The measurement of historical trends in fetal mortality in England and Wales

This paper critically discusses recent attempts to estimate long-term trends in the stillbirth rate for England and Wales. It assesses the available historical evidence for the level of late-fetal mortality, drawing especially on examples from Norway, Sweden, and Denmark. A theoretical fetal–infant life table for a high-mortality population is also outlined as a means of analysing the relationship between segments of the conception-to-first-birthday mortality curve. Finally, new estimates of the stillbirth rate for England and Wales are proposed, based on variations in the early neonatal and maternal mortality rates during the 1930s. These estimates are substantially lower than the earlier estimates and are more in keeping with the available evidence from northern Europe. The implications of the revised estimates for interpretations of historical changes in mortality patterns are also considered.     

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

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

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.     

Estimating the completeness of under-5 death registration in Egypt

To evaluate the completeness of registration of infant and child deaths in Egypt, reinterviews were conducted with families who had reported a death of a child under age 5 in the five years before the survey for two national surveys recently conducted in Egypt: the United Nations PAPCHILD survey of1990-1991 and the Egyptian Demographic and Health Survey (EDHS) of 1992. The survey instrument included questions regarding notification of the death at the local health bureau. If the family said the death had been notified, separate employees searched the health bureau records for the registration. Overall 57% of infant deaths were reported as notified and 68% of those death reports were found; the corresponding figuresfor child deaths were 89% and 74%. Using the percentage reported as notified as an estimate for completeness of registration, we adjusted upward the national infant and child mortality rates from registration data, giving values of 73 per 1,000 for infant mortality and 99 for ₅q₀ for the period 1987-1990. These values are approximately 20% above the corresponding direct estimates from the PAPCHILD and EDHS surveys.     

Temporal variations in the relationship between infant mortality and economic status

Data from a metropolitan aggregate comprising three Ohio cities for the years 1959–61, 1969–71 and 1979–81 reveal some noteworthy variations over time in the nature and magnitude of the traditional inverse association between economic status and infant mortality. This brief paper describes these variations and offers an explanation for the observed temporal changes that relates the influence of medical and infant health care advances to the prevailing overall economic situation.

     

Infant Mortality in Nine Industrial Parishes in Northern England, 1813–1836

Evidence about infant mortality in a number of industrial towns was derived from baptismal and burial registers of the Anglican Church. The level of infant mortality during the period 1813–1836, after correction for underregistration, was comparable to that of British towns during the second half of the century. Infant mortality increased during this period, perhaps as a reflection of rapid population growth. In each of the parishes a winter peak and a summer trough was found in the seasonal index of infant deaths during this period. This pattern is very different from the high summer mortality that prevailed in British towns during the late nineteenth century. However, mortality in the summer increased over time, thus reducing the depth of the summer trough in infant deaths, and perhaps represents a movement towards the summer peak so apparent later in the century.     

A simulation of the impact of changes in age at marriage before and during the advent of industrialization in England

Summary The quantitative significance of changes in age at marriage on family size is assessed by applying a simple simulation model of family reproduction, using data broadly related to England in the period 1700-1850. Within this context, the impacts of parity-specific infant mortality, and an association between age at marriage and potential fertility are considered. The evidence concerning variations in marriage and mortality distributions over the period in question is examined and linked to the simulation results to produce some tentative conclusions relating to the impact of changes in the distribution of age at marriage on the birth rate and rate of population growth and to an assessment of such changes as an homeostatic adjustment mech-anism. In particular, it is argued that age at marriage played no more than a secondary role in the English demographic revolution.     

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.     

Levels and patterns of infant and child mortality in ghana

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

Mortality in Ghana: Evidence from the cape coast project data

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

Breast feeding, fertility and infant mortality: An analysis of some early German data

Abstract Concern about high infant mortality and its suspected connection with the lack of breast-feeding stimulated the collection of statistics about the frequency of breast-feeding in several German states during the late roth and early 20th centuries. Contrary to the assumption that universal and extended breast-feeding is customary among rural agricultural populations, large regional variations existed both in the proportion of children who were breast-fed and in the average duration of the period for which they were breast-fed. An analysis of these data in connection with statistics of infant mortality and marital fertility confirms the association between high infant mortality and the absence of breast-feeding. An hypothesis linking breast-feeding and fertility, however, is not confirmed. Marital fertility appears to be much more closely associated with infant mortality than with breast-feeding.     

Breast feeding,fertility and infant mortality: An analysis of some early German data

Concern about high infant mortality and its suspected connection with the lack of breast-feeding stimulated the collection of statistics about the frequency of breast-feeding in several German states during the late roth and early 20th centuries. Contrary to the assumption that universal and extended breast-feeding is customary among rural agricultural populations, large regional variations existed both in the proportion of children who were breast-fed and in the average duration of the period for which they were breast-fed. An analysis of these data in connection with statistics of infant mortality and marital fertility confirms the association between high infant mortality and the absence of breast-feeding. An hypothesis linking breast-feeding and fertility, however, is not confirmed. Marital fertility appears to be much more closely associated with infant mortality than with breast-feeding.     

Mother’s,Household, and Community U.S. Migration Experience and Infant Mortality in Rural and Urban Mexico

This study explores rural and urban differences in the relationship between U.S. migration experience measured at the individual, household, and community levels and individual-level infant mortality outcomes in a national sample of recent births in Mexico. Using 2000 Mexican Census data and multi-level regression models, we find that women’s own U.S. migration experience is associated with lower odds of infant mortality in both rural and urban Mexico, possibly reflecting a process of healthy migrant selectivity. Household migration has mixed blessings for infant health in rural places: remittances are beneficial for infant survival, but recent out-migration is disruptive. Recent community-level migration experience is not significantly associated with infant mortality overall, although in rural places, there is some evidence that higher levels of community migration are associated with lower infant mortality. Household- and community-level migration have no relationship with infant mortality in urban places. Thus, international migration is associated with infant outcomes in Mexico in fairly complex ways, and the relationships are expressed most profoundly in rural areas of Mexico.

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.     

Determinants of Regional Variations in Infant Mortality in Rural India

An analytical framework is specified for understanding the determinants of infant mortality. It distinguishes between factors at three levels – village, household and individual – and arranges them in ascending order with respect to their proximity to infant mortality. Village and household-level factors are assumed to influence infant mortality indirectly by influencing at least one of the six individual-level factors. The present analysis of the data aggregated at the state level clearly demonstrates the importance of both medical and non-medical factors for explaining the observed regional differences in infant mortality in rural India. The percentage of births attended by trained medical personnel and poverty, are the two important determinants of regional variations in neo-natal mortality; and the village-level availability of medical facilities and the extent of triple vaccination are the two important determinants of post-neo-natal mortality. The influence of adult women's literacy on infant mortality is explained by better medical care at birth, and preventive and curative medical care during the post-neo-natal period. Medical factors have been shown to be slightly more important than non-medical factors. This suggests that it might be possible to reduce the high level of infant mortality currently prevalent in many states in India by simple preventive medical interventions.     

Polygyny and child survival in Nigeria: Age-dependent effects

Mortality risks under age five are estimated using data from the 1990 Nigerian Demographic and Health Survey for children in monogamous and polygynous families. Integrating existing theories on polygyny’s relationship with infant and child mortality and some demographic concepts, the study shows that polygyny has different effects on infant and child mortality at different ages. The results indicate that polygyny does not have a significant effect on neonatal mortality (age less than one month). In contrast to the results of previous research, polygyny is significantly associated with lower child mortality during the post-neonatal period (1–11 months), but not during childhood (12–59 months). The study found socio-economic factors to be important confounders of the relationship between polygyny and mortality during the neonatal and post-neonatal periods. The protective effect of polygyny during the post-neonatal period suggests the need to further investigate circumstances that may favour post-neonatal child survival in polygynous families including availability of childcare.     

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4–14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4–14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.     

Evaluation of estimates of underenumeration in the census and the age pattern of mortality,philadelphia, 1880

The schedule of mortality by age for Philadelphia's 1880 population classified by sex and race showed aberrations from Coale and Demeny West, South, and North model life tables. Deviations from standard age patterns of mortality were especially pronounced for the black population. The question addressed in this paper is whether the alternative age patterns of mortality are produced by underenumeration in the 1880 census or by actual variations in the age-specific mortality experience. The conclusion was reached that the underenumeration of the urban population, especially the blacks, exceeds estimates for the national population. In addition, the results indicated that the black population faced risks of dying that genuinely differed from standard age patterns. An attempt to use a Brass logit model to generalize the black mortality experience met with success for females but not for males.     

Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983–2002

This paper examines absolute change in infant mortality from 5 leading causes of death for whites and blacks over a 20 year period. Change in infant mortality varies by cause, race, and birth weight. Absolute decline in mortality from respiratory distress syndrome (RDS) and sudden infant death syndrome (SIDS) in the overall study population has been more rapid for black infants during the period after specific technological innovations were approved and behavioral practices were recommended for these conditions. For low birth weight infants, blacks experienced greater decline in mortality from SIDS and whites experienced greater decline in RDS mortality. Despite remarkable declines in mortality from these causes, relative racial disparities have increased over this time period. For the overall study population, blacks and whites experienced similar rates of mortality decline from congenital anomalies. Mortality decline from this cause among low birth weight infants occurred at a faster pace for whites. Mortality from causes for which no specific innovations were developed increased for blacks but remained relatively constant for whites. An analysis of absolute change complements the relative disparities approach by revealing the dynamics of change, thus providing a more complete understanding of changing racial disparities in infant mortality.     

Public policy and the total fertility rate: cross-sectional evidence from the LDCs

A framework developed by Easterlin for the analysis of fertility in developing societies is modified and then tested using a sample of 65 less-developed countries. The focus is on assessing the impact of public policy on the national fertility rate. Public policy is reflected in the average levels of education and health in the population and in the condition of the national family planning program. To test for threshold effects with respect to socioeconomic development, the sample is divided on the basis of the infant mortality rate. Fertility rates in those nations characterized by high infant mortality are likely to be determined more by conditions of natural fertility. Those nations with lower infant mortality, and hence greater socioeconomic development, are more likely to exhibit deliberate fertility control. The results of the regression analysis do suggest that different factors influence the national fertility rate depending upon the stage of development. For the least-developed nations, the secondary school enrollment rate, an indicator of the extent of economic mobility, and the ratio of school age children to teachers, a proxy for the national commitment to human capital formation, are important. For the more advanced of the LDCs, adult literacy and the infant mortality rate seem to predominate. For all the developing nations, however, the results confirm the importance of strong family planning programs. The paper concludes with a discussion of the policy implications of the research.