume 51 - Article 37    | Keywords: adult mortality, data collection, mobile phones, selection bias, sibling survival histories

Children under 5 in polygynous households in sub-Saharan Africa, 2000 to 2020
Volume 51 - Article 32    | Keywords: children, Demographic and Health Surveys (DHS), family demography, polygyny, sub-Saharan Africa

Using household death questions from surveys to assess adult mortality in periods of health crisis: An application for Peru, 2018–2022
Volume 51 - Article 8    | Keywords: adult mortality, data quality, household surveys, Peru

Using Respondent-Driven Sampling to measure abortion safety in restrictive contexts: Results from Kaya (Burkina Faso) and Nairobi (Kenya)
Volume 50 - Article 47    | Keywords: induced abortion, respondents-driven samples, social networks, sub-Saharan Africa