Maternal education and child health: Is there a strong causal relationship?

Using data from the first round of Demographic and Health Surveys for 22 developing countries, we examine the effect of maternal education on three markers of child health: infant mortality, children s height-for-age, and immunization status. In contrast to other studies, we argue that although there is a strong correlation between maternal education and markers of child health, a causal relationship is far from established. Education acts as a proxy for the socioeconomic status of the family and geographic area of residence. Introducing controls for husband’s education and access to piped water and toilet attenuate the impact of maternal education on infant mortality and children’s height-for-age. This effect is further reduced by controlling for area of residence through the use of fixed-effects models. In the final model. maternal education has a statistically significant impact on infant mortality and height-forage in only a handful of countries. In contrast. maternal education remains statistically significant for chidren’s immunization status in about one-half of the countries even after individual-level and community-level controls are introduced.     

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.     

Child mortality in Malaysia: explaining ethnic differences and the recent decline

Infant and child mortality rates have dropped sharply for all ethnic groups in Malaysia between 1950 and 1988, but persistent ethnic differences remain. In this article we assess the contribution of several potential reasons both for the decline and the remaining differences between the Malay and Chinese sub-populations. Increased use of health inputs is found to explain a substantial part of the decline, but increased education of mothers, and income growth are also important. Longer spacing between births, and, higher average age at birth as a result of lower fertility and higher age at marriage provide only a marginal direct contribution to the fall in mortality. We find that lower mortality among the Chinese is accounted for by their higher incomes and greater propensty to purchase medical care. We also control for self-selection among users of medical care, and find that those who use health care in Malaysia tend to be subject to higher-than-average risks.     

Children as insurance

This paper presents a dynamic model of fertility decisions in which children serve as an incomplete insurance good. The model incorporates uncertainty about future income and the survival of children as well as a discrete representation of the number of children. It contributes to the understanding of the negative relation between fertility and education, shows why parents may demand children even if the return is negative, and explains why fertility might rise with increasing income when income is low and decrease when income is high. Furthermore, the model can account for the decline in fertility when the risk of infant and child mortality decreases. Finally, the implications for empirical tests of the demand for children are also examined. Received: 8 September 1998/Accepted: 9 June 1999     

Children’s educational attainment,occupation, and income and their parents’ mortality

Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970–2007. Higher levels of children's education are associated with 30–36 per cent lower parental mortality at ages 50–75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11–16 per cent lower all-cause mortality at ages 50–75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39–46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.     

Socioeconomic ramifications of changing cohort size: an analysis of U.S. postwar suicide rates by age and sex

This paper presents a relative cohort size model of suicide. The model states that as relative cohort size (the ratio of younger to older workers) rises, income and income aspirations diverge for the young. One possible extreme reaction to this disequilibrium is suicide. The model explains the variation in age- and sex-specific suicide rates for the United States over the period 1948 to 1976. It identifies the direct effect of changes in cohort size on suicide rates as well as the indirect effect operating through other demographic variables. The model predicts the suicide rates for males above 45 years of age to rise and those for all other groups to decline. For most groups this is a reversal of recent movements in their suicide rates.     

Economic determinants of family size in West Africa

The economic theory of fertility postulates that income and prices, broadly defined, are important determinants of family size. What follows is an attempt to test this theory against the behavior of 717 predominantly urban households in Sierra Leone. Husband's education is used as a proxy for income; the "price" of a child is accounted for by wife's education and wife's wage rate. Other important variables are wife's age, a measure of child "quality," wife's age at first birth, and child mortality. The findings of the study tend to lend support to the economic theory of fertility but contain certain peculiarities which indicate a need for further research.     

Theoretical explanation of rapid decline in China's fertility]

China's fertility decline is widely acknowledged. The 1982 census and a random survey of 1/1,000th of the nation's population set the total fertility rate at 2.6%. Bureau of statistics data collected in 1984 showed the nation's birth rate as 1.7% and total fertility rate 1.94%. Friendly observers call this a miracle; others blame the decline on forced government family planning policy. Scientific pursuit of the causes for the decline is an issue of practical and realistic value. First, favorable conditions for fertility decline have been fostered by the socialist system and are deeply rooted in the country's economic development. China's industrialization and urbanization have brought new lifestyles and liberated individuals and families from the constraints of traditional family life. Couples have chosen to limit the number of children, to enhance the quality of life and education potential of their children, thus altering the traditional high fertility in China. Education of women has played a role in raising women's consciousness; a 1982 census placed the fertility rate of women with high-school level education or above, lower than that for less or uneducated women. Neonatal mortality rate decline is also related to the spontaneous decline in fertility rate, as high fertility has historically been intended to compensate for high child mortality rates. Welfare and social security systems for the elderly have also helped change the traditional mentality of having many children as assurance of life support in old age. Social organizations have accelerated knowledge and methods of planned fertility. Later marriages are also a factor: in 1970 the average marriage age was 19 - 20 and had increased by 1976 to 22 - 23. Other favorable social factors include free birth control and the view of population planning as an essential part of national welfare.     

Child mortality and fertility: public vs private education

How does the effect of child mortality reductions on fertility and education vary across educational systems? To answer this question, we develop an overlapping-generations model where altruistic parents care about both the number and human capital of their surviving children. We find that, under a private education system, if income is low initially, the economy converges to a Malthusian stagnation steady state. For a high level of initial income, the economy reaches a growth path in which children’s education rises and fertility decreases with income. In the growth regime under private education, exogenous shocks that lower child mortality are detrimental for growth: fertility increases and education declines. In contrast, under a public education system, the stagnation steady state does not exist, and health improvement shocks are no longer detrimental for growth. We therefore offer a new rationale for the introduction of public education.     

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.     

Explaining Disability Trends in the United States, 1963–2015

The National Health Interview Survey is the world's longest survey time series of health data. In spite of the availability of such a long time series, previous studies did not attempt to explain long‐term trends in disability, because the design of the question in the survey has changed over time. To control for changes in the design of the question, I added two variables indicating major changes in the design to the analysis. My results show that the decline in mortality from cardiovascular disease is associated with the rise in disability in the 1970s, whereas better education is associated with the long‐term decline in disability that started in the 1980s. Combined, the two variables are able to account for all major trends in disability at age 50–84 from 1963 to 2015, leaving limited room for other explanations. The statistical model predicts that the trend in falling disability rates will end as the rise in educational levels draws to a halt.     

Infant mortality decline in Malaysia, 1946–1975: The roles of changes in variables and changes in the structure of relationships

This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)     

Trends in the association between educational attainment and class destinations in West Germany: Looking inside the service class

The paper investigates long-term trends in the association between educational attainment and class destinations in Germany. Most recent evidence for several European countries reveals a downward effect of education on social class. To test changes in the association in Germany I use the 1976–2007 waves of the German Microcensus (GMC), which is a nationally representative, repeated cross-sectional survey. For Germany, log-linear models indicate that the relationship between education and class destinations remains rather constant for both sexes. I also find that returns to higher education in access to service class positions do not consistently decline either. Only university graduates’ relative access chances slightly decreased in comparison to Abitur-holders from the 1980s to the 1990s. In order to consider compositional changes in the service class in more detail, I further disaggregate the service class into three types of employment: administrative/managerial positions, professional experts and professional positions in the social services. In fact, I find that access to administrative and managerial positions is less dependent on education than access to the professions. While professional positions in the social services become less stratified by education over time, it is compensated by a reverse development for professional experts. As substantially more employees work in administrative and managerial jobs since the 1970s, the slight reduction in university returns can indeed be attributed to a compositional effect. In spite of these qualitative and quantitative changes, the strong impact of education on access to the service class does not become blurred. The paper concludes that the persistent institutional framework in Germany does not lead to a decline in the overall association between educational attainment and class destinations.     

Child care arrangements and fertility: An analysis of two-earner households

The determinants of child care arrangements and relations between child care and fertility are examined using data on two-earner households from the 1976 National Survey of Family Growth. We find that the probability of relying on market arrangements is higher among families in which the husband's income, the wife's wage, and the level of the wife's labor supply are high; these households are likely to benefit the most from subsidies to the market forms of care that are small relative to the total cost of care (e.g. the present system of tax credits). In addition, parental education, family size, child's age, race, religion, and place of residence have important influences on the choice of child care mode. When other factors are held constant, reliance on a relative for child care is positively associated with intentions to have further children among couples with infants and preschoolers.     

Child mortality, fertility, and human capital accumulation

This article analyzes the impact of decline in child mortality on fertility and economic growth. The study shows that the timing of mortality relative to education is crucial to implications of mortality decline. If child mortality is realized before education starts, an exogenous decline in child mortality leads to a decline in education—a finding that is opposite to those of studies that considered a decline in mortality after the cost of education has been incurred. The work also demonstrates the role of parental human capital in reducing child mortality and the causal link between rising education and declining child mortality.

Trends,Age Patterns and Differentials in Childhood Mortality in Haiti (1960–1987)

This paper examines the trends, patterns and differentials in childhood mortality in Haiti between 1960 and 1987 with data from three surveys and one census. Data comparability is maximized by a series of adjustments, and both direct and indirect techniques are applied. The results indicate that a slow decline in childhood mortality has occurred since 1960 for the country as a whole. Neonatal survival has shown impressive gains, especially in rural Haiti. Post-neonatal mortality has not, however, declined at the same rate. Mortality between the ages of one and five years has declined at about the same pace as infant mortality, maintaining consistency with model patterns of mortality change. The overall national decline in child mortality appears to have consisted of two phases. The first occurred in rural Haiti during the late 1960s and early 1970s and was due largely to a fall in neonatal mortality. The second phase of the decline was concentrated in Port-au-Prince, and seems to have affected all ages of childhood.     

Infant mortality by Father’s occupation from the 1911 Census of England and Wales

Infant mortality in England and Wales only began its secular decline at the beginning of this century, although mortality among those aged 1-4 began to decline earlier. The 1911 Census of Fertility provides the basis for estimates of infant mortality among occupational groups. A diagrammatic model of decline is elaborated, using fertility decline, social class, income, and urban/rural distribution as explanatory variables. Results of the analysis suggest that infant mortality decline, whose average value was 35 percent from a peak of 132 per 1,000, was increased by improvements in the urban environment and advanced by high or regular income, whereas fertility decline had only a small effect.     

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.     

Child mortality in India: the community-level effect of education

When assessing the health benefits of increased education in less developed countries, many researchers have been concerned about the omission of important determinants of an individual's education from the models. The study presented here shows that one should also be concerned about the limitations of the individual-level perspective. According to a multilevel discrete-time hazard model estimated with data from the National Family Health Survey II, the average education of women in a census enumeration area has a strong impact on child mortality, in addition to the effect of the mother's own education. The lower child mortality associated with women's autonomy is taken into account in this estimation. Results from similar models for various health and health-care variables suggest that the effect of community education, like that of individual education, operates through the use of maternity services and other preventive health services, the child's nutrition, and the mother's care for a sick child.     

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.