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.     

Maternal union instability and childhood mortality risk in the Global South, 2010–14

Efforts to improve child survival in lower-income countries typically focus on fundamental factors such as economic resources and infrastructure provision, even though research from post-industrial countries confirms that family instability has important health consequences. We tested the association between maternal union instability and children’s mortality risk in Africa, Latin America and the Caribbean, and Asia using children’s actual experience of mortality (discrete-time probit hazard models) as well as their experience of untreated morbidity (probit regression). Children of divorced/separated mothers experience compromised survival chances, but children of mothers who have never been in a union generally do not. Among children of partnered women, those whose mothers have experienced prior union transitions have a higher mortality risk. Targeting children of mothers who have experienced union instability—regardless of current union status—may augment ongoing efforts to reduce childhood mortality, especially in Africa and Latin America where union transitions are common.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

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.     

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.     

Comparing Observed and Unobserved Components of Childhood: Evidence From Finnish Register Data on Midlife Mortality From Siblings and Their Parents

In this study, we argue that the long arm of childhood that determines adult mortality should be thought of as comprising an observed part and its unobserved counterpart, reflecting the observed socioeconomic position of individuals and their parents and unobserved factors shared within a family. Our estimates of the observed and unobserved parts of the long arm of childhood are based on family-level variance in a survival analytic regression model, using siblings nested within families as the units of analysis. The study uses a sample of Finnish siblings born between 1936 and 1950 obtained from Finnish census data. Individuals are followed from ages 35 to 72. To explain familial influence on mortality, we use demographic background factors, the socioeconomic position of the parents, and the individuals’ own socioeconomic position at age 35 as predictors of all-cause and cause-specific mortality. The observed part—demographic and socioeconomic factors, including region; number of siblings; native language; parents’ education and occupation; and individuals’ income, occupation, tenancy status, and education—accounts for between 10 % and 25 % of the total familial influence on mortality. The larger part of the influence of the family on mortality is not explained by observed individual and parental socioeconomic position or demographic background and thus remains an unobserved component of the arm of childhood. This component highlights the need to investigate the influence of childhood circumstances on adult mortality in a comprehensive framework, including demographic, social, behavioral, and genetic information from the family of origin.     

Disparities in Children’s Family Experiences by Mother’s Socioeconomic Status: The Case of Finland

A well-known argument claims that socioeconomic differentials in children’s family structures have become increasingly important in shaping child outcomes and the resources available to children in developed societies. One assumption is that differentials are comparatively small in Nordic welfare states. Our study examines how children’s experiences of family structures and family dynamics vary by their mother’s educational attainment in Finland. Based on register data on the childbearing and union histories of women in Finland born from 1969 onwards, we provide life-table estimates of children’s (N?=?64,162) experiences of family dissolution, family formation, and family structure from ages 0–15 years, stratified by mother’s education level at the child’s birth. We find huge socioeconomic disparities in children’s experiences of family structures and transitions. Compared to children of highly educated mothers, children of mothers with low levels of education are almost twice as likely to be born in cohabitation and four times as likely to be born to a lone mother. They are also much more likely to experience further changes in family structure—particularly parental separation. On average, children of low-educated mothers spend just half of their childhood years living with both their parents, whereas those of high-educated mothers spend four-fifths of their childhood with both parents. The sociodemographic inequalities among children in Nordic welfare states clearly deserve more scholarly attention.     

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.     

Polygyny and child survival in Nigeria: Age-dependent effects

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

Is There an Urban Advantage in Child Survival in Sub-Saharan Africa? Evidence From 18 Countries in the 1990s

Evidence of higher child mortality of rural-to-urban migrants compared with urban nonmigrants is growing. However, less attention has been paid to comparing the situation of the same families before and after they migrate with the situation of urban-to-rural migrants. We use DHS data from 18 African countries to compare child mortality rates of six groups based on their mothers’ migration status: rural nonmigrants; urban nonmigrants; rural-to-urban migrants before and after they migrate; and urban-to-rural migrants before and after they migrate. The results show that rural-to-urban migrants had, on average, lower child mortality before they migrated than rural nonmigrants, and that their mortality levels dropped further after they arrived in urban areas. We found no systematic evidence of higher child mortality for rural-to-urban migrants compared with urban nonmigrants. Urban-to-rural migrants had higher mortality in the urban areas, and their move to rural areas appeared advantageous because they experienced lower or similar child mortality after living in rural areas. After we control for known demographic and socioeconomic correlates of under-5 mortality, the urban advantage is greatly reduced and sometimes reversed. The results suggest that it may not be necessarily the place of residence that matters for child survival but, rather, access to services and economic opportunities.     

Determinants of infant and child mortality in Kenya: an analysis controlling for frailty effects

In this paper, Weibull unobserved heterogeneity (frailty) survival models are utilized to analyze the determinants of infant and child mortality in Kenya. The results of these models are compared to those of standard Weibull survival models. The study particularly examines the extent to which child survival risks continue to vary net of observed factors and the extent to which nonfrailty models are biased due to the violation of the statistical assumption of independence. The data came from the 1998 Kenya Demographic and Health Survey. The results of the standard Weibull survival models clearly show that biodemographic factors are more important in explaining infant mortality, while socioeconomic, sociocultural and hygienic factors are more important in explaining child mortality. Frailty effects are substantial and highly significant both in infancy and in childhood, but the conclusions remain the same as in the nonfrailty models.     

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.     

Urban determinants of racial differentiation in infant mortality

This study relates differential socioeconomic status between blacks and whites to racial differentiation in infant mortality rates. The basic assumption is that decreases in socioeconomic differentiation and related variables lead to decreases in the black—white infant mortality differential. A comparative approach based on aggregate measures of socioeconomic differentiation is utilized to compare sixty-one United States urban places. Path analysis shows that neonatal mortality differentiation is virtually unaffected by socioeconomic differentials while decreased racial differences in hospital births tend to increase neonatal mortality differentiation. In contrast, postneonatal differentiation is affected by socioeconomic differentiation, especially along the dimensions of income, education, and regional location. It is concluded that despite some suggestions that infant mortality is no longer responsive to socioeconomic factors, postneonatal differentation is affected by socioeconomic differentials when comparison is based on city units.     

Reproductive patterns and child mortality in guatemala

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child.     

Measuring socioeconomic mortality differentials over time

Using 1973 Current Population Survey data matched to 1973-1978 Social Security mortality records, this study measures the relationship between the income and education of men and their subsequent mortality. The estimated relationships are compared with socioeconomic mortality differentials found by Kitagawa and Hauser in their study of 1960 census-death certificate matched data. The comparison suggests that there has been no improvement in the relative mortality experience of low socioeconomic status men. More generally, the article discusses how Social Security data could be used to monitor, on a continual basis, our progress toward eradicating significant mortality differentials in the United States.     

Socio-economic determinants of mortality in Latin America

The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.     

Males’ Later-Life Mortality Consequences of Coresidence With Paternal Grandparents: Evidence From Northeast China, 1789–1909

In this study, we investigate the effect of early-life coresidence with paternal grandparents on male mortality risks in adulthood and older age in northeast China from 1789 to 1909. Despite growing interest in the influence of grandparents on child outcomes, few studies have examined the effect of coresidence with grandparents in early life on mortality in later life. We find that coresidence with paternal grandmothers in childhood is associated with higher mortality risks for males in adulthood. This may reflect the long-term effects of conflicts between mothers and their mothers-in-law. These results suggest that in extended families, patterns of coresidence in childhood may have long-term consequences for mortality, above and beyond the effects of common environmental and genetic factors, even when effects on childhood mortality are not readily apparent.     

Going it alone and adrift: the socioeconomic profile and parental involvement of single-father and single-mother families in post-industrial Taiwan

In spite of the rising prevalence of marital dissolution in Asia over the past decades, little is known about single-parent families in Asia. The present study aims to contribute to the literature by investigating the changing socioeconomic characteristics and parental involvement (measured by parent–child activities and parental awareness of children) of single-father and single-mother families in Taiwan around the millennium. Using a nationally representative sample of 641 single fathers and 730 single mothers from the Taiwan Social Trend Survey collected in 1998, 2002 and 2006, this study found that the apparent socioeconomic advantage of single-father families over single-mother families has weakened. Parent–child activities and parental awareness are lower for single fathers than for single mothers and married fathers. The association between higher parental education and more parent–child activities and parental awareness is more pronounced among single fathers than among single mothers. The presence of co-residential grandparents is associated with lower parent–child activities with pre-teen children among single mothers. The results warrant greater attention to the wellbeing and development of adults and children from low SES single-father families in post-industrial Taiwan.     

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.     

Christian–Muslim differences in child survival in Egypt

Ethnic and religious inequalities in child survival have been documented in many countries. In Egypt, during the 1980s and 1990s, Christians had higher childhood mortality than Muslims despite their higher socio-economic status (SES) and concentration in urban areas. This paper explores reasons for this Christian–Muslim mortality gap. Data for this study are drawn from Egypt’s 1988, 1992, 1995, 2005 and 2008 Demographic and Health Surveys, which recorded the respondents’ religious affiliation. The main analysis compares children of Christian and Muslim mothers in survival to age five using proportional hazards Cox regression models. Results indicate that differences in the regional distributions of Christians and Muslims positively contributed to the mortality gap during the 1980s–1990s. The majority of Christians resided in Upper Egypt where childhood mortality rates were considerably higher than in other regions. However, only part of higher Christian mortality can be explained by their regional concentration. In Upper Egypt, despite their higher SES, as well as greater urban residence, Christians had higher mortality than Muslims. These findings are at odds with research demonstrating the significance of SES and urban concentration in explaining ethnic–religious mortality gaps.