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.     

Trends in socioeconomic inequalities in mortality in developing countries: The case of child Survival in São Paulo,Brazil*

I examined trends in socioeconomic inequalities in under-five mortality for the state of São Paulo, Brazil, over a 21-year period from 1970 to 1991, during which much of the mortality transition unfolded. During this time, there was a decline in inequality in under-five mortality by household wealth but a substantial increase by mother’s education. Improvements in infrastructure and economic development were associated with lower levels of socioeconomic inequality in under-five mortality. Mother’s education emerged as the key factor underlying socioeconomic inequalities in under-five mortality even as levels of education for women increased and inequality in schooling fell.     

Inequality in Life Spans and a New Perspective on Mortality Convergence Across Industrialized Countries

The second half of the twentieth century witnessed substantial convergence in life expectancy around the world. We examine differences in the age pattern of mortality in industrialized countries over time to show that inequality in adult life spans, which we measure with the standard deviation of life table ages at death above age 10 years, S₁₀, is increasingly responsible for the remaining divergence in mortality. We report striking differences in level and trend of S₁₀ across industrialized countries since 1960, which cannot be explained by aggregate socioeconomic inequality or differential external‐cause mortality. Rather, S₁₀ reflects both within‐ and between‐group inequalities in life spans and conveys new information about their combined magnitudes and trends. These findings suggest that the challenge for health policies in this century is to reduce inequality, not just lengthen life.     

An Index of Maternal and Child Healthcare Status in India: Measuring Inter- and Intra-State Variations from Capability Perspectives

Despite remarkable progress in past few decades India’s current maternal and child mortality levels fall significantly short to attain many of the targets of MDGs. The variation in attainments across and within regions has always been a crucial dimension of Indian concerns. The present paper takes a closer look at the spatial variation of maternal and child healthcare status in India by summarising a set of constituent indicators that are instrumental in nature, and result in debilitating outcomes for women and their newborn. Taking the stock of information generated by the third round of District Level Health and Facility Survey (DLHS-3) this paper adopts the Pena Distance Method to gauge the spatial variations. The states are classified first in terms of their MCH status in 2007–2008. At later stage intrastate disparities are captured by measuring rural–urban inequality, and inter-district disparity within states. Key results indicate that the overall state ranking is, to a significant extent, explained by the intrastate variations. However, the major contribution of this paper lies in quantifying the relative role of constituent indicators that are responsible for the existing disparities across and within state boundaries.     

Dimensions of social inequality in the Third World

This cross-national assessment of the empirical determinants of income inequality and infant mortality employs policy-relevant variables suggested by the major macrosocial theories of development and stratification. Findings based on sample sizes ranging from 34 to 61 LDCs indicate that modernization and ecological-evolutionary theories provide more consistent explanations of social inequalities than either dependency/world-systems theory or urban bias theory. Our analyses point to economic growth and the development of rural infrastructure and social complexity as the most expedient methods for facilitating mortality reduction and income equalization. We conclude that simplistic policy-orientations stressing such phenomena as urban bias or population growth should be replaced by more complex perspectives that include an emphasis on rural social organization.     

The dynamics of the population sex ratio in India, 1971–96

This paper reconstructs the trend in the population sex ratio in India between 1971 and 1996 from available information on changes in sex differentials in mortality in the country since the beginning of the century. It is estimated that, although the mortality of females relative to that of males in India has improved since 1968, the population sex ratio increased between 1971 and 1981, stayed constant between 1981 and 1991, and started to decrease only after 1991. This implies that the recorded decrease and increase in the periods 1971–81 and 1981–91 respectively were both spurious and were the results of undercounts of females in 1971 and 1991. Another implication of this finding is that, owing to the lagged effect of past mortality on current trends in the population sex ratio, this ratio is a bad proxy for use in the study of changes in differential mortality by sex.     

Polygynous Contexts,Family Structure,and Infant Mortality in Sub-Saharan Africa

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.     

Mortality in Ghana: Evidence from the cape coast project data

This paper deals with the estimation of mortality for a rural community of about 20,000 persons in the rain-forest area of south-west Ghana. Specifically, infant, child and adult mortality estimates have been obtained by the application of a wide range of direct and indirect methods of measuring mortality from the different statistics collected by a longitudinal mortality and fertility project conducted during 1974–7. It was noted that infant and childhood mortality rates obtained from death registrations were consistent with those rates yielded by pregnancy histories and child survival statistics. However, the adult mortality estimates derived from orphanhood statistics tended to be lower than those suggested by death registrations. The analysis revealed an infant mortality rate of 100 for boys and 84 for girls, equal childhood mortality rates for boys and girls (85–6), a lower expectation of life at birth for men (45.8 years) than for women (52.8), and a much more severe incidence of mortality among men aged over 40 than for women at the corresponding ages.     

Christian–Muslim differences in child survival in Egypt

Ethnic and religious inequalities in child survival have been documented in many countries. In Egypt, during the 1980s and 1990s, Christians had higher childhood mortality than Muslims despite their higher socio-economic status (SES) and concentration in urban areas. This paper explores reasons for this Christian–Muslim mortality gap. Data for this study are drawn from Egypt’s 1988, 1992, 1995, 2005 and 2008 Demographic and Health Surveys, which recorded the respondents’ religious affiliation. The main analysis compares children of Christian and Muslim mothers in survival to age five using proportional hazards Cox regression models. Results indicate that differences in the regional distributions of Christians and Muslims positively contributed to the mortality gap during the 1980s–1990s. The majority of Christians resided in Upper Egypt where childhood mortality rates were considerably higher than in other regions. However, only part of higher Christian mortality can be explained by their regional concentration. In Upper Egypt, despite their higher SES, as well as greater urban residence, Christians had higher mortality than Muslims. These findings are at odds with research demonstrating the significance of SES and urban concentration in explaining ethnic–religious mortality gaps.     

Socio-economic Differentials in Infant and Child Mortality during Mortality Decline: England and Wales, 1890–1911

In this paper data from the 1911 Census of the Fertility of Marriage of England and Wales are used to study patterns of mortality decline by socio-economic characteristics, principally the occupation of husband. That census reported data on number of wives, children ever born, and children dead by marriage-duration cohorts for 190 non-overlapping occupations of husband. These results, along with those on number of rooms in the dwelling of the family are used to make indirect estimates of childhood mortality using the techniques described in United Nations, Manual X. These procedures produce values of q(a), the probability of dying before reaching some exact age ‘a’. Estimates for q(2), q(3), q(5), q(10), q(15), and q(20) are derived from data on women married 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 years, respectively. These estimates can also be dated to a point in the past. These values can also be converted to a corresponding level of a Model West life table, which describes the ‘average’ mortality regime which the children of those women experienced. This furnishes a basis to look at mortality decline for various social classes and occupational groups. Ordinary least squares regressions of the levels of Model West life tables implied by the 1(a) values on time give one measure of mortality decline. Another is the absolute amount of the increase in the level of the Model West life tables from marriage-duration cohort 20–24 years to 0–4 years. The aggregate results indicate that social class in England and Wales during the 1890s and 1900s tended to be related to the speed of mortality decline: childhood mortality declined more rapidly in the higher and more privileged social class groups. But the results were neither nearly as strong nor as regular as those which predicted the level of mortality within any marriage-duration cohort. These outcomes are not particularly sensitive to the three different social-class stratification schemes used: the 1911 English Registrar General's classification; the 1951 English Registrar General's classification; and the 1950 U.S. Census classification. There was also a fairly regular and predictable gradient for the number of rooms in the home: child mortality was higher in families who lived in larger dwellings. Analysis of 190 detailed male occupational groups revealed that considerably more of the variation in mortality levels than of trends could be explained by social-class categories. Between 20 and 40 per cent of variation in mortality trend could be accounted for by social class alone, as opposed to 50 to 80 per cent of mortality levels for different marriage-duration cohorts. Results for a more restricted sample of 116 occupations for which income estimates could be made revealed a similar pattern. In addition, income was virtually unrelated to the pattern of mortality decline, and improvement was more rapid in groups who were more urban. This reflects the role of rapidly improving urban sanitation in the late nineteenth and early twentieth centuries in England. In contrast, income was significantly related to childhood morality levels for various marriage-duration cohorts (with higher income associated with lower mortality), while urbanization was inversely correlated with mortality levels (more urban groups experienced higher mortality). Overall, social class (or occupation group), income, and urbanization were more successful in explaining mortality levels than time trends across occupations, although social class and the extent of urbanization did reasonably well in accounting for trends. Over a longer period, the transition in child mortality was under way by the 1890s, but its pace and timing varied in different occupations and social class groupings. Although absolute differences in infant mortality were reduced after about 1911, relative inequality persisted even as infant and child survival improved for all groups.     

Child mortality in rural India

This paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child’s age and individual, socioeconomic, and environmental characteristics. The model is estimated using the Indian National Family and Health Survey 1998/1999. The estimation results show that socioeconomic and environmental characteristics have significantly different impacts on mortality rates at different ages. These are particularly important immediately after birth. The parameter estimates indicate that child mortality can be reduced substantially, particularly by improving the education of women, providing safe water, and reducing indoor air pollution caused by dirty cooking fuels. Finally, we still found substantial differences in mortality rates between states, which are associated with differences in schooling expenditures, female immunization, and poverty rates.     

Accounting for Cross-National Differences in Infant Mortality Decline (1965–1991) among less Developed Countries: Effects of Women's Status,Economic Dependency,and State Strength

The present study tests models derived from four theoretical perspectives: Modernization/free trade theory, gender inequality theory, developmental state theory, and dependency theory. It is based on a sample of 82 less developed countries for the period from 1965 to 1991. We find some support for each theoretical perspective. Foreign trade, investment, and debt dependency have adverse effects on infant mortality, mediated by variables linked to modernization/free trade theory and gender inequality theory. State strength has a beneficial direct effect on infant mortality decline. Women's education and reproductive autonomy have significant direct effects, but also play important roles as mediating variables as does rate of economic growth.     

Black-white differentials in infant mortality in the south, 1940–1970

Demography - This paper examines the trends and variations in the black-white differentials in infant mortality in ten selected Southern states during the 1940–1970 period. The patterns...     

Inequality and demographic response to short-term economic stress in North Orkney,Scotland, 1855–1910: Sector differences

We examine economic inequality and social differences in infant and child mortality, and fertility responses to food price changes in North Orkney, 1855–1910, using linked vital records. This small population featured a diverse occupational structure, limited land resources, and geographic isolation from mainland Scotland. Segments of Orkney’s non-agricultural working population were living so close to the margin of subsistence in normal years that an increase in food prices in bad years cost the lives of their children. Delayed childbearing, in addition to increased labour intensity, occupational diversification, and poor relief, failed to mitigate the negative effects of unfavourable prices in this group. While previous studies for Western Europe show a strong social gradient in mortality responses to food prices, and for Eastern Asia a strong household gradient, this study shows a strong sectoral gradient, indicating low standards of living for the non-agricultural working population well into the twentieth century.     

The linked survival prospects of siblings: Evidence for the Indian states

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights.     

Changes in world inequality in length of life: 1970–2000

Previous research has revealed much global convergence over the past several decades in life expectancy at birth and in infant mortality, which are closely linked. But trends in the variance of length of life, and in the variance of length of adult life in particular, are less well understood. I examine life-span inequality in a comprehensive panel of 180 countries observed in 1970 and 2000. Convergence in infant mortality has unambiguously reduced world inequality in total length of life starting from birth, but world inequality in length of adult life has remained largely unchanged. Underlying both of these observations is a growing share of total inequality attributable to between-country variation. Especially among developed countries, the absolute level of between-country inequality has risen over time. The sources of widening inequality in length of life between countries remain unclear, but signs point away from changes in income, leaving patterns of knowledge diffusion as a likely candidate.     

The linked survival prospects of siblings: evidence for the Indian states

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights.     

Levels and patterns of infant and child mortality in ghana

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968–1969 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960’s. The urban rate is lower than the rural rate, 98 as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0–4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1–4 years.     

Religion and Health in Early Childhood: Evidence from South Asia

This article studies early childhood health in India, Bangladesh, and Nepal, focusing on inequalities in anthropometric outcomes by religious adherence. India and Nepal have Hindu majorities, while Bangladesh is predominantly Muslim. The results suggest that Muslim infants have an advantage over Hindu infants in height‐for‐age in India (for boys and girls) and in Bangladesh (for boys). However, this advantage disappears beyond 12 months of age, at which point Hindu children in all three countries are found to have significantly better anthropometric outcomes than Muslim children. We report tests that rule out mortality selection and undertake falsification and robustness exercises that confirm these findings. Further results suggest that exposure to Ramadan fasting in utero may lead to positive selection of Muslim male infants, partially explaining the Muslim infant health advantage, but this does not fully explain the shift from Muslim advantage in infancy to Hindu advantage in childhood in all three countries.     

Bridging the gap: Determining long-term changes in infant mortality in pre-registration England and Wales

Much effort has been expended in analysing a small sample of parish registers to produce national estimates of infant mortality for the period 1570–1840. However, in an age when inter-parish variations in infant mortality were considerable, national trends often obscured local and regional differences. By analysing data from the initial years of Civil Registration (1839–1846) together with infant mortality rates from a range of parishes, it is possible to assess the extent of variation and change in England and Wales during the period 1580–1840. The geographical variations in infant mortality and the age structure of infant deaths were sufficient to suggest that the most important influence on whether infants survived was disease environments.