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.     

Parental underinvestment: A link in the fertility-mortality continuum

Selective parental investment in siblings has been used to describe differential mortality rates. Using data from 986 Filipino women who had an average of 4.8 live births, a LISREL and six sets of regression models support the hypothesis that fertility is linked to underinvestment and that mortality, as a consequence, is linked to high birth order. The analysis also identifies intervening factors associated with this relationship. Age of mother at childbirth showed a strong influence on the relationship of birth order and infant and child mortality; correlations are stronger among older than youger mothers. However, even after the effect of age of mother at childbirth was partialled out, the effect of birth order on infant and child mortality remained significant and substantial. The conclusion is that parental underinvestment represents a link between fertility and mortality during infancy and early childhood that has not been described previously. Policy makers appear to have overlooked parental underinvestment in favor of more obvious economic and health mediators.     

Maternal Age and Offspring Adult Health: Evidence From the Health and Retirement Study

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age?Coffspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25?C34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age?Coffspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.     

Birth and death in cities in the developing world

City dwellers in Sub-Saharan Africa have increased roughly 600% in the last 35 years. Throughout the developing world, cities have expanded at a rate that has far outpaced rural population growth. Extensive data document lower fertility and mortality rates in cities than in rural regions. But slums, shantytowns, and squatters' settlements proliferate in many large cities. Martin Brockerhoff studies the reproductive and health consequences of urban growth, with an emphasis on maternal and child health. Brockerhoff reports that child mortality rates in large cities are highest among children born to mothers who recently migrated from rural areas or who live in low-quality housing. Children born in large cities have about a 30% higher risk of dying before they reach the age of 5 than those born in smaller cities. Despite this, children born to migrant mothers who have lived in a city for about a year have much better survival chances than children born in rural areas to nonmigrant mothers and children born to migrant mothers before or shortly after migration. Migration in developing countries as a whole has saved millions of children's lives. The apparent benefits experienced in the 1980s may not occur in the future, as cities continue to grow and municipal governments confront an overwhelming need for housing, jobs, and services. Another benefit is that fertility rates in African cities fell by about 1 birth per woman as a result of female migration from villages to towns in the 1980s and early 1990s. There will be an increasing need for donors and governments to concentrate family planning, reproductive health, child survival, and social services in cities, particularly in Sub-Saharan Africa, because there child mortality decline has been unexpectedly slow, overall fertility decline is not yet apparent in most countries, and levels of migration to cities are anticipated to remain high.     

Parental age and offspring mortality: Negative effects of reproductive ageing may be counterbalanced by secular increases in longevity

As parental ages at birth continue to rise, concerns about the effects of fertility postponement on offspring are increasing. Due to reproductive ageing, advanced parental ages have been associated with negative health outcomes for offspring, including decreased longevity. The literature, however, has neglected to examine the potential benefits of being born at a later date. Secular declines in mortality mean that later birth cohorts are living longer. We analyse mortality over ages 30–74 among 1.9 million Swedish men and women born 1938–60, and use a sibling comparison design that accounts for all time-invariant factors shared by the siblings. When incorporating cohort improvements in mortality, we find that those born to older mothers do not suffer any significant mortality disadvantage, and that those born to older fathers have lower mortality. These findings are likely to be explained by secular declines in mortality counterbalancing the negative effects of reproductive ageing.     

Maternal Age and Child Development

Although the consequences of teen births for both mothers and children have been studied for decades, few studies have taken a broader look at the potential payoffs—and drawbacks—of being born to older mothers. A broader examination is important given the growing gap in maternal ages at birth for children born to mothers with low and high socioeconomic status. Drawing data from the Children of the NLSY79, our examination of this topic distinguishes between the value for children of being born to a mother who delayed her first birth and the value of the additional years between her first birth and the birth of the child whose achievements and behaviors at ages 10–13 are under study. We find that each year the mother delays a first birth is associated with a 0.02 to 0.04 standard deviation increase in school achievement and a similar-sized reduction in behavior problems. Coefficients are generally as large for additional years between the first and given birth. Results are fairly robust to the inclusion of cousin and sibling fixed effects, which attempt to address some omitted variable concerns. Our mediational analyses show that the primary pathway by which delaying first births benefits children is by enabling mothers to complete more years of schooling.     

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.     

Working and caring for large families: do mothers face a trade-off?

Does having three or more children lower the chance that mothers participate in the labour force compared to those who have two children? Most of the previous literature on this topic describes the substantial indirect costs of children for first-time mothers, but having additional children at higher parities can entail even higher indirect costs. This paper finds a labour force participation gap between mothers who have three or more children and those who have two children. It explores whether this gap is caused by the selectivity of those who purposely choose to have large families or by family size itself. It also questions if the gap occurs simply because mothers with 3 or more children are consequently more likely to care for young children: 42?% of them have a child under the age of five compared to only 38.7?% of mothers with 2 children. A priori, it is unclear if the employment gap between these two groups of mothers is driven by the difference in the age of the youngest child or by the difference in the number of children. This paper contributes to the literature by disentangling the effect of having an additional child from having an additional young child in the household with a simple but innovative approach (grouping by mother??s age and her age at the second pregnancy) that avoids controlling for the age of the youngest child in regression.     

The impact of childhood mortality on Fertility in six rural Thanas of Bangladesh

In this article, we examine the relationship between child mortality and subsequent fertility using prospective longitudinal data on births and childhood deaths occurring to nearly 8000 Bangladeshi mothers observed over the 1982-1993 period, a time of rapid fertility decline. Generalized hazard-regression analyses are employed to assess the effect of infant and child mortality on the hazard of conception, with controls for birth order and maternal age and educational attainment. Results show that childhood mortality reduces the time to subsequent conception if the death occurs within a given interval, representing the combined effect of biological and volitional replacement. The time to conception is also reduced if a childhood death occurs during a prior birth interval, a finding that signifies an effect of volitional replacement of the child that died. Moreover, mortality effects in prior birth intervals are consistent with hypothesized insurance (or hoarding) effects. Interaction of replacement with elapsed time suggests that the volitional impact of child mortality increases as the demographic transition progresses. This volitional effect interacts with sex of index child. Investigation of higher-order interactions suggests that this gender-replacement effect has not changed over time.     

Uncovering the impact of the HIV epidemic on fertility in Sub-Saharan Africa: the case of Malawi

We evaluate the impact of the HIV/AIDS epidemic on the reproductive behaviour for all women in Malawi, HIV-negative and HIV-positive alike, allowing for heterogeneous response depending on age and prior number of births. HIV/AIDS increases the probability that a young woman gives birth to her first child, while it decreases the probability to give birth of older women and of women who have already given birth. The resulting change in the distribution of fertility across age groups is likely to be more demographically and economically important than changes in the total number of children a woman gives birth to.     

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.     

Communication about sex and birth control between mothers and their adolescent children

This paper explores the extent of communication about sex and birth control between mothers and two of their children between the ages of ten and eighteen. Results indicate that mothers are more likely to discuss these issues with their older and female children. Variations in patterns of communication are also examined by mother's education, race, and family income. Since many of the questions were asked of both mothers and children, comparisons are made of mother and child reports of discussions about sexual relations and birth control. Mothers' attitudes toward premarital sex and use of birth control, as well as her own behaviors in these areas are examined for their relationships to whether she communicates with her children about these topics. The relationship between presence of communication and children's knowledge about birth control is also discussed.This article is based on data collected by William and Susan Philliber, and the methodology students of the Department of Sociology, University of Cincinnati. An earlier version of this paper was presented at the Annual Meeting of the Population Association of America, April 13–15, 1978, Atlanta, Georgia. Requests for reprints should be sent to Pearila Brickner Rothenberg, Center of Population and Family Health, Columbia University, 60 Haven Avenue, New York, New York 10032.     

Family planning's benefits include improved child health and nutrition: new data from Bangladesh

2 recent studies from the Matlab in Bangladesh confirm that family planning promotes child survival. The 1st study is a longitudinal analysis of 3370 births in 1985 to women living in 70 villages who were served by the International Centre for Diarrhoeal Disease Research, Bangladesh's Matlab Family Planning and Health Services Project. The 2nd is a study of 12-26 month old children and 24-36 month old children, all of whom were born in the same 70 villages between July 1985 and June 1986. The 1st study demonstrates that family planning improves child survival by lengthening the birth interval. In fact, if women delay a subsequent birth by about 2 years, child survival improves at all ages up to 5 years. Longer birth intervals result in a reduction of very high order births. The same study also reveals that family planning improves child survival indirectly by granting mothers access to integrated maternal and child health services. The 2nd study indicates that a child is 3 times more likely to suffer malnutrition, even at age 3, than a child whose mother gives birth again at an interval greater than 24 months. Specifically, the mother removes the index child from the breast prematurely, thereby adversely affecting the index child's nutrition. The birth interval prior to the index child does not adversely affect the index child's nutritional status, however. The 2nd study's result suggest that birth spacing, as promoted by family planning programs, improves child health and nutrition. The findings from these studies show the importance of continued investments in family planning programs in developing countries.     

Single Motherhood and Child Mortality in Sub-Saharan Africa: A Life Course Perspective

Single motherhood in sub-Saharan Africa has received surprisingly little attention, although it is widespread and has critical implications for children’s well-being. Using survival analysis techniques, we estimate the probability of becoming a single mother over women’s life course and investigate the relationship between single motherhood and child mortality in 11 countries in sub-Saharan Africa. Although a mere 5 % of women in Ethiopia have a premarital birth, one in three women in Liberia will become mothers before first marriage. Compared with children whose parents were married, children born to never-married single mothers were significantly more likely to die before age 5 in six countries (odds ratios range from 1.36 in Nigeria to 2.61 in Zimbabwe). In addition, up to 50 % of women will become single mothers as a consequence of divorce or widowhood. In nine countries, having a formerly married mother was associated with a significantly higher risk of dying (odds ratios range from 1.29 in Zambia to 1.75 in Kenya) relative to having married parents. Children of divorced women typically had the poorest outcomes. These results highlight the vulnerability of children with single mothers and suggest that policies aimed at supporting single mothers could help to further reduce child mortality in sub-Saharan Africa.     

Child mortality and reproductive behaviour in German village populations in the past: A micro-level analysis of the replacement effect

Abstract Reproductive histories of couples married during the eighteenth and nineteenth centuries in a sample of 14 German villages are analysed in order to answer several questions regarding the relationship between child mortality and reproductive behaviour. An effort is made through selection of cases and use of multiple classification analysis to eliminate or control non-volitional or otherwise confounding influences on the relationship between a couple's experience with child mortality and their fertility. The results do not provide a decisive answer to the question of whether, under a regime of otherwise presumed natural fertility, previous experience of child mortality affected subsequent reproductive behaviour. The evidence was much clearer in indicating that behaviour consistent with replacement efforts emerged or strengthened as family limitation spread. Finally, the results indicated that though it was not necessary for overall child mortality to decline before family limitation practices were adopted, couples with the most favourable child mortality experience were most likely to practise family limitation and to reduce their fertility. Child mortality appeared at least to impede, if not totally prevent, efforts to reduce the number of children ever born or to cease childbearing at an earlier age or at a given parity.     

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.     

Perception of HIV risk and the quantity and quality of children: the case of rural Malawi

The empirical literature on the impact of HIV on the quality (Q) and quantity (N) of children provides limited and somewhat mixed evidence. This study introduces individual HIV risk perceptions, as a predictor of mortality, into a Q–N investment model. In this model, higher maternal mortality predicts lower N, while higher child mortality predicts lower Q. Thus, the two effects together make likely negative associations between HIV and both Q and N. Based on longitudinal micro-data on mothers and their children in rural Malawi, our results suggest that higher mothers’ reported HIV risk reduces both child quality, as reflected in children’s schooling and health, and child quantity, when the perceived risk is already moderate or high. The effects are sizable and, in the case of Q (schooling and health), are found for children and teenagers, both boys and girls, while in the case of N, they are found for young and mature women.     

An analysis of population growth in Romania]

After liberation in Romania the high birth rate, high mortality rate, and high population growth rate pattern changed to a low birth rate, low mortality rate, and low growth rate pattern. Higher standard of living and educational level, the increasing involvement of women in social and economic activities, the rapid development of cities, and the lower infant mortality rate are the 4 main factors responsible for this development. Consequently, Romania is facing a problem of increasing labor shortages. People who would otherwise be in the labor force are in school to allow the rapid development in science and technology. The increasing proportion of older retirees in the population also decreases the labor supply. Agricultural mechanization has provided labor to support industrialization in the past. Future increases will emphasize irrigation and soil improvement rather than mechanization. The Romanian government has established 6 new laws to stimulate population growth. First, award bonuses to families with more children and tax childless couples. Second, eliminate factors destabilizing families, preference to young couples, and restrict abortion and divorce. Third, protect women's societal rights through bonuses to mothers and paid maternity leave to pregnant women. Fourth, reduce mortality rate and improve people's health and life span. Fifth, better utilize the labor force and redistribute the population by economic methods. Six, use longterm procedures to achieve the best population structure and to have a younger population.     

Thailand population statistics

A few statistics on population for Thailand are reported for April 1, 1993. Total population is determined to be 58,113,000 of which 29,039,000 are males and 29,074,000 are females. The urban population was 17,852,000 and the rural population was 40,261,000. Regional distribution showed population in the north to be 9,443,000, in the northeast to be 19,590,000, in the south to be 7,107,000, and in the center excluding Bangkok to be 14,517,000. The population of Bangkok Metropolitan area was 7.5 million. Age distribution was 16.7 million under the age of 15 years, 19.4 million 6-21 years, 37.1 million 15-59 years, 4.2 million 60 years and older, and 35.3 million 20 years and older. There were 15,002,000 women in the reproductive ages of 15-44 years. The crude birth rate was 17.4/1000 population. The crude death rate was 5.9/1000 population. Infant mortality was 35.5/1000 live births. The natural growth rate was 1.15%. Life expectancy at birth was 66.4 years for males and 71.8 years for females. Life expectancy at 60 years was 17.9 years for males and 21.2 years for females. The total fertility rate was 2.2/woman. Contraceptive prevalence was 75.0%. Estimated population in the year 2012 is expected to be 71,310,000. A graph provides the projected number of living children per 1000 aged 12 years or younger who would be born to mothers with HIV infection and the number who would be orphans between 1990 and 2000. 350,000 children 12 years and under are expected to be born to HIV-infected mothers in the year 2000.