One-third of young people in low- and middle-income countries have lost a sibling

One of the first studies to examine sibling death in dozens of low- and middle-income countries finds that roughly one-third of their young women have lost at least one sibling before the age of 25. As many as half of respondents in multiple African countries had lost at least one sibling.

“There’s extensive social science research on family dynamics and childhood emphasizing siblings as key agents of young people’s socialization, so it’s concerning how frequently youth experience their traumatic loss,” said Emily Smith-Greenaway, associate professor of sociology and spatial sciences at the USC Dornsife College of Letters, Arts and Sciences.

“This study reveals a major inequality in the frequency of adverse life course events in these societies and emphasizes the need to pay more attention to sibling relationships lost to premature death.”

The study was published today in PLOS ONE.

While there is a growing body of research examining the impact of sibling death on children and families, most of it focuses wealthy countries in North America and Europe. Smith-Greenaway and co-author Abigail Weitzman of the University of Texas at Austin sought to address this gap by studying the experiences of women from 43 different countries in sub-Saharan Africa, South and Southeast Asia, Latin America and the Caribbean.

Sibling loss more common than expected, varies by region

The authors used data from nationally representative samples of more than 350,000 women aged 15 to 34 and born between 1985 and 2003 to examine experiences of sibling death. The dataset comes from the Demographic and Health Surveys Program, which has administered regular household-based surveys across more than 90 low- and middle-income countries for the past three decades.

The researchers found that in all 43 studied countries, on average, one-third of the young women had experienced the death of a sibling. Most of the reported sibling deaths occurred during the respondent’s lifetimes, rather than prior to the respondent’s birth.

In contrast, previous research shows approximately 8% of young women and men in the United States have experienced a sibling’s death before age 25. In prior studies of some European countries, the prevalence of bereaved siblings is even lower. For example, only 1% of young people in Denmark and Sweden report losing a sibling before age 18.

The new study revealed significant variation by region, and countries affected by war and conflict tended to have an even higher burden of sibling deaths. For example, over half of respondents in Burkina Faso, Democratic Republic of the Congo, Cameroon, Niger, Burundi and Rwanda had at least one deceased sibling. Sibling loss was relatively less common in South Africa, Bolivia and Colombia, at slightly more than 10% of respondents.

The emotional and psychological impact of sibling death

Psychologists describe sibling relationships as providing important opportunities early in life for cognitive development, the development of language and emotional understanding, and a feeling of belonging. These relationships are also typically the longest-lasting family tie. For these reasons, the experience of sibling loss may significantly disrupt the life course trajectory for the surviving siblings.

Even in high-income countries, surviving siblings in families that suffer the loss of a child have been called “the forgotten grievers.”

“Although mortality and fertility patterns would suggest that this experience is much more common in the regions of the world referred to as the ‘global south,’ there’s very little information on it,” Smith-Greenaway said.

“Even the World Health Organization’s widely used adverse childhood experiences questionnaire focuses narrowly on parental death. The result is overlooking siblings as people affected by the grief of the premature loss of one another.”

The authors point to prior research findings that a sibling’s death can elevate young people’s risk of health problems and negatively influence their transition to adulthood. It may even have a greater impact on young people’s emotional and behavioral problems and health risks than a parent’s death.

Multiple sibling losses could exacerbate those challenges. Across the countries the researchers examined in Asia and Latin America and the Caribbean, over one-third of bereaved respondents experienced the loss of two or more siblings. Respondents in Western, Central and Eastern African countries — where there is high fertility and high rates of under-five mortality — were even more likely to have experienced multiple sibling losses.

Notably, bereaved respondents in the majority of studied countries — including those who experienced multiple sibling deaths — still had a comparable number of remaining living siblings when compared with peers whose siblings were all still alive.

The authors note that the survey data represents only those sibling deaths that the respondents were aware of and remembered, meaning the deaths may be undercounted. However, they say these results are an important step to understanding the implications of sibling mortality for young people across the world.

“Our research also reveals quite variable experiences of sibling death,” Smith-Greenaway said. “Some people experienced the death of an older sibling versus a younger sibling. Some experienced this loss when they’re very young, and others when they’re exiting adolescence and entering adulthood.

“Our study sheds light on these differences in hopes that future research will acknowledge these intimate losses as the impressionable life course experiences that they are.”