Maternal Education, Birth Weight, and Infant Mortality in the United States

This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its “indirect” effect (operating through birth weight) and/or to its “direct” effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27–108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40–0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.     

Paradox Revisited: A Further Investigation of Racial/Ethnic Differences in Infant Mortality by Maternal Age

I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995–2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.     

Sustained Effects of the 1974–5 Famine on Infant and Child Mortality in a Rural Area of Bangladesh

In this paper the sustained effects of the 1974–75 famine on cohort mortality in a rural area of Bangladesh are studied. In the analysis, mortality rates for children born and conceived during the famine are compared with those from a post-famine cohort. In the famine-born cohort, mortality was higher during the first and second years of life, while in the famine-conceived cohort it was higher during the first year and lower during the second compared to the non-famine cohort. No significant differences in mortality by cohort were observed between the ages of 24 and 59 months. Using logistic regression, interactions between famine and socio-demographic characteristics were also studied. Three principal results emerged: first, a differential effect of the famine by socio-economic group was only present during the post-neonatal period for the famine-born cohort; secondly, children aged 12–23 months who were born to younger mothers were more adversely affected by the famine than those born to older mothers; and thirdly, although there was excess mortality for girls aged 24–59 months relative to boys of the same age in the non-famine and famine-conceived cohorts, there was little difference between mortality by sex for the famine-born.     

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.     

Famine,Disease, and Mortality Patterns in the Parish of Borshevka,Russia, 1830–1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availability and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Persistence,Mean-Reversion and Non-linearities in Infant Mortality Rates

This study examines the time series behavior of infant mortality rates within a long memory approach with non-linear trends using data for 37 countries. The main results show significant differences both in the degree of integration and non-linearities among the analyzed series. Furthermore, non-linearities in the time trends are found in most of the cases, in contrast with the main assumption of linearity used in the literature. Finally, the results on the integration order of the series have important policy implications in many areas, such as on international convergence in mortality rates, on the income and infant mortality relationship, and, on whether health policy interventions will have transitory or permanent effects on infant mortality rates.     

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

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

Polygynous Contexts,Family Structure,and Infant Mortality in Sub-Saharan Africa

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.     

Gender Inequality,Maternal Mortality and Inclusive Growth in Nigeria

The relevance of women in contributing to inclusive growth and consequently economic development in Nigeria cannot be overemphasized. Women play important social, economic and productive roles in any economy. Maternal mortality rate refers to the annual number of deaths of women from pregnancy-related causes per 100,000 live births, and Nigeria’s rate is still relatively high at about 630 when compared with the figures of the developed countries. For inclusive growth to be achieved in Nigeria, women should not be neglected and marginalized so they can contribute their quota to the growth of the country, but maternal mortality rate needs to be reduced because it is only the living that can make contributions to growth. Thus, this study examined the long run effect of gender inequality, maternal mortality and inclusive growth in Nigeria using time series data spanning from 1985 to 2017, and employed the ARDL econometric technique. The results showed that gender inequality and maternal mortality have negative impacts on inclusive growth in Nigeria. Therefore, the study recommends that women should be properly taken care of during pregnancy so that the maternal mortality rate can be reduced and hence they will be able to make meaningful contributions to the growth of the Nigerian economy.

     

改善村级社会服务能力,降低贫困户母婴健康风险

较高的母婴死亡率不仅与社区贫困紧密相关,而且与家庭贫困互为因果.目前,在贫困人口的食品短缺问题逐渐获得缓解的情况下,消除健康贫困特别是降低贫困户孕产妇和婴儿健康风险的议题理应尽快纳入政府扶贫日程.中国扶贫基金会在加强乡村妇幼保健网、重设激励机制、改善村级保健服务和直接援助贫困户妇女儿童方面的制度创新,为政府在更广阔的范围内实施此类项目提供了有益的经验.     

Infant Mortality by Cause of Death: Main and Interaction Effects

We examine infant mortality among the 1980-1982 live birth cohorts in the state of Florida, specific to five categories of underlying cause of death: infections, perinatal conditions, delivery complications, congenital malformations, and sudden infant death syndrome. The gross and net effects of eight categorical and continuous independent variables, along with 11 first-order interactions, are examined with microlevel data through the use of multinomial logit regression. Findings suggest the complexity of variable effects by cause of death and indicate the simultaneous importance of biological and social factors. It is important that the pattern of interactions suggests an overall dependence of infant life chances on social circumstances. It also suggests that these effects are attenuated for some variables and causes of death at lower birth weights, probably due to advances in health care organization, access, and technology.     

Spanish Surname and Anglo Infant Mortality: Differentials Over a Half-Century

Using a half-century of death records from San Antonio/Bexar County, Texas, we examine the timing and cause structure of Spanish surname and Anglo infant mortality. Our findings show that despite the substantial disparities between ethnic-specific infant mortality rates in the early years of the study, there have been consistent declines in overall, neonatal, and postneonatal mortality for both groups, as well as a major convergence of mortality rates between Spanish surname and Anglo infants. Further, we demonstrate that the convergence is of relatively recent origin and is due primarily to shifts in postneonatal mortality. Finally, we examine the transition reflected in the cause structure of ethnic-specific infant mortality and show that the convergence was largely the result of reductions in deaths from exogenous causes. Implications for research into the "epidemiologic paradox" are discussed.     

Maternal Reading Skills and Child Mortality in Nigeria: A Reassessment of Why Education Matters

Mother’s formal schooling—even at the primary level—is associated with lower risk of child mortality, although the reasons why remain unclear. This study examines whether mother’s reading skills help to explain the association in Nigeria. Using data from the Demographic and Health Survey, the analysis demonstrates that women’s reading skills increase linearly with years of primary school; however, many women with several years of formal school are unable to read at all. The results further show that mother’s reading skills help to explain the relationship between mother’s formal schooling and child mortality, and that mother’s reading skills are highly associated with child mortality. The study highlights the need for more data on literacy and for more research on whether and how mother’s reading skills lower child mortality in other contexts.     

The determinants of Infant Mortality in the Less Developed Countries: A Cross-National Test of Five Theories

The infant mortality rate varies widely across theless developed countries. Five macro-social changetheories exist that can explain the variation of theinfant mortality rate across the less developedcountries: modernization theory,dependency/world-systems theory, gender stratificationtheory, economic disarticulation theory, anddevelopmental state theory. Although research supportsthe claims of each theoretical narrative, no singlestudy examines all five narratives simultaneously oris based on recent data. The purpose of the researchreported here was to fill this gap in the literatureby examining the simultaneous effects ofindustrialization, four alternative measures ofeconomic dependence, female educational attainment,economic disarticulation, state strength, and acontrol variable, Sub-Saharan African status, on theinfant mortality rate for 59 less developed countriesin 1991. Results of eight tests of the fivetheoretical narratives indicate thatindustrialization, state strength, and three of thefour measures of economic dependence have little neteffect on infant mortality, whereas economicdisarticulation, female education, debt dependence,and Sub-Saharan African status have the expectedeffects on infant mortality. Theoretical and policyimplications of the results are briefly discussed.