The influence of child spacing on child survival

Summary This study evaluates the strength of the influence of spacing on child survival. Data related to a traditional culture (Punjab) in which almost all children are breast-fed up to the age of 17 months. An initial pregnancy history survey, subsequent four years updating through continuous monitoring of vital events and a second cross-sectional pregnancy history survey at the mid-point provided a file containing information on pregnancies and survival of children of 5,018 women. The analysis first looks at the correlation between the lengths of the preceding and subsequent intervals of index children, then examines whether this correlation was related to the repeated pattern of child death or survival. Next, the influence of the duration of the preceding interval on the survival of the index child in general and after accounting for the fate of the preceding child were considered. Then the influence of the length of the subsequent interval on the survival of the index child after conception and after the birth of the next child were studied. Lastly, regression analyses with preceding and subsequent intervals as independent variables and age-specific survival or death as the dependent variable were performed.     

The effect of female migration on infant and child survival in Uganda

This article uses data from the 1996 Uganda Demographic and Health Survey to examine whether migration of women improves the survival chances of their children to age five. We expand on prior research by testing not only the hypothesized positive effect of rural-urban migration, but also the effects of other migration stream behaviours on child survival. Results show that up to 10% of children die before age five and within-group differences in mortality exist among urban and rural children depending on their mother's migration status. Only urban-urban migration was significantly related to child survival, compared to rural non-migrants, after controlling for other factors, although other streams of migration (rural-urban, urban-rural, rural-rural) were positively related to child survival. Generally, migration explains a small component of the variance in child survival. Several other factors, including parents' education, household size, household headship, mother's age at birth, duration of breastfeeding, and place of delivery have a significant predictive power on child survival.     

Demographic Determinants of Infant and Early Child Mortality: A Comparative Analysis

In this paper we examine the relative importance of a number of demographic determinants of infant and early child mortality using information from 39 World Fertility Survey countries. We include sex of the child, age of the mother at the time of the birth, birth order, mother's educational level and a number of indicators of spacing of adjacent births among the correlates of chances of survival for children below the age of five years. Mortality of firstborn children and of those born to teenage mothers is shown to be higher than average; that of later children and those of older mothers was not much higher than average, once other factors are controlled. Effects of poor birth-spacing persist even after other factors have been controlled, and are similar where a sib was born during the two years preceding the birth of the child, regardless of the survival status of that sib; however, mortality was higher when that sib had died, due to increased familial risks of mortality. Rapid subsequent births also raise mortality for their earlier sibs. The findings are generally remarkably consistent in a wide range of countries and associated mortality conditions, although attention is drawn to a few interesting geographically clustered exceptions which deserve further investigation. The study leaves little room for doubt that poor child-spacing is clearly linked to decreased survival chances.     

Changes in fertility patterns can improve child survival in Southeast Asia

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

Birth spacing and child mortality in bangladesh and the Philippines

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

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.     

Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries

This paper investigates whether children later reported as having been unwanted or mistimed at conception will, when compared with children reported as wanted, show adverse effects when the following criteria are applied: receipt of antenatal care before the sixth month of gestation, supervised delivery, full vaccination of the child, and child growth (stunting). The study uses data from five recent Demographic and Health Survey enquiries in Bolivia, Egypt, Kenya, Peru, and the Philippines. In Peru, children unwanted at conception were found to have significantly worse outcomes than other children, but in the other countries, a systematic effect was found only for receipt of antenatal care. Weak measurement of the complex concept of wantedness may have contributed to these results. Birth order of the child, with which wantedness is inextricably linked, has more powerful and pervasive effects, with first-born and second-born children being much less likely to show adverse effects.     

Child gender and father involvement in fragile families

In this article, we use data from the first two waves of the Fragile Families and Child Wellbeing Study to examine the effects of child gender on father involvement and to determine if gender effects differ by parents' marital status. We examine several indicators of father involvement, including whether the father acknowledges "ownership" of the child, whether the parents live together when the child is one year old, and whether the father provides financial support when the child is one year old. We find some evidence that child gender is associated with unmarried father involvement around the time of the child's birth: sons born to unmarried parents are more likely than daughters to receive the father's surname, especially if the mother has no other children. However, one year after birth, we find very little evidence that child gender is related to parents' living arrangements or the amount of time or money fathers invest in their children. In contrast, and consistent with previous research, fathers who are married when their child is born are more likely to live with a son than with a daughter one year after birth. This pattern supports an interpretation of child gender effects based on parental beliefs about the importance of fathers for the long-term development of sons.     

Economic Development,Gender Inequality,and Demographic Outcomes: Evidence from India

This article examines the determinants of fertility, child mortality, and female disadvantage in child survival in India, using a district‐level panel data set linking 1981 and 1991 censuses. The results question the dominant view that variables directly related to women's agency (specifically, the female literacy rate and the female labor force participation rate) have played the crucial roles here. Instead, variables reflecting the general level of development and modernization are shown to have had the greatest effect in reducing fertility and child mortality during the period of the study. Both economic development and women's agency are seen to have had significant effects in reducing the female disadvantage in child survival. The results suggest, however, that with continued economic development, the two women's agency variables lose their significance in influencing this disadvantage. The policy implications of these findings are considered.     

New evidence about effects of reproductive variables on child mortality in sub-Saharan Africa

There is still considerable uncertainty about how reproductive factors affect child mortality. This study, based on Demographic and Health Survey data from 28 countries in sub-Saharan Africa, shows that mortality is highest for firstborn children with very young mothers. Other children with young mothers, or of high birth order, also experience high mortality. Net of maternal age and birth order, a short preceding birth interval is associated with above average mortality. These patterns change, however, if time-invariant unobserved mother-level characteristics of importance for both mortality and fertility are controlled for in a multilevel–multiprocess model. Most importantly, there are smaller advantages associated with longer birth intervals and being older at first birth. The implications of alternative reproductive ‘strategies’ are discussed, taking into account that if the mother is older at birth, the child will also be born in a later calendar year, when mortality may be lower.     

A Sibling Death in the Family: Common and Consequential

Although a large literature analyzes the determinants of child mortality and suggests policy and medical interventions aimed at its reduction, there is little existing analysis illuminating the consequences of child mortality for other family members. In particular, there is little evidence exploring the consequences of experiencing the death of a sibling on one’s own development and transition to adulthood. This article examines the prevalence and consequences of experiencing a sibling death during one’s childhood using two U.S. data sets. We show that even in a rich developed country, these experiences are quite common, affecting between 5 % and 8 % of the children with one or more siblings in our two data sets. We then show that these experiences are associated with important reductions in years of schooling as well as a broad range of adult socioeconomic outcomes. Our findings also suggest that sisters are far more affected than brothers and that the cause of death is an important factor in sibling effects. Overall, our findings point to important previously unexamined consequences of child mortality, adding to the societal costs associated with childhood mortality as well as suggesting additional benefits from policy and medical innovations aimed at curbing both such deaths and subsequent effects on family members.     

Re-Conceptualizing Gaps by Socioeconomic Status in Parental Time with Children

Differences in the total time that parents spend with their children by socioeconomic status (SES) are well documented. However, the qualitative aspects of such gaps are potentially important, yet relatively understudied. The current study analyzes time-use data for a nationally representative sample of married households with at least two children, one of whom is under 13 (N = 21,016), from the American Time Use Survey to provide a more nuanced analysis of previously documented differences in the time parents spend with children by SES. Specifically, two understudied aspects of family time are considered, both of which are distinct from other types of parent–child time and are potentially particularly developmentally beneficial: shared time when both parents are present with a child and individual child time when no siblings are present. We find that shared time when both parents are simultaneously present with a child often comprises a substantial portion of the total gap in parental time spent with children between college-educated parents and parents who did not complete high school. Similarly, college-educated parents spend more time with children in the absence of the child’s siblings than do less-educated parents. Gaps in this time classification are often found within enriching time, which is likely especially developmentally beneficial, potentially amplifying the effects of these gaps on child development. Generally, these results suggest that gaps in parental time with children by SES are more nuanced than previous research has recognized.     

Fathers and infant health and survival in Ende,a rural district of Eastern Indonesia

Studies have shown that child survival can be greater when fathers are more highly involved in infant care than when they are less involved. This paper investigates fathers’ and paternal grandmothers’ knowledge and experiences relating to infants’ survival in a rural district of Eastern Indonesia, a context for which such information is lacking. Twenty fathers or replacement relatives participated in in-depth interviews. Most had very limited knowledge of the danger signs of childhood illness. None of participants had received child health-related information from local health personnel. Male-dominated forms of decision-making in relation to infant health care are the norm. Inadequacies in the child health services, such as difficulties in accessing health facilities, health personnel unavailability and discomfort during delivery, remain as challenges. Fathers appear to rely largely on their wives for their infant health and survival knowledge and have little involvement with their infants. They see their roles in terms of providing economic support and basic care for their infants. Grandmothers are seen as a major source of health information by fathers, but have limited knowledge of infant survival. The findings demonstrate a need for child health promotion programs and campaigns, including the safe motherhood program, to include fathers as well as mothers, in order to increase their awareness of infant survival and involvement in infant raising, and to persuade them to allow mothers greater scope to make child health-seeking decisions, especially when children require emergency treatment.     

The prediction of completed fertility

There has been considerable interest in the relation between familysize desires and completed fertility. Longitudinal data from the Princeton Fertility Study provide a unique opportunity to compare the number of children desired after the birth of a second child to the size of completed families. The average number of children desired by women after the birth of their second child predicts very well the average size of their completed families. The average family size desired at the first interview and average estimated completed family size some eight years later are identical for the total sample, and vary hardly at all within religious or education subgroups. One-third of the variance in the completed fertility of couples is "explained" by wife's family-size desires and the proportion of explained variance increases to two-fifths when we include the husband's first interview desires and the interval between marriage and second birth. Yet in spite of the relatively high correlation between desires and achievement, only 41 percent of these women achieved exactly the number of children they desired at the first interview, while 14 percent had two children more or fewer than originally desired. Nevertheless, data on contraceptive efficiency indicate that desires after the birth of the second child constitute meaningful goals in terms of which the respondents regulate their subsequent behavior-efficacy of contraceptive practice shows substantial improvement after the desired number has been achieved.     

Nepal survey shows that "family planning saves lives"

This article presents the results of the Nepal Family Health Survey (NFHS) conducted from January through June 1996. Data on fertility, family planning, and maternal and child health were collected from 8429 ever-married women aged 15-49 years. These women provided information on 29,156 children. Using the method of regression analysis, findings reveal those factors, such as young mothers, large families, and short birth intervals, substantially increase under-five mortality risks. However, socioeconomic factors have only a limited effect on under-five mortality. Statistics have suggested that much of the urban/rural differences in mortality have been due to factors closely related to residence, mother's level of education and economic status. In addition, although positive effects of interventions (antenatal and postpartum checkups, tetanus immunization and assistance at delivery by a traditional birth attendant) have been documented, statistical results show that few children in Nepal are receiving the benefits of maternal health care. In conclusion, results of the 1996 NFHS show that delaying, spacing, and limiting births can substantially reduce infant and child mortality.     

Pre-term Foetal Life Times in Scotland

A proportional hazards model was used to evaluate the association between ten categorical covariates and the risk of pre-term delivery for women having their first child and women in subsequent pregnancies. An adaptation of the model for use with grouped survival times made it possible to model foetal life times between 28 and 36 completed weeks of gestation for 67,000 Scottish singleton births in 1981. The use of the model was justified by testing time-dependent effects. For both groups of women age, and a history of abortion, were major factors associated with increased hazard. For women experiencing a second or higher-order birth a history of perinatal death was also associated with substantially increased hazard to the pregnancy.     

Paternal Incarceration and Support for Children in Fragile Families

High U.S. incarceration rates have motivated recent research on the negative effects of imprisonment on later employment, earnings, and family relationships. Because most men in jail and prison are fathers, a large number of children may be placed at considerable risk by policies of incarceration. This article examines one dimension of the economic risk faced by children of incarcerated fathers: the reduction in the financial support that they receive. We use a population-based sample of urban children to examine the effects of incarceration on this support. Both cross-sectional and longitudinal regressions indicate that formerly incarcerated men are less likely to contribute to their families, and those who do contribute provide significantly less. The negative effects of incarceration on fathers’ financial support are due not only to the low earnings of formerly incarcerated men but also to their increased likelihood to live apart from their children. Men contribute far less through child support (formal or informal) than they do when they share their earnings within their household, suggesting that the destabilizing effects of incarceration on family relationships place children at significant economic disadvantage.     

The Role of Family Policy in Explaining the International Variation in Child Subjective Well-Being

The article proposes an innovative analyse for cross-national differences in the subjective child well-being introducing new indicators and measures. This dimension addresses the issue of welfare support to parents and child early education. The question of this research is to what extend family policies can explain the variability of subjective child well-being components in different European countries. Based on this question, the two objective of this proposal are: (1) to review the existing literature with respect to conceptualization, measurement, and correlates of children’s subjective well-being, with a special emphasis on the context of family policies and family well-being in different European welfare states, and (2) to analyse the relation between these policies and subjective child well-being. In order to get these aims we have elaborated two indexes: the index of child subjective well-being and family policy index. Data for HBSC (Health Behaviour in School-aged Children) for the first index and data from OECD Family Database is used to build these indicators. We found that the index of child subjective well-being is comparatively higher in those countries where family policies are more generous in the areas of preschool education, family services, family spending and duration of paid parental leave.     

Elderly parent health and the migration decisions of adult children: Evidence from rural China

Recent research has shown that participation in migrant labor markets has led to substantial increases in income for families in rural China. This article addresses the question of how participation is affected by elderly parent health. We find that younger adults are less likely to work as migrants when a parent is ill. Poor health of an elderly parent has less impact on the probability of employment as a migrant when an adult child has siblings who may be available to provide care. We also highlight the potential importance of including information on nonresident family members when studying how parent illness and elder care requirements influence the labor supply decisions of adult children.     

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.