On long-term mortality trends in the United States, 1850–1968

This study of United States life tables analyzes the process of mortality transition during 1850–1968. Special features of the study are (1) a phase-specific, rather than an age-specific, analysis of mortality and (2) use of measures based on person-years of life (nL _x ) in phase-intervals, rather than survival rates (nPx) or expectation of life at given ages (e _x ^o). The analysis suggests that the historical transition of mortality in the United States can be described as a three-stage process: an initial stage of slow improvement in life expectancy during 1850–1900, a second stage of rapid improvement during 1900–1950, and a third stage of slower improvement since 1950. Quantitative measures of rapidity of mortality decline in the several phases indicate that they are not identical for all phases and in all stages. The analysis also suggests that there have been rapid changes in the components of overall mortality differentials by sex and race in the United States. The paper draws attention to the need for studies of factors in variations of mortality at ages beyond 50 in the United States population subgroups.     

Assessing the effects of intermediate variables on birth interval-specific measures of fertility

This paper proposes a technique to simultaneously assess the effect of selected intermediate variables on the dynamics of birth intervals and to aggregate such effects across births of different order. The essentials, virtues and limitations of other approaches are 1st summarized. A method to link measures of birth interval dynamics to aggregated measures of fertility such as the age-specific fertility rates and total fertility is explained. A set of operations is suggested, required to translate estimates of birth interval-specific effects of intermediate variables into aggregate effects (e.g., effects at the level of fertility rates). These operations effectively permit the synthesis of results from multivariate procedures and those of techniques aimed at decomposing the effects of intermediate variables. Discussed are estimation and measurement procedures to deal with deal available from retrospective interviews carried out as part of the World Fertility Survey (WFS) program. The effects of marriage pattern are not considered. The effects of lactation are measured by using a dichotomous variable with a value of 1 if the preceding child was breast fed for at least as long as 9 months less than the beginning of the segment of interest and 0 otherwise. Following the assignment of a measure of effectiveness, 3 groups are distinguished in measuring contraceptive use: non-contraceptors, those using an ineffective method, and effective contraceptors. With respect to measuring the effects of induced abortion and spontaneous fetal losses, a variable is created indicating whether or not a birth leading to a fetal loss or the fetal loss itself had occurred within the segment being examined. 2 indicators, 1 a binary variable and the other aimed at measuring gradations of sterility are introduced to measure exposure to intercourse and sterility. Logit regression coefficients for selected intermediate variables are presented for Peru. The tables reveal the power of the variables measuring contraception. The evidence offers strong indications to support the contention that some form of birth control makes a difference as it does to confirm a priori expectations about success of different types of users. The inhibiting effects of breast feeding are generally in the direction expected but they are not always statistically significant. They appear to be stronger at higher parities and more intense in the earlier parts of the birth intervals. The effects of the variable representing continuity of marital union are surprisingly strong and significant for all segments of 10 months of width and for all births of order higher than 1.     

Changes in fertility patterns can improve child survival in Southeast Asia

This analysis of 1988 Philippine Demographic Survey data provides information on the direct and indirect effects of several major determinants of childhood mortality in the Philippines. Data are compared to rates in Indonesia and Thailand. The odds of infant mortality in the Philippines are reduced by 39% by spacing children more than two years apart. This finding is significant because infant mortality rates have not declined over the past 20 years. Child survival is related to the number of children in the family, the spacing of the children, the mother's age and education, and the risks of malnutrition and infection. Directs effects on child survival are related to infant survival status of the preceding child and the length of the preceding birth interval, while key indirect or background variables are maternal age and education, birth order, and place of residence. The two-stage causation model is tested with data on 13,716 ever married women aged 15-49 years and 20,015 index children born between January 1977 and February 1987. Results in the Philippine confirm that maternal age, birth order, mortality of the previous child, and maternal education are directly related to birth interval, while mortality of the previous child, birth order, and maternal educational status are directly related to infant mortality. Thailand, Indonesia, and the Philippines all show similar explanatory factors that directly influence infant mortality. The survival status of the preceding child is the most important predictor in all three countries and is particularly strong in Thailand. This factor acts through the limited time interval for rejuvenation of mother's body, nutritional deficiencies, and transmission of infectious disease among siblings. The conclusion is that poor environmental conditions increase vulnerability to illness and death. There are 133% greater odds of having a short birth interval among young urban women than among older rural women. There is a 29% increase in odds for second parity births compared to third or higher order parities. Maternal education is a strong predictor of infant survival only in the Philippines and Indonesia. Adolescent pregnancy is a risk only in Indonesia. Socioeconomic factors are not as important as birth interval, birth order, and maternal education in determining survival status.     

Calculating life tables by estimating Chiang’s a from observed rates

A simple, accurate method of life table construction is advanced based upon a new way to estimate Chiang’s _n a _x (the average number of years lived in the x to x + n age interval by those dying in the interval). The estimate for _n a _x leads immediately to an expression for l _x+n (the survivors to age x + n) in terms of l _x and the known mortality rates for the interval x to x+n and the two adjacent intervals. The complete solution for the basic life table is given. The proposed method and five other easily applied methods are then compared against the standard provided by the U.S. life tables for 1969–1971. The results attest to the excellent performance and high degree of accuracy of the proposed method. Finally, extensions of the method to multiple decrement and associated single decrement life tables are briefly described.     

Urban determinants of racial differentiation in infant mortality

This study relates differential socioeconomic status between blacks and whites to racial differentiation in infant mortality rates. The basic assumption is that decreases in socioeconomic differentiation and related variables lead to decreases in the black—white infant mortality differential. A comparative approach based on aggregate measures of socioeconomic differentiation is utilized to compare sixty-one United States urban places. Path analysis shows that neonatal mortality differentiation is virtually unaffected by socioeconomic differentials while decreased racial differences in hospital births tend to increase neonatal mortality differentiation. In contrast, postneonatal differentiation is affected by socioeconomic differentiation, especially along the dimensions of income, education, and regional location. It is concluded that despite some suggestions that infant mortality is no longer responsive to socioeconomic factors, postneonatal differentation is affected by socioeconomic differentials when comparison is based on city units.     

Race/ethnic differentials in heavy weight and cesarean births

Objectives: The general objectives of this research are tofurther our understanding of the distribution and incidence of heavy weight births and to examine differentials in the use of cesarean section as a response to macrosomia in models that are more broadly comparative by race/ethnicity than any that have heretofore been estimated. Methods: The data are drawn from the combined 1989–1991 NCHS Linked Birth/Infant Death Cohort Files,a data set of over 12 million live births and over 100,000 infant deaths that allows for highly reliable estimations for relatively small race/ethnic sub populations. Results: The results confirm that previously identified determinants of macrosomia such as maternal diabetes,maternal weight gain, parity and a previous heavy weight infant are highly predictive of a macrosomic birth, independent of race/ethnic effects. With respect to the management of heavy weight births, race/ethnic differentials exist in the odds of a cesarean delivery, theprocedure most often used to limit the risks of a macrosomic delivery.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

Household income and child survival in Egypt

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.     

Feeling Close to Fellow Citizens in Hong Kong,Korea, Taiwan,and Thailand

Feeling close to fellow citizens in the city is a feature of social cohesion that is worth investigation among East Asian societies for exploring societal conditions for the closeness. Because of the variation of such conditions among the societies, differentials in the closeness among the societies are possible. As the variation of societal conditions can translate into differences in personal characteristics and experiences, such differences are likely to explain differentials in the closeness. This likelihood is a focus for the present study, which surveyed 4,087 adult citizens in Hong Kong (n = 681), South Korea (n = 1,006), Taiwan (n = 1,200), and Thailand (n = 1,200). Results revealed significant differentials in the closeness among the societies, showing that it was highest in Thailand and lowest in Taiwan. Furthermore, these differentials were largely due to differences in personal and characteristics among citizens in the four societies. Among the significant predictors of the closeness, work-family conflict and the costliness of medical expense are two experiences. The two experiences, as well as other predictors, champion a conflict or social force explanation for citizens’ closeness. Accordingly, conflict or social force that is incapacitating would estrange the incapacitated individual from others. The results and explanation imply that relieving work and family conflicts is relevant to lifting citizens’ closeness. In conclusion, the East Asian societies manifested differentials in citizens’ social cohesion, and the differentials are explicable by differentials in resources and conflicts among the societies.     

Life table technique for the working ages

Some results of efforts to design an integrated formula system for age-specific death rates, survivals and expectation of life are presented. The report deals only with the active ages 15–80. The system is based on the assumption that the age-specific central mortality rate (m _x ) can be expressed satisfactorily by means of a polynomial m = a ₀ + a ₁ x + a ₂ x ²+ ….     

Multilevel Models of Fertility Determination in Four Southeast Asian Countries: 1970 and 1980

Using microdata from the 1970 and 1980 censuses, we specify and test multilevel models of fertility determination for four Southeast Asian societies--Indonesia, Peninsular Malaysia, the Philippines, and Thailand. Social context is indexed by provincial characteristics representing women's status, the roles of children, and infant mortality. These contextual variables are hypothesized to have direct and indirect (through individual socioeconomic characteristics) effects on current fertility. The contextual variables account for a modest but significant share of individual variation in fertility and about one-half of the total between area variation in fertility. The women's status contextual variables, particularly modern sector employment, have the largest and most consistent effect on lowered fertility. The results based on the other contextual variables provide mixed support for the initial hypotheses.     

The Contraceptive Confidence Idea: An Empirical Investigation

In this paper the hypothesis that ‘contraceptive confidence’ promotes accelerated childbearing is presented and examined. Methodological difficulties in investigating the question empirically are discussed. Because of the absence of a direct measure, a proxy indicator of ‘contraceptive confidence’ is used in multivariate analyses of maternity history data. These give results consistent with the existence of a contraceptive confidence effect. Evidence is also presented (a) of shorter second birth intervals among women who were in higher status occupations before marriage and (b) of an inverse association between educational qualifications and length of intervals after the first. These findings are construed as supporting the basic thesis regarding contraceptive confidence. The contraceptive confidence idea is discussed in the context of related work on an acceleration effect associated with women's labour-force participation. Several difficulties in interpreting the findings are considered and some implications are discussed.     

Birth spacing and child mortality in bangladesh and the Philippines

This analysis uses data from Bangladesh and the Philippines to demonstrate that children who are born within 15 months of a preceding birth are 60 to 80% more likely than other children to die in the first two years of life, once the confounding effects of prematurity are removed. The risks associated with short conception intervals are confined to children who are also high birth order; they persist in the presence of controls for prior familial child mortality, breast-feeding, mother's age, and socioeconomic status. In Bangladesh but not in the Philippines, these effects are confined to the neonatal period.     

Urban-rural differentials in infant mortality in Victorian England

This paper examines the magnitude of urban-rural differentials in infant mortality in England during the nineteenth and early twentieth centuries and also compares the timing of decline for a selection of towns of varying size, and their immediate rural hinterlands. Most towns continued to experience short-term fluctuations in infant mortality until the very end of the nineteenth century; however, in some of the adjacent rural communities--where levels of infant mortality were much lower--conditions were sufficiently favourable to allow a continuous decline in infant mortality from at least the 1860s, if not before. The final part of the paper considers the causes of these patterns and their implications for explanations of infant mortality decline.     

Infant mortality and socioeconomic development: Evidence from Malaysian household data

Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers' education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development--reduced reduced breastfeeding--has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.     

Continuity of women's work,breastfeeding, and fertility in Ghana in the 1980s

Much of the inconsistency that has appeared in studies of the effect of women's work on fertility in less developed countries has been attributed to the varying accessibility of employment in the modern sector. The analysis presented in this paper shows that continuity of work matters more than sector of work. It also confirms that, even in a setting of low contraceptive prevalence, increased fecundity associated with the less intense breastfeeding practices of working women do not result in shorter birth intervals. The influence of women's work on fertility control is likely to be underestimated if the effects of sporadic versus continuous work are conflated, or if fecundity differentials by work status are unmeasured.     

Future population growth: researchers in three countries quantify causes and propose policies

This article discusses Population Council analyses conducted by social scientists from India, Kenya, and the Philippines. These scientists agreed that population momentum would continue to increase population size, and that governments must strengthen and create a range of economic, health, and social programs and policies to slow population growth. Multiple approaches will be needed. John Bongaarts is credited with being the first to identify the key role of population momentum and to decompose growth into unwanted fertility, high desired fertility, and population momentum. Unwanted fertility is responsible for about 19% of projected population growth in India, 26% in Kenya, and 16% in the Philippines. High wanted fertility accounts for 20% of future growth in India, 6% in Kenya, and 19% in the Philippines. Population momentum can account for under 50% or over 90% of growth. Unwanted fertility can be addressed by fulfilling unmet need and increasing knowledge of methods, reducing the fear of side effects and disapproval, and eliminating poor service. Family planning programs need to be strengthened and integrated with maternal and child health services. Preferred and actual family sizes can be reduced by lowering infant mortality by means of increasing infant and child health services and girls' educational attainment. Population momentum can be addressed by delaying age at marriage and childbearing through improving social conditions. Investments in human development through education, training, and income generation can create the conditions for slowing population growth. Countries should decompose population growth into its components of unwanted and high wanted fertility and population momentum as a means of distributing resources most effectively.     

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.     

Mortality and Attrition Processes in Longitudinal Studies in Africa: An Appraisal of the Iford Surveys

This paper considers the impact of sample-attrition through dropouts on mortality analyses, using the pioneering IFORD survey of Yaounde (Cameroon). The essential issue in the IFORD surveys is the possibility that mortality of members of the cohort may differentially select some children, with specific underlying characteristics. The paper implements a method to assess the following three distinct concerns that may arise in the analysis of the IFORD data: (a) the estimation of the relationship between the covariates and the rate of occurrence of mortality or attrition over time; (b) the study of the interrelation between processes under a specific set of conditions during intervals between rounds for those children still alive and in the survey at the beginning of each interval; and (c) the issue of whether mortality and mortality differentials are affected when attrition is ignored. This approach accounts for sample-selection bias that may have resulted in the attrition process. The analyses provide insights into the debate, which has been ongoing since the late 1970s among students of African demography, regarding the selection problem in the IFORD surveys. Based on a multinomial survival modelling and bivariate probit with sample-selection framework, the results substantiate the belief that average levels and differentials of mortality would not have been different for children who dropped out from the survey than for those who remained in the survey. This is evidence that mortality estimates are virtually unaffected if attrition is ignored.     

Migration and fertility in the Philippines: Hendershot's selectivity model revisited

A demographer compared 1983 data on 5092 currently married migrant and nonmigrant women living in the Philippines to determine whether migration was still selective in terms of fertility behavior or not. Fertility was basically the same between migrant and nonmigrant women in their early reproductive years, but clear differences existed between older migrants and nonmigrants as indicated by children ever born (CEB). In fact, migration did not significantly affect cumulative fertility at all (correlation ratio=.03). Moreover its effect was further reduced when the researchers controlled for age and duration of marriage. Besides level of education and contraceptive use status contributed more to explanations of fertility differentials (correlation ratio=.09 for both) than did migration. The mean number of CEB adjusted for all variables fell with level of education from 4.18 for those with primary education to 3.63 to those with college education. This result identified education as a means to reduce high fertility in the Philippines. On the other hand, the mean was higher among women who ever used contraception than it was for those who never used it (4.21 vs. 3.72). Apparently considerable family size motivated mothers to use contraception. Since women who migrated to cities tended to be in the beginning of their reproductive period, considerable natural increase could occur in urban areas. Therefore the Philippines needed to devise a strategy for reducing fertility among migrant women as well as strategies for other groups such as professional/career oriented women and women who remained at home to tend to children and/or the home.