Birth and death in cities in the developing world

City dwellers in Sub-Saharan Africa have increased roughly 600% in the last 35 years. Throughout the developing world, cities have expanded at a rate that has far outpaced rural population growth. Extensive data document lower fertility and mortality rates in cities than in rural regions. But slums, shantytowns, and squatters' settlements proliferate in many large cities. Martin Brockerhoff studies the reproductive and health consequences of urban growth, with an emphasis on maternal and child health. Brockerhoff reports that child mortality rates in large cities are highest among children born to mothers who recently migrated from rural areas or who live in low-quality housing. Children born in large cities have about a 30% higher risk of dying before they reach the age of 5 than those born in smaller cities. Despite this, children born to migrant mothers who have lived in a city for about a year have much better survival chances than children born in rural areas to nonmigrant mothers and children born to migrant mothers before or shortly after migration. Migration in developing countries as a whole has saved millions of children's lives. The apparent benefits experienced in the 1980s may not occur in the future, as cities continue to grow and municipal governments confront an overwhelming need for housing, jobs, and services. Another benefit is that fertility rates in African cities fell by about 1 birth per woman as a result of female migration from villages to towns in the 1980s and early 1990s. There will be an increasing need for donors and governments to concentrate family planning, reproductive health, child survival, and social services in cities, particularly in Sub-Saharan Africa, because there child mortality decline has been unexpectedly slow, overall fertility decline is not yet apparent in most countries, and levels of migration to cities are anticipated to remain high.     

Is There an Urban Advantage in Child Survival in Sub-Saharan Africa? Evidence From 18 Countries in the 1990s

Evidence of higher child mortality of rural-to-urban migrants compared with urban nonmigrants is growing. However, less attention has been paid to comparing the situation of the same families before and after they migrate with the situation of urban-to-rural migrants. We use DHS data from 18 African countries to compare child mortality rates of six groups based on their mothers’ migration status: rural nonmigrants; urban nonmigrants; rural-to-urban migrants before and after they migrate; and urban-to-rural migrants before and after they migrate. The results show that rural-to-urban migrants had, on average, lower child mortality before they migrated than rural nonmigrants, and that their mortality levels dropped further after they arrived in urban areas. We found no systematic evidence of higher child mortality for rural-to-urban migrants compared with urban nonmigrants. Urban-to-rural migrants had higher mortality in the urban areas, and their move to rural areas appeared advantageous because they experienced lower or similar child mortality after living in rural areas. After we control for known demographic and socioeconomic correlates of under-5 mortality, the urban advantage is greatly reduced and sometimes reversed. The results suggest that it may not be necessarily the place of residence that matters for child survival but, rather, access to services and economic opportunities.     

我国人口流动中的健康选择机制研究

利用2008年中国流动与健康调查数据,对农村留守人口、农村外出返乡人口、乡城流动人口以及城镇居民等不同流动特征群体之间的健康差异进行比较,并系统检验了我国人口流动过程中的两种健康选择机制——"健康移民"(healthy migrant)效应和"三文鱼偏误"(salmon bias)效应。模型分析结果表明,我国人口流动存在着较为明显的"健康移民"和"三文鱼偏误"选择效应。在控制被访者的年龄、性别、主要社会经济特征以及相关健康行为后,流动人口自评一般健康、慢性病状况、经常性身体不适和肺活量等健康指标显著优于农村留守人口,乡城流动人口患有慢性病和出现经常性身体不适的可能性也显著低于农村返乡人口。在控制相关变量后,乡城流动人口与城镇居民的健康状况(除慢性病和心率过高症状外)不存在显著差别。     

The informal health sector and health care-seeking behaviour of mothers in urban Dhaka slums

Infant and child mortality in Bangladesh has declined in recent years but early death rates remain high among Bangladesh’s urban poor, even in comparison to rates in rural Bangladesh. Although they live close to the country’s leading public hospitals and private health clinics, the urban poor continue to rely heavily on services and advice provided by the informal health sector. This paper examines the use of the informal health sector by urban poor children’s main caregivers, their mothers, and the key role performed by pharmacists in treating these children. It explores the nature of the relationship between the mothers and the health providers and the implications for the broader health system. The study combines in-depth interviews with survey data.     

Rural–Urban Child Height for Age Trajectories and Their Heterogeneous Determinants in Four Developing Countries

The large literature on health differentials between rural and urban areas relies almost exclusively on cross-sectional data. Bringing together the demographic literature on area-level health inequalities with the bio-physiological literature on children’s catch-up growth over time, this paper uses panel data to investigate the stability and origins of rural–urban health differentials. Using data from the Young Lives longitudinal study of child poverty, I present evidence of large level differences but similar trends in rural versus urban children’s height for age in four developing countries. Further, observable characteristics of children’s environment such as their household wealth, mother’s education, and epidemiological environment explain these differentials in most contexts. In Peru, where they do not, children’s birthweight and mothers’ health and other characteristics suggest that initial endowments—even before birth—may play an important role in explaining "residual" rural–urban child height inequalities. These latter results imply that prioritizing maternal nutrition and health is essential—particularly where rural–urban height inequalities are large. Interventions to reduce area-level health inequalities should begin even before birth.     

Rural-urban migration and the social mobility of individuals in the Republic of Korea: an analysis of life history data

The paper explores the impact of rural-to-urban migration on the social mobility of individuals, comparing rural-to-urban migrants with rural and urban natives. Using life history data from the 1983 Korean National Migration Survey, the authors examined the pattern of migrant adjustment by estimating the 1st difference form of the autoregressive equation. They found a disruptive effect of rural-to-urban migration that disappears gradually after migration. This study provides strong evidence that most rural-to-urban migrants successfully adapt to urban life through upward occupational mobility relative to both rural and urban natives. This finding sharply contrasts with previous studies on the urban informal sector, which emphasize selective rural-to-urban migration or the inability of migrating individuals to adapt to city life. Moreover, this study showed that a principle cause of the rapid expansion of Seoul is that migrants are more likely to be upwardly mobile when they are destined for Seoul rather than other cities.     

Migration and Father Absence: Shifting Family Structure in Mexico

Despite many changing demographic processes in Mexico—declining adult mortality, rising divorce, and rising nonmarital fertility—Mexican children’s family structure has been most affected by rising migration rates. Data from five national surveys spanning three decades demonstrate that since 1976, migration has shifted from the least common to the most common form of father household absence. Presently, more than 1 in 5 children experience a father’s migration by age 15; 1 in 11 experiences his departure to the United States. The proportions are significantly higher among those children born in rural communities and those born to less-educated mothers. The findings emphasize the importance of framing migration as a family process with implications for children’s living arrangements and attendant well-being, particularly in resource-constrained countries. The stability of children’s family life in these regions constitutes a substantial but poorly measured cost of worldwide increases in migration.     

The Standard of Living of the Workers in a Spanish Industrial Town: Wages,Nutrition, Life Expentancy and Heigth in Alcoy (1870–1930)

This is the first study that empirically examines how migration influences migrants’ time use patterns in China, utilizing a mixed-method approach. We systematically estimate the migration effects on weekly hours on working, leisure, personal care and domestic responsibilities, based on data from the nationally representative 2010 Chinese Family Panel Studies. We then supplement these analyses with in-depth interviews conducted in Beijing to further understand the underlying mechanisms. Compared with urban locals, rural-to-urban migrants have longer work hours and less leisure time. The largest differences are found among men. On average, migrant men work 5 h longer and have 7 fewer hours of leisure per week than urban local men. These differences are moderated by migrants’ and their parents’ socioeconomic status, and their family responsibilities. The in-depth interviews reveal that the busier work schedules are largely motivated by the transient nature of most rural-to-urban migration and the overwhelming economic pressures for household establishment and career development.     

Perception of HIV risk and the quantity and quality of children: the case of rural Malawi

The empirical literature on the impact of HIV on the quality (Q) and quantity (N) of children provides limited and somewhat mixed evidence. This study introduces individual HIV risk perceptions, as a predictor of mortality, into a Q–N investment model. In this model, higher maternal mortality predicts lower N, while higher child mortality predicts lower Q. Thus, the two effects together make likely negative associations between HIV and both Q and N. Based on longitudinal micro-data on mothers and their children in rural Malawi, our results suggest that higher mothers’ reported HIV risk reduces both child quality, as reflected in children’s schooling and health, and child quantity, when the perceived risk is already moderate or high. The effects are sizable and, in the case of Q (schooling and health), are found for children and teenagers, both boys and girls, while in the case of N, they are found for young and mature women.     

Migration, fertility, and state policy in Hubei Province, China

Despite China s one-child family planning policy, the nation experienced a slight rise in the birth rate in the mid-1980s. Many observers attributed this rise to the heightened fertility of those rural-to-urban migrants who moved without a change in registration (temporary migrants), presumably to avoid the surveillance of family planning programs at origin and destination. Using a sequential logit analysis with life-history data from a 1988 survey of Hubei Province, we test this possibility by comparing nonmigrants, permanent migrants, and temporary migrants. While changing family planning policies have a strong impact on timing of first birth and on the likelihood of higher-order births, migrants generally do not have more children than nonmigrants. In fact, migration tends to lower the propensity to have a child. More specifically, the fertility of temporary migrants does not differ significantly from that of other women.     

Organized Violence and Institutional Child Delivery: Micro-Level Evidence From Sub-Saharan Africa, 1989–2014

The conditions under which a mother gives birth greatly affect the health risk of both the mother and the child. This article addresses how local exposure to organized violence affects whether women give birth in a health facility. We combine geocoded data on violent events from the Uppsala Conflict Data Program with georeferenced survey data on the use of maternal health care services from the Demographic and Health Surveys. Our sample covers 569,201 births by 390,574 mothers in 31 countries in sub-Saharan Africa. We use a mother fixed-effects analysis to estimate the effect of recent organized violence events within a radius of 50 km of the home of each mother on the likelihood that her child is born in a health facility. The results indicate that geographical and temporal proximity to organized violence significantly reduces the likelihood of institutional births. Although the level of maternal health care overall is lower in rural areas, the negative effect of violence appears to be stronger in urban areas. The study further underscores the importance of household and individual resilience, indicating that the effect of organized violence on institutional child delivery is greater among poor and less-educated mothers.     

Maternal Age and Offspring Adult Health: Evidence From the Health and Retirement Study

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age?Coffspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25?C34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age?Coffspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.     

Rural–Urban Migration and Cross-National Variation in Infant Mortality in Less Developed Countries

The relationship between migration and child health in individual countries is well known, but the cross-national variation in this relationship is largely untested. Using Demographic and Health Survey (DHS) data from 52 medium and low income countries, this study examines the effect of rural–urban migration on infant mortality and whether its effect varies cross-nationally. A secondary objective is to determine whether there is a relationship between the time a child is born in the migration process and infant mortality. Hypotheses are developed on the basis of competing theories on the relationship between migration and health. There are modest, but significant cross-national effects of rural–urban migration on infant mortality, which were better revealed in the presence of family- and child-level variables. The results also show that the unadjusted effects of rural–urban migration are quite substantial, but were largely accounted for by family- and child-level factors including education, socioeconomic status (SES), marital status, birth order, maternal age at child’s birth, and inter-births intervals. The results largely point to a selection process, which is further confirmed by results showing that the hazards of infant death increase with length of urban residence. Programs that target increasing maternal education, improving household SES, and lengthening interbirth intervals would therefore greatly benefit child survival in less developed countries.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

Magic Moment? Maternal Marriage for Children Born Out of Wedlock

To test the existence of the “magic moment” for parental marriage immediately post-birth and to inform policies that preferentially encourage biological over stepparent marriage, this study estimates the incidence and stability of maternal marriage for children born out of wedlock. Data came from the National Survey of Family Growth on 5,255 children born nonmaritally. By age 15, 29 % of children born nonmaritally experienced a biological-father marriage, and 36 % experienced a stepfather marriage. Stepfather marriages occurred much later in a child’s life—one-half occurred after the child turned age 7—and had one-third higher odds of dissolution. Children born to black mothers had qualitatively different maternal marriage experiences than children born to white or Hispanic mothers, with less biological-parent marriage and higher incidences of divorce. Findings support the existence of the magic moment and demonstrate that biological marriages were more enduring than stepfather marriages. Yet relatively few children born out of wedlock experienced stable, biological-parent marriages as envisioned by marriage promotion programs.     

Maternal union instability and childhood mortality risk in the Global South, 2010–14

Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children’s mortality risk in Africa, Latin America and the Caribbean, and Asia using children’s actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability—regardless of current union status—may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.     

Child Mobility,Maternal Status,and Household Composition in Rural South Africa

This article examines the influence of maternal status, socioeconomic status of the household, and household composition on the mobility of children aged 0–14 in Mpumalanga Province, South Africa, from 1999 to 2008. Using data from the Agincourt Health and Demographic Surveillance System, we found that children whose mothers were temporary migrants, living elsewhere, or dead had higher odds of moving than children whose mothers were coresident. Older children and children living in richer households faced lower odds of mobility. For children whose mothers were coresident, there was no effect of maternal substitutes on child mobility. However, among children whose mothers were temporary migrants or living elsewhere, the presence of prime-aged and elderly females lowered the odds of mobility. For maternal orphans, the presence of elderly women in the household lowered their odds of mobility. The results underscore the importance of examining the conditions under which children move in order to strengthen service delivery targeted at safeguarding children’s well-being.     

母亲劳动供给行为与中国农村儿童健康

本文使用"中国家庭营养与健康调查"(CHNS)数据,测度了母亲劳动供给行为对于中国农村儿童健康的影响,重点研究了全职和兼职母亲在儿童不同的年龄阶段进入劳动力市场对于儿童健康的影响。研究结果显示:母亲进入劳动力市场并不必然导致母亲照料儿童时间的减少,从事兼职工作的母亲由于工作的灵活性对于儿童的照料甚至比不参加工作的母亲更为充分;此外,在母亲劳动收入增加的正效应的作用下,母亲从事全职、兼职工作对于儿童健康有正的影响,但兼职工作的影响并不显著。在控制住儿童健康对于母亲劳动供给的反作用之后发现,母亲在儿童0～2岁阶段进入劳动力市场会对儿童健康产生负面影响,但影响在统计上并不显著。     

Nepal survey shows that "family planning saves lives"

This article presents the results of the Nepal Family Health Survey (NFHS) conducted from January through June 1996. Data on fertility, family planning, and maternal and child health were collected from 8429 ever-married women aged 15-49 years. These women provided information on 29,156 children. Using the method of regression analysis, findings reveal those factors, such as young mothers, large families, and short birth intervals, substantially increase under-five mortality risks. However, socioeconomic factors have only a limited effect on under-five mortality. Statistics have suggested that much of the urban/rural differences in mortality have been due to factors closely related to residence, mother's level of education and economic status. In addition, although positive effects of interventions (antenatal and postpartum checkups, tetanus immunization and assistance at delivery by a traditional birth attendant) have been documented, statistical results show that few children in Nepal are receiving the benefits of maternal health care. In conclusion, results of the 1996 NFHS show that delaying, spacing, and limiting births can substantially reduce infant and child mortality.     

Rural-to-urban Migration and Rising Evaluation Standards for Subjective Social Status in Contemporary China

People’s evaluation standards in rating social status may evolve when exterior living circumstances change, and studying whether and how migration process changes individuals’ evaluation standards in rating social status can shed new light on this issue. Utilizing the dataset from 2010–2012 China Family Panel Studies and by employing the anchoring vignette method, this study reveals for the first time that rural-to-urban migrants adopt higher standards than those who stay behind in the countryside, but their evaluation standards still remain significantly lower than those adopted by urban residents. Heterogeneity in transitions of reference points within the migrants group is also explored. Except for the eldest cohort, all other younger migrants employ significantly higher standards in rating social status than rural villagers; the new generation of migrants is not significantly different from the elder in terms of the evaluation standards. More importantly, the increase in evaluation standards of migrants becomes greater through the years, from the moment of departure from one’s hukou registration place. These findings challenge the prevalent practice of assigning or assuming an ad hoc reference group to migrants in many studies, and advance our understanding on the determinants of the reference points used to evaluate social status, on which little is known so far.