Polygynous family system, neighbourhood contexts and under-five mortality in sub-Saharan Africa

Based on the competing theories regarding the relationship between family structure and child health outcomes, this article examined the effects of polygynous family system (PFS) on under-five mortality (U5M) across different socio-economic and neighbourhood contexts in selected sub-Saharan African countries. Cox proportional regression analysis was performed on pooled data of children (n = 54 842) born in the five years before the Demographic and Health Surveys of selected countries. Results indicated differential effects of PFS on U5M across varying contexts, because risks of U5M were significantly higher for children of polygynous mothers in poor communities (hazard ratio: 2.98, 95% confidence interval: 2.23 to 3.95, p 0.001) and children of monogamists in poor communities (hazard ratio: 2.24, 95% confidence interval: 1.69 to 2.98, p 0.001) compared with the children of monogamists in rich communities. Given the worsening effects of polygyny on childhood survival across different contexts, this study stressed the need for marriage reforms and enforcement of a monogamous family system if significant U5M reduction would be achieved in sub-Saharan African countries during the post-2015 development era.