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.     

Two and a half centuries of demographic history in a Bavarian village

Abstract A village genealogy containing family histories of couples married between 1692 and 1939 serves as the basis for a study of the demographic history of a Bavarian village. The past patterns of marriage, re-marriage, widowhood, illegitimacy, bridal pregnancy, marital fertility, family size, and birth intervals are examined. Both the age at marriage and illegitimacy increased and then declined during the nineteenth century, apparently in response to changes in restrictive marriage legislation. Differences in fertility for occupational groups were insignificant. Marital fertility remained extremely high before 1900 suggesting the absence of any substantial family limitation within marriage. A rise in marital fertility that occurred during the last half of the nineteenth century appears to result from a change in breast-feeding customs. The actual number of children surviving to maturity for most couples was kept quite low, however, through late marriage and high infant mortality. Only during the twentieth century are substantial declines in infant mortality and fertility evident.     

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

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

Demographic and Health Survey--1993

The author briefly outlines some of the major findings of the 1993 Sri Lanka Demographic and Health Survey. Information is provided on fertility, family planning, infant and child mortality, maternal and child health, breast-feeding, and nutritional status of children.     

Mortality in Ghana: Evidence from the cape coast project data

Abstract 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.     

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.     

The Middle East population puzzle

An overview is provided of Middle Eastern countries on the following topics; population change, epidemiological transition theory and 4 patterns of transition in the middle East, transition in causes of death, infant mortality declines, war mortality, fertility, family planning, age and sex composition, ethnicity, educational status, urbanization, labor force, international labor migration, refugees, Jewish immigration, families, marriage patterns, and future growth. The Middle East is geographically defined as Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Gaza and the West Bank, Iran, Turkey, and Israel. The Middle East's population grew very little until 1990 when the population was 43 million. Population was about doubled in the mid-1950s at 80 million. Rapid growth occurred after 1950 with declines in mortality due to widespread disease control and sanitation efforts. Countries are grouped in the following ways: persistent high fertility and declining mortality with low to medium socioeconomic conditions (Jordan, Oman, Syria, Yemen, and the West Bank and Gaza), declining fertility and mortality in intermediate socioeconomic development (Egypt, Lebanon, Turkey, and Iran), high fertility and declining mortality in high socioeconomic conditions (Bahrain, Iraq, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates), and low fertility and mortality in average socioeconomic conditions (Israel). As birth and death rates decline, there is an accompanying shift from communicable diseases to degenerative diseases and increases in life expectancy; this pattern is reflected in the available data from Egypt, Kuwait, and Israel. High infant and child mortality tends to remain a problem throughout the Middle East, with the exception of Israel and the Gulf States. War casualties are undetermined, yet have not impeded the fastest growing population growth rate in the world. The average fertility is 5 births/woman by the age of 45. Muslim countries tend to have larger families. Contraceptive use is low in the region, with the exception of Turkey and Egypt and among urban and educated populations. More than 40% of the population is under 15 years of age. The region is about 50% Arabic (140 million). Educational status has increased, particularly for men; the lowest literacy rates for women are in Yemen and Egypt. The largest countries are Iran, Turkey, and Egypt.     

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.     

Fertility and mortality in Finland since 1750

Summary In this paper the development of fertility and mortality in Finland, and their interrelations with each other and with economic factors is discussed. An analysis by individual years shows that rises and falls in mortality and fertility rates did not always coincide with poor and good harvests. Fertility in Finland decreased slightly at the turn of the eighteenth and nineteenth centuries, but fell sharply over the period 1876-1925. This fall corresponded closely to changes in the death rate, especially for infants, and appears to justify the conclusion that the changes were connected. These population shifts have been called the first and second demographic transitions, of which the latter was the more dramatic. Factors tending to reduce mortality among infants and in other age groups during the second demographic transition are obvious; those underlying the first demographic transition are less clear. In this connection, the importance of breast feeding and campaigns designed to favour the practice are stressed. These helped to reduce infant mortality and were one of the main reasons for the first demographic transition. Finnish material also suggests that some kind of family planning existed during the pre-industrial period; it is only by making this assumption that the various figures can be made compatible.     

Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country’s health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized.     

Determinants of temporal and areal variation in infant mortality in Germany, 1871–1933

This article investigates how sociodemographic, economic, medical, and public health factors influence infant mortality by using data about German administrative areas from 1871 to 1933. Marital fertility has the largest impact on infant mortality, followed by illegitimacy, medical care, urbanization, and infant welfare centers. The variables considered here account for most of the variation in infant mortality. Some of the unexplained variance is due to factors associated with regions, such as breastfeeding patterns, and with time periods, such as national health insurance. The analyses found no evidence that advances in medical technology affected infant mortality or that the influence of economic development changed over time.     

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.     

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.     

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.     

Altitude, fertility and mortality in Andean countries

Abstract Using the census data for Peru, Bolivia and Ecuador, previous writers have investigated some possible determinants of inter-regional differences in fertility; language spoken, female participation rates, and altitude. This paper points out the many sources of inaccuracy in the census data used. It argues that the indicators of unusually low fertility in the highland, predominantly Indianspeaking areas fail to control effectively for the very high levels of infant mortality in these regions. Fragmentary survey results give some indication of the scale of infant mortality, and appear to refute the idea that fertility is exceptionally low in areas of high altitude. In an attempt to explain why such high mortality rates persist in the Andean region the main health problems of Bolivia are examined. It seems that the causes are economic and social, rather than physiological. Unfortunately a change of policy which reduced death rates would produce grave new social problems.     

The cocos-keeling islands: A demographic laboratory

The Cocos Islands, which are situated in the Indian Ocean approximately halfway between Colombo and Fremantle, were first peopled early in the nineteenth century and were gradually developed as a very isolated coconut plantation with a labour force consisting partly of persons of Malay stock descended from the original group of settlers and partly of Bantamese contract labourers from Java. As the Cocos-born population increased in size, the dependence on contract labour decreased and, before the end of the century, all immigration ceased. The 1947 Malay population of the islands was about 1,800.

The islands are fascinating from a demographer's point of view because there was a virtually complete registration of live births, deaths and marriages and a partial registration of stillbirths. With these registration records it was possible to construct the life history of every individual from birth, through infancy and childhood to marriage, and thence through fatherhood or motherhood to death.

The picture revealed by an analysis of these records is that of a population with very high fertility and with mortality at a high level before the first World war and at a medium level after that war. Crude birth rates varied between 50 and 60 per thousand population during the period 1888 to 1947. Crude death rates were between 30 and 40 per thousand population until 1912 but under 2.0 per thousand population after 1918.

Most Cocos girls married before reaching the age of 20 and there were an average of between eight and nine live births per woman living through the childbearing period. There was a steady decline in the average number of live births with advancing age at marriage from age 16 onwards. A significantly high proportion of those dying in the middle of the childbearing period had never married, but the fertility of those marrying at an early age (14, 15 and 16) and dying before reaching the age of 36 was slightly higher than that of those who married at a similar age and survived. Women who survived to the age of 55 were of higher fertility than those who died between the ages of 40 and 55. An analysis of birth intervals revealed significant differences (a) between birth intervals after a stillbirth or after a live birth in which the child died in early infancy, and birth intervals after a live birth in which the offspring survived for longer than 0.4 years, and (b) between the interval from first to second birth and the subsequent birth intervals. There was a difference of almost exactly a year between the average birth interval after a stillbirth or live birth ending in a neo-natal death and the average birth interval after the birth of a child surviving to age 2; there was a similar difference of a year between corresponding median birth intervals.

From 1888 to 1912 infant mortality was well above 300 per thousand. After 1918 infant mortality averaged rather under 100 infant deaths per 1,000 live births. The reduction in infant mortality rates was accompanied by an increase in the mortality of children aged 1 to 4, and the heavy incidence of mortality at these ages after 1918 is the most striking feature of the analysis of mortality by age. Whilst mortality in infancy fell much more heavily on males than on females, early childhood mortality was much higher in Cocos for girls than for boys. The life table computed for the period 1918 to 1947 indicated a life expectancy of about 50 years for males and 47 years for females.     

The effects of infant mortality on fertility revisited: new evidence from latin america

In this paper, we examine empirical evidence for a relation between infant and child mortality and fertility in Latin American countries from 1920 to 1990. We investigate the relation at several levels of aggregation and evaluate the extent to which evidence at one level is consistent with evidence at other levels. We first examine aggregate cross-country information over several decades, a type of data typically used in past research on the topic. We also examine yearly series of births, deaths, infant deaths, and socioeconomic indicators for selected countries to track the association between short-term fluctuations in fertility and infant mortality. Finally, we use micro-level data from the Demographic and Health Surveys (DHS) to assess the relation between fertility and child mortality from individual reproductive histories. The evidence we assemble from these different data sets is remarkably consistent and suggests small positive effects of infant mortality on fertility. These effects, however, may be too small to support the hypothesis that changes in child mortality are of more than modest importance in the process of fertility decline in Latin America in the late twentieth century.     

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     

Fertility decisions when infant survival is endogenous

There is evidence that fertility is positively correlated with infant mortality, and that a child‘s chance of surviving to maturity increases with the level of nutrition, medical care, etc. received in the early stages of life. By modelling parental decisions as a problem of choice under uncertainty, the paper shows that fertility and infant mortality are most likely to move in opposite directions if, as implicitly assumed by existing economic theories, parents believe that there is nothing they can do to improve the survival chances of their own children. By contrast, if parents realize that those chances improve with the amount they spend for the health, nutrition, etc. of each child that they put into the world, then fertility and infant mortality may move in the same direction. Under such an assumption, the model has the strong policy implication that directly death-reducing public expenditures are most effective, but stimulate population growth, at low levels of development. By contrast, at high levels of development, such expenditures tend to crowd out parental expenditures, and are a factor in fertility decline. Received: 14 October 1996 / Accepted: 28 July 1997