ABSTRACT
Context: Declining fertility and increased longevity have shifted the age distribution of populations upward in high-income countries. This shift is also underway in low- and middle-income countries where social safety nets are less comprehensive, often resulting in multigenerational living arrangements. Multigenerational households are not new; many families rely on grandparental paid and unpaid work. However, increased longevity results in a longer period of grandparental coresidence with family members in earlier life course stages. This study uses a child-centered dataset to examine the relationship between grandparental coresidence and nutritional status for a cohort of children in Ethiopia, India, Peru, and Vietnam at approximate ages 1, 5, and 8 years of age. Grandparental age (over or under 65 years) is used to explore whether aging grandparents represent a net additional competition for limited resources within the household or supplement household resources provided by others.
Methods: Nutritional indicators including height-for-age (HAZ), weight-for-age (WAZ), and body mass index-for-age (BMIZ) z-scores are predicted using ordinary least squares (OLS) regression and child and household characteristics including grandparental coresidence and age. Exploratory analyses include country-level fixed effects and interactions to examine the association between grandparental coresidence and child anthropometric status at ages 1, 5, and 8 years of age. Final models stratified by country and controlling for child age include indicators for grandparental age (< 65, ≥65) and wealth as a moderator.
Results: Household wealth, caregiver education, and number of coresident children
under the age of 5 are among the most consistent predictors of child nutritional status across the four countries in this study. Analyses suggest a positive association between coresidence and nutritional status for at least one coresident grandmother <65 and grandmothers of two different age groups residing in the same household in Peru and Vietnam. This relationship persists only in Peru after including wealth as a moderator. A non-statistically significant, negative main association with child nutritional status is mitigated by wealth among households with coresident grandparents in India and Vietnam. Including household wealth in the analyses suggests a negative, nonsignificant association between coresidence and child nutritional status is moderated by a positive, interaction with household wealth across countries and sex of grandparent.
Conclusion: Grandparents are not uniformly associated with childhood nutritional status
by sex, age, or wealth across countries. There is evidence of a positive association
between coresident grandmothers and nutritional status in Peru. Grandparental coresidence is negatively associated with nutritional status in several countries, though households with higher wealth indices appear to buffer children against any negative nutritional outcomes stemming from the burden of coresident elderly grandparents. Grandparental coresidence may affect other aspects of child development, but children in multigenerational households in the low- and middle-income countries in this sample have similar nutritional status to peers with non-coresident grandparents. Additional research measuring motivations for multigenerational living arrangements and how these impact child development is of especial interest as longevity increases in low and middle-income contexts.
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INTRODUCTION
Population aging through increased longevity and declining fertility has far- reaching demographic and economic implications across countries, including shifting burdens of disability, work, household composition, and care for older adults (Anderson and Hussey 2000, Naidoo, Abdullah et al. 2010). Though individuals are living longer without severe disability, healthy life expectancy is likely to vary across economic contexts (Christensen, Doblhammer et al. 2009, Naidoo, Abdullah et al. 2010). Studies examining household composition and grandparental coresidence vary in focus; in low- fertility, aging countries the “sandwich generation” comprised of individuals caring for children and aging parents simultaneously are a central concern (Spillman and Pezzin 2000, Grundy and Henretta 2006). In high-fertility, high HIV settings, orphanhood and grandparents-turned-caretakers are the focus of intergenerational studies, concentrating on the welfare of caregivers and orphaned children (Joslin and Harrison 1998, Linsk and Mason 2004). The literature on the influence of grandparents and kin networks on child wellbeing ranges in scope of outcomes from mortality to birthweight and nutritional status (Sear, Mace et al. 2000, Beise and Voland 2002, Duflo 2003, Jingxiong, Rosenqvist et al. 2007, Cunningham, Elo et al. 2010). A common thread among all of these studies is both the cost and contribution of coresident grandparents, where “overlapping life lines” and the confluence of life course stages within the same household causes a complex exchange of resources.
In high-income countries such as the US and Italy with large elderly cohorts and large numbers of adult children who have not yet left the home, it is predicted that households will become increasingly multigenerational and the “sandwich generation” that cares for both for frail elderly parents and supports adult children will experience a double burden of paid and unpaid work (Spillman and Pezzin 2000, Grundy and Henretta 2006). In the US, caring for parents is increasingly becoming a “normative part of the life course” (Silverstein, Gans et al. 2006). Evidence thus far suggests complexity in direction of flows in kind and care, with contributions via income and unpaid work in both directions and across multiple generations rather than a unidirectional upward flow to the oldest generation (Grundy and Henretta 2006). Evidence of this phenomenon in low- and middle-income countries (LMICs) is lacking, though there is some qualitative evidence of the “sandwich generation” emerging in China, where it is proposed that the
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one-child policy has precipitated population aging and complicated care for the elderly with increased rural to urban migration of the second generation (Zhang and Goza 2006). Increased morbidity including depression and depressive symptoms have been documented in the elderly when care is provided by non-preferred caregivers; in China, middle-aged daughters and specifically daughters-in-law are preferred among the elderly (Cong and Silverstein 2008). Distinct preferences among the elderly for living and care arrangements together with their potential contributions to the household present a nexus of household conditions that require further exploration; understanding whether and how grandparents contribute to the household and subsequent generations is a critical component to understanding the implications of population aging.
While care of the elderly presents a question to be addressed at household and societal levels, grandparents also return care and resources over the life course of their children and grandchildren. The anthropological literature suggests that contributions from grandparents facilitated by increased post-reproductive lifespan increases the odds of survival for grandchildren (Sear, Mace et al. 2000, Lahdenperä, Lummaa et al. 2004, Gibson and Mace 2005). Grandmothers and their role in food sharing within the household are proposed to have played a key role in the evolution of post-menopausal lifespan; longer-lived women were hypothesized to have increased the odds of child survival, thereby increasing their own fitness and likelihood of genetic representation in future generations (Hawkes, O’Connell et al. 1998). There is mixed empirical evidence of grandparental presence predicting improved child survival, largely varying by gender of grandparent (Sear, Mace et al. 2000, Duflo 2003). A review of 45 studies of historical and contemporary high-fertility populations find a positive association between grandmother presence and child survival, however, the key finding among many of these studies was that the presence of at least one additional adult relative was associated with improved survival of children and that the helper’s specific relationship to the child (father, sibling, grandparent) varies by ecological context. This was primarily measured by grandparental survival status rather than coresidence (Sear and Mace 2008). Comparative research assessing grandparental coresidence will go beyond including survival as a proxy for grandparental contact. In contexts where lifespan is increasing and coresidence of multiple generations is a common pattern, grandparents can possibly contribute in this “helper at the nest” capacity for a significant portion of a child’s life.
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The following analyses use data from the Young Lives cohort study sites in Ethiopia, Andhra Pradesh and Telangana (India), Vietnam, and Peru to consider whether grandparental coresidence is associated with child nutritional status across several low- and middle-income countries (Figure 3.1). Child height-for-age, weight-for- age, and BMI-for-age z-scores measured in the younger cohort at approximate ages 1, 5, and 8 years are included as measures of long- and short-term nutritional status (Figure 3.2). No direct measures of care are measured for non-primary caregivers for each round, and the majority of caregivers are mothers as opposed to grandparents (98% mothers, all countries at round 1). In place of direct measures of grandparental caregiving, grandparental coresidence and type (grandmothers vs. grandfathers) are included in the household roster. Nutritional status is predicted as a function of grandparent type (grandmothers vs. grandfathers) and coresidence in addition to other household factors including parental residence, caregiver education, and household wealth. To better understand how aging may contribute to this relationship, grandparental age (over or under 65 years) is added in addition to grandparental coresident status. The association between grandparental coresidence and age may be moderated by household wealth, and wealthier households may be better able to accommodate additional household members regardless of their ability to contribute to the household. This study seeks to describe the relationship between grandparental coresidence and child nutritional status across countries, and further unpack whether this relationship varies by grandparental age and household wealth.