Early-life conditions and adult mortality decline in Dutch cohorts born 1812–1921

Mounting evidence suggests that early-life conditions have an enduring effect on an individual’s mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women’s life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men’s life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions.     

The effect of female migration on infant and child survival in Uganda

This article uses data from the 1996 Uganda Demographic and Health Survey to examine whether migration of women improves the survival chances of their children to age five. We expand on prior research by testing not only the hypothesized positive effect of rural-urban migration, but also the effects of other migration stream behaviours on child survival. Results show that up to 10% of children die before age five and within-group differences in mortality exist among urban and rural children depending on their mother's migration status. Only urban-urban migration was significantly related to child survival, compared to rural non-migrants, after controlling for other factors, although other streams of migration (rural-urban, urban-rural, rural-rural) were positively related to child survival. Generally, migration explains a small component of the variance in child survival. Several other factors, including parents' education, household size, household headship, mother's age at birth, duration of breastfeeding, and place of delivery have a significant predictive power on child survival.     

The relative effects of shocks in early- and later-life conditions on mortality

The relative importance of cohorts' early-life conditions, compared to later period conditions, on adult and old-age mortality is not known. This article studies how cohort-level mortality depends on shocks in cohorts' early- and later-life (period) conditions. I use cohorts' own mortality as a proxy for the early-life conditions, and define shocks as deviations from trend. Using historical data for five European Countries i find that shocks in early-life conditions are only weakly associated with cohorts' later mortality. This may be because individual-level health is robust to early-life conditions, or because at the cohort level scarring, selection, and immunity cancel each other. Shocks in period conditions, measured as deviations from trend in period child mortality, are strongly and positively correlated with mortality at all older ages. The results suggest that at the cohort level changing period conditions drive mortality variation and change.     

A demographic perspective on the Muslim world

A demographic perspective is relevant to understanding the position of Muslims in today’s world. This paper examines the size and growth of Muslim populations, and whether most Muslims live in overwhelmingly Muslim countries. It also examines indices of poverty and human development for Muslimmajority countries, and the growth of the youth population; finally, it examines the key components of population growth: mortality and fertility. Mortality has declined sharply over the past 15 years in many Muslim countries, though not in all, and Muslim countries are no longer prominent among the ‘outliers’ with higher mortality than expected on the basis of their income levels. Fertility rates are also declining sharply in a number of major Muslim-majority countries, raising interesting issues about attitudes of different schools of Islamic jurisprudence, village-level religious leaders and ordinary Muslims towards contraception and abortion, as well as the role of socio-economic development and family planning programs in fertility declines. Despite these declines, past high fertility in many Muslim-majority countries leaves as a legacy a rapidly growing adolescent population and a burgeoning, inadequately educated labour force.     

High-risk families: the unequal distribution of infant mortality in nineteenth-century Sweden

An analysis of infant mortality (based on 133,448 births) in two regions, Sundsvall and Skellefte?, in north-eastern Sweden during the nineteenth century shows that infant mortality was highly clustered with a relatively small number of families accounting for a large proportion of all infant deaths. Using logistic regression, two important factors were found to be associated with high-risk families: (i) a biological component evidenced by an over-representation of women who had experienced stillbirths, and (ii) a social component indicated by an increased risk among women who had remarried. The results strengthen the argument for using the family rather than the single child as the unit of analysis. The clustering of infant deaths points to the need to re-evaluate our interpretations of the causes of infant mortality in the past.     

Death Clustering,Mothers' Education and the Determinants of Child Mortality in Rural Punjab,India

In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled. It is argued that this clustering of deaths is partly due to the poor basic abilities of some mothers and other carers.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Direct and indirect effects on infant mortality in a high-fertility US population

This article examines the direct and indirect effects of social and demographic measures on infant mortality using data from a church directory of the Old Order Amish of the Lancaster, PA, Settlement. The sample includes all infant deaths and a simple random sample of survivors (total n=2013). The results reveal that the death of the immediately prior sibling directly increases the risk of infant death nearly 30%, net of other factors. Also, the risk of mortality in the first year increases as birth order increases, particularly at the highest orders (8–17 prior sibs). Infants of the youngest mothers (age 13) are nearly 10% more likely to die in the first year of life than are infants of mothers age 24, nearly all of which is indirect via parity, prior sib death and birth interval. Further analysis shows that families adapting more rapidly to external community pressures face a higher risk of infant death than families living in more stable areas. These relationships emerge even in this homogeneous population with a relatively high standard of living and a traditional lifestyle, Implications are that indirect effects should be included in research on teen pregnancy and infant survival, and might be especially important for studies in transitional geographic areas.An earlier version of this paper was presented at the 1993 meetings of Population Association of America, Cincinnati.     

The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751–2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

Truncated cross-sectional average length of life: A measure for comparing the mortality history of cohorts

Period life expectancies are commonly used to compare populations, but these correspond to simple juxtapositions of current mortality levels. In order to construct life expectancies for cohorts, a complete historical series of mortality rates is needed, and these are available for only a subset of developed countries. The truncated cross-sectional average length of life (TCAL) is a new measure that captures historical information about all cohorts present at a given moment and is not limited to countries with complete cohort mortality data. The value of TCAL depends on the rates used to complete the cohort series, but differences between TCALs of two populations remain similar irrespective of the data used to complete the cohort series. This result is illustrated by a comparison of TCALs for the US with those for Denmark, Japan, and other high-longevity countries. Specific cohorts that account for most of the disparity in mortality between the populations are identified.

Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2015.1019955     

Sibling loss and fertility desires in the high-mortality context of Peru

Despite demographers’ long-standing preoccupation with the effects of child mortality on women’s fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women’s current number of children and a range of conditions related to siblings’ deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent’s lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.     

Is prenatal sex selection associated with lower female child mortality?

I examine whether prenatal sex selection has substituted postnatal excess female mortality by analysing the dynamics of child sex ratios between 1980 and 2015 using country-level life table data. I decompose changes in child sex ratios into a ‘fertility’ component attributable to prenatal sex selection and a ‘mortality’ component attributable to sex differentials in postnatal survival. Although reductions in numbers of excess female deaths have accompanied increases in missing female births in all countries experiencing the emergence of prenatal sex selection, relative excess female mortality has persisted in some countries but not others. In South Korea, Armenia, and Azerbaijan, mortality reductions favouring girls accompanied increases in prenatal sex selection. In India, excess female mortality was much higher and largely stable as prenatal sex selection emerged, but slight reductions were seen in the 2000s. In China, although absolute measures showed reductions, relative excess female mortality persisted as prenatal sex selection increased.     

The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Infant mortality and fertility in three Bavarian villages: An analysis of family histories from the 19th century

Abstract Family history data derived from the records of three parishes in Bavaria provide evidence for several important demographic questions when analysed in conjunction with information concerning the prevalent breast-feeding practices. The results suggest strongly that breast feeding can prolong birth intervals substantially. The evidence concerning the independent influence of infant deaths on subsequent birth intervals is inconclusive. It is clear, however, that even if such an influence did exist it was relatively small, compared to the effect of lactation. In addition the results do not lend support to the hypothesis that couples experiencing low child mortality practised family limitation more than couples experiencing high child mortality. In all three parishes, however, fertility appeared to influence infant mortality. Infants born after short intervals were subject to considerably higher mortality risks than infants following longer intervals.     

Do family planning programs enhance children's health?

The findings of the 1993 National Demographic Survey (NDS) in the Philippines provide implications for child health of family size and whether a child was wanted at the time of conception. About 15% of the more than 8000 births considered in the NDS were classified as unwanted. In 1995, the East-West Center's Program on Population has helped research centers in the Philippines to conduct an extended analysis of NDS results. Children under age 5 who had been unwanted at the time of conception (unwanted children) were almost 25% and 15% more likely to have had diarrhea or respiratory infections, respectively, in the last two weeks than those who were wanted at the time of conception (wanted children). Unwantedness had little effect on the likelihood of treatment once the child was ill, however. When the researchers controlled all other variables, including unwantedness, family size did not have a direct influence on the likelihood that a child would become ill, but it did have a significant influence on whether or not an ill child would receive treatment. Each additional sibling reduced the likelihood that an ill child would receive treatment by about 5% for diarrhea and by about 4% for respiratory infection. Another factor that influenced disease incidence was age (at 18 months, most likely to be ill with respiratory infection or diarrhea). Older children were more likely to receive treatment than younger children. Other factors influencing treatment and disease incidence were socioeconomic status and maternal educational status. These findings further justify family planning programs based on child health. They demonstrate that children suffer when they are born into a household where they are not wanted. Since about 33% of all child deaths are caused by diarrhea or respiratory infections in the Philippines, unwantedness affects the incidence of these infections, and family size has a direct effect on the likelihood an ill child will receive treatment. A policy intervention that would greatly reduce child mortality would be extremely beneficial.     

Progress in demographic methodology

This paper examines developments in demographic methodology during the past decade or so. It focuses on methodological advances in the analysis of mortality of infants and young children, of adults, and on problems of mortality estimation in small populations. The other major areas reviewed here are related to the study of birth intervals, parity progression, proximate determinants of fertility, and the demography of the family. Concluding remarks relate the methodological issues to the information explosion in demography.     

社会经济地位对我国老年人死亡风险的影响

本文以中国老年人健康长寿影响因素跟踪调查2002年和2005年数据连接生成的面板数据,应用Cox等比例风险模型就社会经济地位对我国老年死亡风险的影响进行了分析。结果发现,是否享有养老金,对于老年人的死亡风险有显著的影响。而且这种影响只有在控制了家庭的代际经济支持与是否享有养老金的交互效应的条件下才是显著的。同时,居住地的社区类型对于老年人的死亡风险有显著的影响,这一点与以往此类研究的结果是一致的。本项研究中,受教育水平对于我国老年人的死亡风险没有显著的影响。     

The First Fifty Years – A Tribute to E. Grebenik

India is a country with a pervasive preference for sons and one of the highest levels of excess child mortality for girls in the world (child mortality for girls exceeds child mortality for boys by 43 per cent). In this article, data from the National Family Health Survey are used to examine the effect of son preference on parity progression and ultimately on child mortality. The demographic effects of family composition are estimated with hazard models. The analysis indicates that son preference fundamentally affects demographic behaviour in India. Family composition affects fertility behaviour in every state examined and son preference is the predominant influence in all but one of these states. The effects of family composition on excess child mortality for girls are more complex, but girls with older sisters are often subject to the highest risk of mortality.     

Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys

South Africa is unique in being a developing country which has asked questions on pregnancy-related deaths in both its 2001 census and 2007 household survey, and monitors maternal and pregnancy-related mortality through vital registration and a confidential enquiry into maternal deaths. These sources of data provide a wide range of estimates of maternal mortality for the country. This paper examines these estimates to assess to what extent the differences between them are due to data deficiencies, methodological deficiencies or definitional differences. The results show that since maternal deaths are relatively rare it is fairly difficult to establish the maternal mortality rate with a great degree of accuracy in a setting where data are less than perfect. They also show that to some extent the differences are due to differences and errors in processing of data but that pregnancy-related mortality should not be treated as synonymous with maternal mortality. However, after adjustment, pregnancy-related mortality from vital registration was comparable with the level that may be expected using several alternative approaches, while the rate reported by households in census and surveys was about double that from vital registration. Nonetheless, all the data indicate an upward trend in maternal mortality that is in keeping with the impact of the HIV/AIDS epidemic, which is likely to have contributed to the discrepancies.     

Do fertility transitions influence infant mortality declines? Evidence from early modern Germany

The timing and sequencing of fertility transitions and early-life mortality declines in historical Western societies indicate that reductions in sibship (number of siblings) may have contributed to improvements in infant health. Surprisingly, however, this demographic relationship has received little attention in empirical research. We outline the difficulties associated with establishing the effect of sibship on infant mortality and discuss the inherent bias associated with conventional empirical approaches. We offer a solution that permits an empirical test of this relationship while accounting for reverse causality and potential omitted variable bias. Our approach is illustrated by evaluating the causal impact of family size on infant mortality using genealogical data from 13 German parishes spanning the sixteenth, seventeenth, eighteenth, and nineteenth centuries. Overall, our findings do not support the hypothesis that declining fertility led to increased infant survival probabilities in historical populations.