The Differential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1–3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.     

Religion and Health in Early Childhood: Evidence from South Asia

This article studies early childhood health in India, Bangladesh, and Nepal, focusing on inequalities in anthropometric outcomes by religious adherence. India and Nepal have Hindu majorities, while Bangladesh is predominantly Muslim. The results suggest that Muslim infants have an advantage over Hindu infants in height‐for‐age in India (for boys and girls) and in Bangladesh (for boys). However, this advantage disappears beyond 12 months of age, at which point Hindu children in all three countries are found to have significantly better anthropometric outcomes than Muslim children. We report tests that rule out mortality selection and undertake falsification and robustness exercises that confirm these findings. Further results suggest that exposure to Ramadan fasting in utero may lead to positive selection of Muslim male infants, partially explaining the Muslim infant health advantage, but this does not fully explain the shift from Muslim advantage in infancy to Hindu advantage in childhood in all three countries.     

The increasing racial disparity in infant mortality: Respiratory distress syndrome and other causes

Although substantial declines in infant mortality rates have occurred across racial/ethnic groups, there has been a marked increase in relative black-white disparity in the risk of infant death over the past two decades. The objective of our analysis was to gain insight into the reasons for this growing inequality on the basis of data from linked cohort files for 1989-1990 and 1995-1998. We found a nationwide reversal from a survival advantage to a survival disadvantage for blacks with respect to respiratory distress syndrome over this period. The results are consistent with the view that the potential for a widening of the relative racial gap in infant mortality is high when innovations in health care occur in a continuing context of social inequality. As expected, the results for other causes of infant mortality, although similar, are less striking. Models of absolute change demonstrate that among low-weight births, absolute declines in mortality were greater for white infants than for black infants.     

Fertility and Financial Development in South Asia

The paper empirically examines old-age security hypothesis to explain fertility rates in South Asia. Panel data is used for the period 1972–2013 for seven South Asian countries which include Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The estimated results reveal that in South Asia fertility rate decreases with the increase in financial development. Thus, the findings support old-age security hypothesis that parents use children as financial instruments to secure their old age. This paper validates the theory that the availability of alternative financial tools reduces the incentives of households to have large offspring. Infant mortality is also shown an important factor for high fertility rate in South Asia. This implies that households cover their risk from losing children by producing more children. The results also reveal that fertility rate decreases with the increase in per capita income, which implies that households treat children as inferior good in this region. In other words, households prefer quality of children over quantity of children when their income level increases. The results have also shown that fertility decreases with the increase in education, urbanization, agriculture productivity and industrialization. The study has some important policy implications.     

Skeletal biology and the history of Native Americans and African Americans

The authors incorporate data from skeletal remains in an attempt to construct health profiles for the Amerindian population before Columbus's arrival and for the antebellum black slave populations of North America and the Caribbean. They examine the impact of poor nutrition among slaves, as evidenced in bone and tooth samples, on infant and childhood mortality, fertility, and adult mortality. They go on to suggest that the change from a hunter-gatherer life-style to a more sedentary agricultural one resulted in poorer health for the Amerindian population. However, agriculture made soft foods more available, allowing women to wean their children earlier, thus increasing overall fertility.     

Why do the children of the poor die in Dhaka,Bangladesh?

Mortality data from much of the developing world show that the health advantage of urban over rural areas is being eroded. The single most important factor is the very high mortality of the slum populations, mostly rural-urban migrants in the large cities. This has been shown to be true of Dhaka, Bangladesh, where much of the mortality differential between the poor and other residents can be explained by higher mortality in the slums among young children, especially infants. This paper reports on a collaborative project, Access to Health and Reproductive Health Services in the Dhaka Slums, which confirmed this situation in a 1999 survey and employed an in-depth approach in 2000 to investigate the circumstances of child deaths. It is shown that these deaths mostly occur among illiterate rural-urban migrants who have brought pre-Islamic folk beliefs about illness and its treatment with them. This and cost in most cases preclude modern medical treatment. These disadvantages are reinforced by treatment decisions being made in a purdah society almost entirely by women, especially old women, with husbands and other male relatives often being beyond contact. Suggestions are advanced for improving the situation.     

Agricultural backwardness being the fundamental cause of rapid population growth]

We have been an agricultural country for more than 2000 years. The low level of mechanization and dependence of manpower in our agriculture required a large quantity of labor. Therefore, development of Chinese feudal society was closely related to the population growth. After the establishment of a new socialistic China, the rapid development of agricultural production resulted in our 1st population boom (1952 to 1957). Later the rapid development of heavy industry demanded the transfer of a large amount of labor from agriculture. The shortage of labor in China caused reductions in agriculture and a 2nd population boom. The backward nature of China's agriculture requires increased labor input to increase production. On the other hand, the increased productivity does not match the demands of the increased population. Consequently, living standards in the society decrease and the population growth slows. The emphasis on population control and family planning is indeed beneficial to China's economy. The fundamental solution of China's population problem must rely on a technical revolution in agriculture and increased agricultural productivity.     

The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Race/Ethnicity/Nativity Differentials and Changes in Cause-Specific Infant Deaths in the Context of Declining Infant Mortality in the U.S.: 1989–2001

Using data from the national linked birth/infant death cohort files, we examined race/ethnicity/nativity disparities and changes in infant mortality due to the five leading causes of infant death between 1989 and 2001. Our results indicate substantial decreases in infant mortality from three causes (congenital anomalies, sudden infant death syndrome, and respiratory distress syndrome) for which specific perinatal health innovations emerged or were expanded. However, for these three causes, the relative disparities in infant mortality between infants born to U.S.-born black women as compared to infants of U.S.-born white women increased following the introduction (or expansion) of beneficial interventions. Among infants of U.S.-born Mexican American mothers, the findings differed. In the static comparisons, our results show the often-reported similarity in the risk of death of these babies compared to those born to non-Hispanic white mothers. However, when changes over time were modeled, there was an erosion of the relatively favorable survival chances of Mexican American infants. Our models show little change in the relative risk of death for infants of immigrant women. Regarding the other two causes (disorders relating to short gestation and unspecified low birth weight and maternal complications) for which no efficacious innovations occurred, either little change or actual increases in risks were observed. Future studies and health policy efforts should be geared toward further understanding and aggressively working to close infant mortality gaps, especially for infants of U.S.-born black mothers—an effort that will be facilitated by research focused on cause-specific infant mortality.     

Population reproduction and migration in Yugoslavia since World War 2]

Yugoslavia is composed of 6 formerly independent countries. Therefore, the economic development and population growth rates are quite different in different areas. The population growth rate varies from .31% in developed areas to 1.37% in mid-developed areas to 2.78% in underdeveloped areas. In developed areas there are large urban populations and more women with higher education and social involvement. The mortality rate in Yugoslavia has been markedly reduced in the last few decades because of the improvement of their health care system. This is especially obvious in mid- and underdeveloped areas. The mortality rate has increased in developed areas because of the increase in traffic accidents, smoking, drinking, and suicides. Yugoslavia is a multiracial country, and the population growth rate differs among the different races. The nationwide family planning program in Yugoslavia is run on a voluntary basis, and they do not have a unified population policy because of their complicated racial and economic situation. After World War 2 a large portion of the population migrated from the country to the cities because of the mechanization of agriculture. The higher living standard in developed areas also attracted people to migrate from mid- and underdeveloped areas. Yugoslavia has a tradition of emigration--a .1 to .2% annual emigration rate. The government encouraged their people to find jobs abroad in the mid 1960's.     

Widowhood,family size,and post-reproductive Mortality: a comparative Analysis of three populations in Nineteenth-Century Europe

Researchers from a number of disciplines have offered competing theories about the effects oJ childbearing on parents 'postreproductive longevity. The "disposable soma theory" argues that investments in somatic maintenance increase longevity but reduce childbearing. "Maternal depletion" models suggest that the rigors of childrearing increase mortality in later years. Other researchers consider continued childbearing a sign of healthy aging and a predictor of future longevity. Empirical studies have produced inconsistent and contradictory results. Our focus is on the experience of widowhood, which has been ignored in previous studies. We hypothesize that the death of a spouse is a stressful event with long-term consequences for health, especially for women with small children. Data are drawn from historical sources in Sweden, Belgium, and the Netherlands from 1766 to 1980. Postreproductive mortality was highest among young widows with larger families in all three samples. Age at last birth had little or no effect. We conclude that raising children under adverse circumstances can have long-lasting, harmful effects on a mother's health.     

Effect of Pregnancy Intention on Child Well-Being and Development: Combining Retrospective Reports of Attitude and Contraceptive use

Prior research has documented a relationship between unintended pregnancy and negative consequences for infants and children. Much of this research is based on retrospective reports of intention, but this method has been critiqued as subject to biases in recall and reporting. Non-retrospective measures have also been employed, but these are less widely available and tend to be hindered by limited samples. Using the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up, a composite measure of reported pregnancy intention and birth control use is constructed to attempt to overcome some limitations of the use of retrospective reports of intention. This composite measure is compared to more conventional measures through analyses predicting the effects of pregnancy intention on child health, activity, and development. Across the different constructions of the pregnancy intention measure, children from unintended pregnancies have poorer outcomes. They are more likely to have less than excellent health, undesirable activity levels, and below median scores on a development assessment. The composite measure predicts similarly to the more conventional measures of intention, but provides an additional dimension that helps address some of the concerns about bias in retrospective reporting, while maintaining the benefit of application in existing large and representative samples. Researchers and policy makers need to continue their concern about the effects of unintended pregnancies, and need widely available measures to understand determinants, consequences, and prevention strategies.     

Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983–2002

This paper examines absolute change in infant mortality from 5 leading causes of death for whites and blacks over a 20 year period. Change in infant mortality varies by cause, race, and birth weight. Absolute decline in mortality from respiratory distress syndrome (RDS) and sudden infant death syndrome (SIDS) in the overall study population has been more rapid for black infants during the period after specific technological innovations were approved and behavioral practices were recommended for these conditions. For low birth weight infants, blacks experienced greater decline in mortality from SIDS and whites experienced greater decline in RDS mortality. Despite remarkable declines in mortality from these causes, relative racial disparities have increased over this time period. For the overall study population, blacks and whites experienced similar rates of mortality decline from congenital anomalies. Mortality decline from this cause among low birth weight infants occurred at a faster pace for whites. Mortality from causes for which no specific innovations were developed increased for blacks but remained relatively constant for whites. An analysis of absolute change complements the relative disparities approach by revealing the dynamics of change, thus providing a more complete understanding of changing racial disparities in infant mortality.     

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.     

Major Socioeconomic Driving Forces of Improving Population Health in China: 1978–2018

China's post-Cultural-Revolution reform generated rapid economic growth. But it also brought about major negative changes, especially in the early stage, which jeopardized population health and mortality gains. Nonetheless, improvements continued. China had achieved the Millennium Development Goal target 4 of reducing under-5 mortality by two-thirds well before the target year of 2015. Life expectancy continued to rise and reached 76.6 years by 2018, notably higher than the world average and that recorded in many countries with similar per capita GDP. By describing China's recent economic growth, the rebuilding of nationwide health insurance systems, the development of medical financial assistance, and poverty alleviation programs, this paper shows how these improvements were achieved. Vulnerability to health and mortality risks has been reduced; the availability of, and people's access to, health insurance have increased; and better medical treatments and health services have become available and accessible. These macro-socioeconomic determinants have played the central role in achieving further population health and mortality progress in China in the past four decades.     

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.     

Nepal: Integrated health services project

The Integrated Health Services Project, part of Nepal's current 5-year development plan, will aim at minimal health services to the maximum number of people. The project plans to provide for basic health needs through home visits by village health workers. The object is to stem high mortality particularly of mothers and infants through home nutrition, immunization, and teaching oral rehydration techniques, and induce a decline in fertility with conventional devices and ad hoc sterilization camps. The health aides will number 1/3000-5000 people who will visit villages with materials and a 12-point health message. 1 implement is an armband to measure the circumference of children's arms to diagnose nutritional status.     

Kenya's record population growth: a dilemma of development

The causes and implications of Kenya's 4% rate of natural increase and fertility rate of 8.1 births per woman were examined. Attention was directed to the following: pronatalist pressures; inadvertent pronatalist impact of development; women's education and employment and fertility; population growth and pressures; mortality decline and population growth; fertility levels and differentials; fertility desires; the family planning program; and family planning knowledge, attitudes, and practice. Kenya's development success has worked to push up the population growth rate. Improved health care and nutrition halved infant mortality from 160 to 87 deaths/1000 live births between 1958 and 1977 and a marked increase in primary school enrollment may be factors in the birthrate increase to 53/1000 population. At this time fertility is highest among women with 1-4 years of education. The 1977-1978 Kenya Fertility Survey showed that only 5.8% of married women were using modern contraception, indicating that the national family planning program, established in 1967, has made little progress. Program difficulties have included shortages of staff, supplies and easily accessible clinic as well as an almost universal desire on the part of Kenyans for families of at least 7 children. Children are viewed as essential to survival and status to the rural population.     

The relationships between population and economy, and between population and education]

The relationship between population and economy is regarded seriously by China and other countries. This problem can be analyzed and studied under 2 aspects: 1) the influence of economic development on changes in population, and 2) the influence of population increases on economic development. Under the 1st aspect, improved living conditions, hygiene, and health care generally result in lowered mortality rates. Improved economic conditions in China also increased the birthrate and at the same time increased birth control among the people; the increased birthrate was due to more marriages after liberation. In economically advanced countries, due to high expenses in raising children, people tend to limit family sizes to 2 children/family. Under the 2nd aspect, population increases place strains on the food supply and nutritional requirements, especially when increases are too rapid. They also demand more educational resources and influence quality of education. As there are currently 210 million students in China, the quality of education suffers, particularly at the college level, since most of Chinese manpower, physical and financial resources are spent on primary and secondary education. In terms of housing, transportation, health care, and natural resources, they are all intimately related to and influenced by increases in population. Consequently, the living standard would be difficult to raise if population increases are too rapid. Since 1971, population increases have been incorporated into 5-yearly and later yearly national economic plans in China. The large Chinese population is a major obstacle in raising the Chinese economic level, hence a well-planned population control program is essential.     

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

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