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.     

Mother’s home time and the production of child quality

This paper deals with the effect of mother’s time spent out of the labor force, and presumably in the home, on the “production” of child quality, where child quality is measured by intelligence (IQ), level of schooling attained, and market earning power. The results indicate that mother’s home time is most effective in producing (male) child quality for mothers who have attained relatively high levels of schooling. The results suggest that education programs which devote equal school resources to all (male) children do not necessarily provide equal educational opportunity and that the influence of family background on economic success is indirect, operating through home investments in children.     

Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the high prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality, whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health.     

Family size and maternal health: evidence from the One-Child policy in China

In this paper, we examine the impact of family size on maternal health outcomes by exploiting the tremendous change in family size under the One-Child policy in China. Using data from the China Health and Nutrition Survey 1993–2006, we find that mothers with fewer children have a higher calorie intake and a lower probability of being underweight and having low blood pressure; meanwhile, they have a higher probability of being overweight. This would occur if a smaller family size increases the food consumption of mothers, leading underweight women to attain a normal weight and normal weight women becoming overweight. Robust tests are performed to provide evidence on the hypothesis that the tradeoff between children’s quantity and mother’s “quality” is through a budget constraint mechanism, that is, having more children decreases the resource allocated to mothers and affects their health outcomes.     

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.     

Estimating seasonality effects on child mortality in Matlab,Bangladesh

This paper estimates the net effect of seasonality on child mortality in Matlab. Results suggest that childhood mortality was well above the average monthly level in the hot, dry month of April and in November, the first harvest month of the aman crop. It was found to be remarkably low in the post harvest months of February and March. and also in August. During the hungry months of September and October, children were at a considerably increased risk of mortality. particularly from diarrheal diseases, if mothers had no schooling. but this was not the case if mothers had schooling. The protective effect of the Matlab interventions on childhood death from diarrheal diseases was also greater during the hungry months than during other months of the year.     

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.     

Left behind: intergenerational transmission of human capital in the midst of HIV/AIDS

This paper provides evidence on how adverse health conditions affect the transfer of human capital from one generation to the next. We explore the differential exposure to HIV/AIDS epidemic in sub-Saharan Africa as a substantial health shock to both household and community environment. We utilize the recent rounds of the Demographic and Health Surveys for 11 countries in sub-Saharan Africa. First, we find that an additional year of maternal education leads to a 0.37-year increase in children’s years of schooling in the developing economies in sub-Saharan Africa. Second, our results show that mother’s HIV status has substantial detrimental effects on inheritability of human capital. We find that the association between infected mothers’ and their children’s human capital is 30 % less than the general population. Finally, focusing only on noninfected mothers and their children, we show that HIV prevalence in the community also impairs the intergenerational human capital transfers even if mother is HIV negative. The findings of this paper are particularly distressing for these already poor, HIV-torn countries as in the future they will have even lower overall level of human capital due to the epidemic.     

The informal health sector and health care-seeking behaviour of mothers in urban Dhaka slums

Infant and child mortality in Bangladesh has declined in recent years but early death rates remain high among Bangladesh’s urban poor, even in comparison to rates in rural Bangladesh. Although they live close to the country’s leading public hospitals and private health clinics, the urban poor continue to rely heavily on services and advice provided by the informal health sector. This paper examines the use of the informal health sector by urban poor children’s main caregivers, their mothers, and the key role performed by pharmacists in treating these children. It explores the nature of the relationship between the mothers and the health providers and the implications for the broader health system. The study combines in-depth interviews with survey data.     

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.     

The problems of eligibility and endogenous confounders when assessing the mortality impact of a nationwide disease-prevention programme: the case of insecticide-treated nets in Togo

Evaluation of the mortality impact of nationwide disease-prevention efforts is complicated by potential endogeneity: programme recipients may have unobserved characteristics that simultaneously make them both more likely to become recipients and more likely to survive as a result of other health practices. This population-based study assesses the mortality impact of a nationwide programme that distributed insecticide-treated nets (ITNs) to mothers of children aged 9-59 months in Togo. By comparing mortality rates before and after the programme according to households' eligibility status, we demonstrate that a one-time programme that restricts eligibility to households with a surviving child excludes some households with a high risk of child mortality. We then apply simultaneous estimation models to untangle the mortality impact of ITNs from the effects of unobserved confounders and show that among eligible households, living in a household with ITNs significantly reduces mortality for children aged 20-59 months, even after controlling for endogeneity.     

The Schooling of Offspring and the Survival of Parents

Contemporary stratification research on developed societies usually views the intergenerational transmission of educational advantage as a one-way effect from parent to child. However, parents’ investment in their offspring’s schooling may yield significant returns for parents themselves in later life. For instance, well-educated offspring have greater knowledge of health and technology to share with their parents and more financial means to provide for them than do their less-educated counterparts. We use data from the 1992–2006 Health and Retirement Study (HRS) to examine whether adult offspring’s educational attainments are associated with parents’ survival in the United States. We show that adult offspring’s educational attainments have independent effects on their parents’ mortality, even after controlling for parents’ own socioeconomic resources. This relationship is more pronounced for deaths that are linked to behavioral factors: most notably, chronic lower respiratory disease and lung cancer. Furthermore, at least part of the association between offspring’s schooling and parents’ survival may be explained by parents’ health behaviors, including smoking and physical activity. These findings suggest that one way to influence the health of the elderly is through their offspring. To harness the full value of schooling for health, then, a family and multigenerational perspective is needed.     

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.     

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.     

Aids mortality and the mobility of children in Kwazulu Natal,South Africa

This paper examines the effect of parental death on the mobility of 39,163 children aged 0-17 in rural KwaZulu Natal, South Africa, in 2000 and 2001. Parental mortality from all causes prior to and during follow-up increased the risk of a child moving by nearly two times after we controlled for the age and gender of the child and household characteristics. However, in the follow-up period, child mobility following maternal deaths from AIDS was lower than child mobility following maternal deaths from other causes. Younger children, boys, and children whose mothers or fathers were resident members of the children's households were also less likely to move.     

When Does Time Matter? Maternal Employment,Children’s Time With Parents,and Child Development

This study tests the two assumptions underlying popularly held notions that maternal employment negatively affects children because it reduces time spent with parents: (1) that maternal employment reduces children’s time with parents, and (2) that time with parents affects child outcomes. We analyze children’s time-diary data from the Child Development Supplement of the Panel Study of Income Dynamics and use child fixed-effects and IV estimations to account for unobserved heterogeneity. We find that working mothers trade quantity of time for better “quality” of time. On average, maternal work has no effect on time in activities that positively influence children’s development, but it reduces time in types of activities that may be detrimental to children’s development. Stratification by mothers’ education reveals that although all children, regardless of mother’s education, benefit from spending educational and structured time with their mothers, mothers who are high school graduates have the greatest difficulty balancing work and childcare. We find some evidence that fathers compensate for maternal employment by increasing types of activities that can foster child development as well as types of activities that may be detrimental. Overall, we find that the effects of maternal employment are ambiguous because (1) employment does not necessarily reduce children’s time with parents, and (2) not all types of parental time benefit child development.     

Differences in Child Health Across Rural,Urban, and Slum Areas: Evidence From India

The developing world is rapidly urbanizing, but an understanding of how child health differs across urban and rural areas is lacking. We examine the association between area of residence and child health in India, focusing on composition and selection effects. Simple height-for-age averages show that rural Indian children have the poorest health and urban children have the best, with slum children in between. With wealth or observed health environment held constant, the urban height-for-age advantage disappears, and slum children fare significantly worse than their rural counterparts. Hence, differences in composition across areas mask a substantial negative association between living in slums and height-for-age. This association is more negative for girls than boys. Furthermore, a large number of girls are “missing” in slums; we argue that this implies that the negative association between living in slums and health is even stronger than our estimate. The missing girls also help explain why slum girls appear to have a substantially lower mortality than rural girls, whereas slum boys have a higher mortality risk than rural boys. We estimate that slum conditions (such as overcrowding and open sewers), which the survey does not adequately capture, are associated with 20 % to 37 % of slum children’s stunting risk.     

HIV and fertility in Africa: first evidence from population-based surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. We utilize recent rounds of the demographic and health surveys that link an individual woman’s fertility outcomes to her HIV status based on testing. The data allow us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that although HIV-infected women have significantly lower fertility, local community HIV prevalence has no significant effect on noninfected women’s fertility.     

The effect of piped water on early childhood mortality in Urban Brazil, 1970 to 1976

The effects of access to piped water on the trends in child mortality and on differentials by income class are analyzed using data on surviving children and other variables in samples of urban mothers aged 20–29 in 1970 and 1976. Path analytic regression techniques are used to test a recursive model linking the supply and demand for piped water to selected household and community level variables, and to examine their joint effect on child mortality. The model’s estimated parameters for 1970 and 1976 are used to analyze changes in mortality between the two dates. Increased maternal education accounts for a larger share of the mortality decline than any other single factor. Increased access to piped water also contributes to mortality decline, and such access helps to reduce the mortality differential between lower and higher income and education classes.