The impact of women's status on infant mortality rate: A cross-national analysis

A number of prior studies have attempted to account for cross-national differences in infant mortality rate using a variety of economic, demographic, and health related variables. These studies have given relatively little attention to the impact of predictors measuring the status of women. The present study, based on a sample of 96 less developed countries circa 1990, tests a series of hypotheses derived from gender stratification theory and industrialism theory. Evidence is presented of an inverse relationship between the status of women and infant mortality rate. The present study shows that it makes a difference whether we use relative or absolute measures of women's status and it shows that in addition to women's educational status, other dimensions of women's status particularly economic status and autonomy are also important predictors of infant mortality rate.     

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.     

Books and Publications Received

Mexican fertility has remained at a high level (a crude birth rate of 42–46) in spite of rapid economic development and its concomitants: rising levels of urbanization, education, income, and female labour force participation, and falling levels of infant mortality and agricultural population, combined with rural-urban migration.

Data on child-woman ratios and children-ever-born statistics, for Mexico and each state, suggest that the constant crude birth rate is not masking age or region-specific declines in fertility.

Cross-section regressions are employed in an attempt to explain Mexico’s paradoxical fertility behaviour. Using measures of income, education, urbanization, occupational status, industrial composition, labour force participation, and the sex ratio, in a weighted log-linear form, a large portion of the variation in state adjusted child-woman ratios is explained by the ‘demographic transition’ variables. The only two which might possibly explain the trend in Mexican fertility are the income variable and the sex ratio, which have positive influences on Mexican fertility in 1960 and 1970.     

Recent fertility in Mexico: measurement and interpretation

Summary Mexican fertility has remained at a high level (a crude birth rate of 42-46) in spite of rapid economic development and its concomitants: rising levels of urbanization, education, income, and female labour force participation, and falling levels of infant mortality and agricultural population, combined with rural-urban migration. Data on child-woman ratios and children-ever-born statistics, for Mexico and each state, suggest that the constant crude birth rate is not masking age or region-specific declines in fertility. Cross-section regressions are employed in an attempt to explain Mexico's paradoxical fertility behaviour. Using measures of income, education, urbanization, occupational status, industrial composition, labour force participation, and the sex ratio, in a weighted log-linear form, a large portion of the variation in state adjusted child-woman ratios is explained by the 'demographic transition' variables. The only two which might possibly explain the trend in Mexican fertility are the income variable and the sex ratio, which have positive influences on Mexican fertility in 1960 and 1970.     

The Differential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1–3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.     

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.     

Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study

In this article, we used the data from the last three population censuses of China in 1982, 1990 and 2000, to study the dynamics of the sex ratio at birth and the infant mortality rate in China. In the late 1970s, China started its economic reform and implemented many family planning programs. Since then there has been great economic development and a dramatic decrease in fertility in most of its provinces. Along with these achievements, the sex ratio at birth of the Chinese population has increased to significantly more males to females, and in some provinces of China reached unprecedented levels. The ratio of infant mortality of the males to females for manyprovinces in China become extremely unbalanced with a much higher female infant mortality rate. In our study, we investigated the statistical relationship between the sex ratio at birth and the ratio of the infant mortality of males to female. Social and economic reasons for these unnatural trends are also discussed.     

Early origins of the gradient: the relationship between socioeconomic status and infant mortality in the United States

Although relationships between social conditions and health have been documented for centuries, the past few decades have witnessed the emergence of socioeconomic gradients in health and mortality in most developed countries. These gradients indicate that health improves, although decreasingly so, at higher levels of socioeconomic status. To minimize problems with reverse causality, I tested competing hypotheses for observed socioeconomic gradients for infant mortality outcomes. I found no support for the income-inequality hypothesis and negligible support for the occupational-grade hypothesis. The results indicate that absolute material conditions are the most important determinants of socioeconomic effects on the risk of infant mortality and that while poverty has the most pronounced effect on risk, income is decreasingly salutary across the majority of the mortality gradient.     

Fertility decline in the modern world and in the original demographic transition: Testing three theories with cross-national data

This study uses aggregate data on a large number of the world's societies to test three theories of fertility decline in the modern world and in the original demographic transition. One prominent theory relates fertility decline to the changing economic value of children. With industrialization and overall modernization the economic value of children's labor shifts from positive to negative. This interpretation has been challenged by those who claim that the flow of wealth in preindustrial societies is always from parent to child rather than from child to parent. An alternative interpretation is that fertility levels reflect people's efforts to promote their reproductive success, and that this requires the careful tracking of infant and child mortality. Fertility rates are adjusted to the rate of infant and child survival, and will be high when survival rates are low and low when survival rates are high. A third theory emphasizes female empowerment. Fertility will be high when women are highly subordinated to men, but as women gain more autonomy and control over their own lives they reduce their fertility levels because, among other possibilities, higher levels of fertility present them with serious burdens. We tested all three theories through multiple regression analyses performed on two samples of societies, the first a large sample of the world's nation-states during the period between 1960 and 1990, and the second a sample of now-developed societies between 1880 and 1940. Our findings showed that infant mortality was an excellent predictor of fertility, and that female empowerment was a good predictor. However, there was only weak support for the argument that the economic value of children's labor plays an important role in fertility decisions. The findings were discussed in the context of a broader interpretation of fertility behavior in societies with high levels of industrialization and modernization.     

Measures and effectiveness in controlling omission of reports on infant deaths in Shanghai metropolitan areas]

The infant mortality rate is a sensitive indicator of a country's or area's economic, cultural, and health care conditions, and in particular, it reflects the quality of health care for women and young children. Since liberation, great progress has been achieved in Shanghai's health and medical care in general as well as in health care for women and young children, and the infant mortality rate has dropped notably. However, the omission of reports on infant deaths is still a very serious problem. In order to control such omissions in reporting, the Shanghai municipal government and Department for Public Health have improved the methods of reporting deaths. Health care units are required to fill out a report on births and deaths, and census registers in the city government are responsible for registering all new births and deaths and preparing complete statistics on new births and deaths. At the end of each year, special investigators are sent to various hospitals to check on omissions of reports on infant deaths and they also help households to report infant deaths to census registers. The new measures have proved to be very effective. According to a new report released in 1980, the omission of reports on infant deaths has been reduced by 94.01% as compared with the 1972 statistics.     

The impact of breast feeding patterns on the biometric analysis of infant mortality

A major assumption of the biometric analysis of infant mortality as developed by Bourgeois-Pichat is that the age structure of infant deaths after the first month of life is virtually constant across time and cultures. Reanalysis of results from studies which compare the mortality of infants according to the type of feeding indicated that the relationship between mortality and age within the first year of life followed different patterns for breast fed and artificially fed infants. Historical data for populations with different breast feeding customs reveal similar differences in the age pattern of infant mortality. In populations where breast feeding was uncommon or of very short duration, infant mortality rises particularly steeply during the early months of the first year of life. The age structure of infant mortality in less developed countries where breast feeding is decreasing rapidly may be similarly affected. When substantial deviations from the linear relationship are evident, particular caution is required in applying the biometric technique, since in such situations the estimated endogenous mortality is very much affected by the particular set of data points within the first year of life which are chosen for the basis of the estimates.     

Birth Outcome Measures and Infant Mortality

Recent studies have proposed alternative birth outcome measures as means of assessing infant mortality risk; nevertheless, there hasn’t yet been an integrated analysis of these approaches. We review 14 strategies, including various combinations of birth weight, gestational age, fetal growth rate, and Apgar scores—as predictors of early neonatal, late neonatal, and postneonatal mortality, and infant mortality. Using the NCHS linked birth/infant death file for 2001, we construct multivariate logit models and assess the associations between each of the 14 key birth outcome measures and four mortality outcomes. We find that all evaluated birth outcome measures are strong predictors, but Apgar scores are the strongest among all models for all outcomes, independent of birth weight and gestational age. Apgar scores’ predictive power is stronger for Mexican-, white-, and female-infants than for black- and male-infants. Second, all birth outcome measures remain significantly associated with mortality, but their predictive power reduces drastically over time. These findings suggest a rule of thumb for predicting infant mortality odds: when available, Apgar scores should always be included along with birth weight (or LBW status) and gestational age. Additionally, these findings argue for the continued study of low birthweight, gestational age, and Apgar scores as independently salient health outcomes.     

Is education a risk factor or social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across public health periods

Early in the 30-year HIV/AIDS pandemic in Sub-Saharan Africa, epidemiological studies identified formal education attainment as a risk factor: educated Sub-Saharan Africans had a higher risk of contracting HIV/AIDS than their less educated peers. Later demographic research reported that by the mid-1990s the education effect had reversed, and education began to function as a social vaccine. Recent counter-evidence finds a curvilinear pattern, with the association between educational attainment and HIV/AIDS infection changing from positive to negative across the education gradient. To reconcile these inconsistent conclusions, a hypothesis is developed and tested that education at early stages functioned as a risk factor and later functioned (and continues to function) as a social vaccine. We reason that this shift in the direction of the education effect was concurrent with changes in the public health environment in SSA that early on heightened material benefits from educational attainment but later heightened cognitive benefits from schooling. Using the 2003/2004 Demographic Health Surveys from four Sub-Saharan African countries (Cameroon, Ghana, Kenya and Tanzania), we tested this hypothesis (differential effects of schooling) using non-linear regression analysis (probit), identifying the different public health periods and controlling for confounding factors. The results support the hypothesis that the education effect shifted historically in the HIV/AIDS pandemic in SSA as we hypothesized.     

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.     

Development,inequality, health care,and mortality at the older ages: a cross-national analysis

We examine mortality at ages 50 and above in female populations of 38 countries and control for variation in quality of the mortality data. We find that economic development, economic distributional inequality, and basic primary health care have independent cross-national effects on cause of death structures and that these effects are not uniform across the age intervals of interest. As improvements occur in level of living and heath care, age-specific death rates decline except at the oldest ages, at which point they may increase. Our results are interpreted in terms of their relevance for mortality research, theory, and policy.     

Women’s autonomy and child survival: A comparison of muslims and non-muslims in four Asian countries

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.     

Trends in the relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1960–1990

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio at four points in time centering on the censuses of 1960, 1970, 1980 and 1990. The basic unit of analysis is the census tract of mother's usual residence, with economic status being determined by the percentage of low income families living in each tract. For each period, the census tracts were aggregated into broad income groups and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality for all socioeconomic groups since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, there is some evidence to suggest that it is stronger in 1990 than it was three decades earlier. The general inverse association is observed for both sexes, for whites and nonwhites, and for all major causes of death. At the same time, the data reveal notable variations in the pattern of the relationship over time, as well as several differences between whites and nonwhites in the nature and magnitude of the relationship. Some macro-economic hypotheses are offered to explain these temporal and racial differences in the pattern of the relationship between economic status and infant mortality.This article is an expanded version of a paper presented at the annual meetings of the Southern Demographic Association in New Orleans, 21–23 October 1993.     

Determinants of Infant Mortality in Older ASEAN Economies

Infant mortality in the Association of Southeast Asian Nations (ASEAN) has been declining, yet disparities remain between the nations. This paper therefore explores the determinants of infant mortality in the older ASEAN-4 economies, Malaysia, Thailand, Indonesia and the Philippines using an Autoregressive Distributed Lag (ARDL) Error Correction Model framework. The key findings of the study are: First, there is evidence of long-run relationships among infant mortality, education, female fertility, income and access to healthcare. Second, the determinants of infant mortality vary between countries. Female fertility emerged as the main determinant of infant mortality in Malaysia, while access to healthcare matter for infant mortality in Indonesia, and to a lesser extent for the Philippines. The income effect is significant for reducing infant mortality in Malaysia, while female education is important for Indonesia and Thailand. Third, the speed of adjustment of infant mortality rate is comparatively low in ASEAN-4.     

The influence of network mortality experience on nonnumeric response concerning expected family size: Evidence from a Nepalese mountain village

This article investigates the effects of sociometric network members' self-reported experiences with infant mortality on nonnumeric responses regarding expected family size among women in a small Nepalese community. The hypotheses tested include (1) that uncertainty about child survival, measured as average infant mortality across social networks, increases the likelihood of a nonnumeric response and (2) that this effect will be stronger when there is less variance in infant mortality experience within women a networks. The results suggest that nonnumeric response may be related to uncertainty about mortality derived through social learning.     

Infant Mortality and Socioeconomic Status: New Bottle,Same Old Wine

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio for the period 1960–2000. The data examined are centered on the five censuses undertaken during this 40-year period. The basic unit of analysis is the census tract of mother’s usual residence, with economic status being determined by the percentage of low income families living in each tract. For each of the five periods covered, census tracts were aggregated into broad income areas and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality at all class levels since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, the evidence indicates that the relationship has become stronger over the years. These observations are applicable for both sexes, for whites and nonwhites, for neonatal and postneonatal deaths, and for both major cause of death groups. It is concluded that while public health programs are important, any progress in narrowing this long-standing differential is unlikely unless ways can be found to enhance the economic well-being of the lower socioeconomic groups.