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.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Infant death clustering in families: magnitude, causes, and the influence of better health services, Bangladesh 1982-2005

This analysis of infant mortality in Bangladesh focuses on explaining death clustering within families, using prospective data from a rural region in Bangladesh, split into areas with and without extensive health services (the area covered by the International Centre for Diarrhoeal Disease Research and the comparison area, respectively). The modelling framework distinguishes between two explanations of death clustering: (observed and unobserved) heterogeneity across families and a causal 'scarring' effect of the death of one infant on the survival chances of the next to be born. Keeping observed and unobserved characteristics constant, we find scarring in the comparison area only. There the likelihood of infant death is about 29 per cent greater if the previous sibling died in infancy than otherwise. This effect mainly works through birth intervals: infant deaths are followed by shorter birth intervals, which increases the risk of infant death for the next child.     

Population trends and differentials in countries of the ESCAP region

The total population of the ESCAP region reached 2.4 billion in 1979, up from 2 billion in 1970. 6 of the 10 largest countries are in the region: China, India, Indonesia, Japan, Bangladesh, and Pakistan. East Asia contains 1.1 billion; Middle South Asia contains 923 million; Eastern South Asia, 354 million; and Oceania, 22 million. The crude birth rate for the total region dropped by 5 points from 1970-9; the crude death rate dropped by 2 points, resulting in a decline in the annual growth rate of .3 percentage points, from 2.1% in 1970 to 1.8% in 1979. Overall, the total fertility rate decreased by 15% from 4.8 to 4.1. The total fertility rate in Australia fell 33% from 2.8 to 1.9 and in New Zealand from 3.0 to 1.9, or 37%. Generally fertility is lower in urban areas than in rural with some exceptions. A strong negative relationship between level of education and fertility exists in all countries of Asia and the Pacific, however, the parity of women with some primary education exceeds that of women with no schooling. Life expectancy at birth for both sexes in the region increased from 55.1 years in 1970 to 58.7 years in 1979, or by 7%. The highest life expectancy is in Japan at 75.2 years. The infant mortality rate in the ESCAP region in 1979 was estimated to be 78/1000. World Fertility Survey data indicate that the mean age of first marriage is generally very low but gradually increasing.     

Estimating the effect of child mortality on the number of births

This article rigorously derives the properties of the regression of births on child deaths. It is shown how the raw regression coefficient may be corrected for the effects of fertility on mortality so that the rate at which dead children are replaced may be estimated. The method is applied to data from Colombia. It is found that the mortality rate differs across individuals and is correlated with fertility. Such conditions vitiate the use of birth intervals and parity progression ratios yet can be dealt with using the new method. On average each death produces 0.2 new births as a direct result of the death. Fertility hoarding may raise the total fertility response to roughly one-half birth per death.     

Some aspects of the relationship between the levels of infant mortality and fertility in the ESCAP region

The death of a child within the first year of life is a crucial factor in fertility decisions in a developing country. The infant mortality rate gives a close, inverse indication of the socioeconomic conditions of a country. This paper presents studies by Brass, Rutherford, Chowdhury, Khan and Chen, Agrawal, Iskander and Jones, in summary/abstract form. It concludes that the probabilities of survival are poorer for births of older women and/or higher parities. Early child deaths may increase the total period of exposure to the risk of conception. A lower infant and child mortality norm calls for fewer births to meet the needs for survivors. Child replacement motivational response seems to be strongest with the birth immediately following a death event. Agrawal analyzed the interval between successive births of 1107 women of Patna, Pakistan, according to the age of mother and sex and fate of the previous child. He observed that if a child died shortly after its birth, often a new pregnancy began within a short interval. The interval between 2 consecutive live births when the previous child was male and alive was greater than when the previous child was female and alive. The interval between 2 births was reduced if the child died in infancy and specially if this was a male child.     

Nutrition and Fertility in Bangladesh: Breastfeeding and Post Partum Amenorrhoea

From 1975 to 1980 a prospective study a nearly 2,500 married, fertile women was conducted in Matlab, Bangladesh at the International Centre for Diarrhoeal Disease Research. Women were interviewed at monthly intervals to collect information on nutritional and reproductive status, in order to study the factors associated with natural fertility. The median duration of amenorrhoea for women with no child deaths was 15.5 months, with older women and those of higher parities recording longer durations than younger women or those of lower parities. Median duration of amenorrhoea for women with six or more years of education was 8.4 months compared to 16.4 months among women with no education. When classified by weight at pregnancy termination, average duration of amenorrhoea of women weighing less than 38 kg was 17.6 months compared to 13.6 months among women weighing more than 44 kg. Proportional hazards analyses show that mother's education, parity, month of birth, supplementation practices and nutritional status were significantly associated with the probability of resuming menstruation.     

Infant mortality and fertility in three Bavarian villages: An analysis of family histories from the 19th century

Abstract Family history data derived from the records of three parishes in Bavaria provide evidence for several important demographic questions when analysed in conjunction with information concerning the prevalent breast-feeding practices. The results suggest strongly that breast feeding can prolong birth intervals substantially. The evidence concerning the independent influence of infant deaths on subsequent birth intervals is inconclusive. It is clear, however, that even if such an influence did exist it was relatively small, compared to the effect of lactation. In addition the results do not lend support to the hypothesis that couples experiencing low child mortality practised family limitation more than couples experiencing high child mortality. In all three parishes, however, fertility appeared to influence infant mortality. Infants born after short intervals were subject to considerably higher mortality risks than infants following longer intervals.     

Birth Intervals and Childhood Mortality in Rural Bangladesh

This study investigates the relationship between birth intervals and childhood mortality, using longitudinal data from rural Bangladesh known to be of exceptional accuracy and completeness. Results demonstrate significant but very distinctive effects of the previous and subsequent birth intervals on mortality, with the former concentrated in the neonatal period and the latter during early childhood. The impact of short birth intervals on mortality, however, is substantially less than that found in many previous studies of this issue, particularly for the previous birth interval. The findings are discussed in terms of the potential for family planning programs to contribute to improved child survival in settings such as Bangladesh.     

The impact of infant and child death on subsequent fertility in Ethiopia

This paper uses hazard regression models to assess the impact of experienced infant and child mortality on the risk of subsequent conceptions in Ethiopia. The purpose of this paper is to test for the presence of a fertility response to an infant or child death, net of the effects of truncated breastfeeding on fecundity. Using retrospective birth history data from a national survey in Ethiopia, we find a significantly higher risk of a conception in the months following the death of an index child, even after controlling for postpartum amenorrhoea and breastfeeding status. The fertility response is strongest after the death of the fourth or fifth child, which is when most women in Ethiopia are at or near their desired family size. However, we find no evidence of a fertility response to the death of a nonindex child. We attribute the higher risk of a conception following an index child’s death to the intentional efforts of couples to reduce the waiting time to a next birth and thereby replace the deceased child. However, absent evidence of replacement fertility in response to the death of older nonindex children, we interpret the response to the death of an index child as an emotional response to child loss rather than a conscious strategy to meet a fertility target.

Retrospective evidence of a decline of fertility and child mortality in Bangladesh

A detailed analysis of survey data collected in 1961–1962 for a sample of 4200 families in central East Pakistan produced consistent and reasonable estimates of birth and death rates for the preceding decade. Extremely high levels of infant and child mortality declined noticeably in the period 1952–1961. Age-specific birth rates to married women also decreased in the decade for women over the age of 19, while a small increase was recorded for married women aged 15 to 19. During the 1950s total marital fertility declined about one-fifth. Birth rates remained high in 1960 according to these estimates, but there is reason to anticipate further reductions in birth rates, particularly among older women. To improve understanding of the determinants of fertility and to aid in the formulation of policy to cope with population trends, statistical analysis must increasingly consider information on families over time. Retrospective household survey data may provide the empirical base for this line of inquiry.     

Mortality in Ghana: Evidence from the cape coast project data

Abstract This paper deals with the estimation of mortality for a rural community of about 20,000 persons in the rain-forest area of south-west Ghana. Specifically, infant, child and adult mortality estimates have been obtained by the application of a wide range of direct and indirect methods of measuring mortality from the different statistics collected by a longitudinal mortality and fertility project conducted during 1974-7. It was noted that infant and childhood mortality rates obtained from death registrations were consistent with those rates yielded by pregnancy histories and child survival statistics. However, the adult mortality estimates derived from orphanhood statistics tended to be lower than those suggested by death registrations. The analysis revealed an infant mortality rate of 100 for boys and 84 for girls, equal childhood mortality rates for boys and girls (85-6), a lower expectation of life at birth for men (45.8 years) than for women (52.8), and a much more severe incidence of mortality among men aged over 40 than for women at the corresponding ages.     

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.     

The Effects of Intrauterine Malnutrition on Birth and Fertility Outcomes: Evidence From the 1974 Bangladesh Famine

This article uses the Bangladesh famine of 1974 as a natural experiment to estimate the impact of intrauterine malnutrition on sex of the child and infant mortality. In addition, we estimate the impact of malnutrition on post-famine pregnancy outcomes. Using the 1996 Matlab Health and Socioeconomic Survey (MHSS), we find that women who were pregnant during the famine were less likely to have male children. Moreover, children who were in utero during the most severe period of the Bangladesh famine were 32 % more likely to die within one month of birth compared with their siblings who were not in utero during the famine. Finally, we estimate the impacts of the famine on subsequent pregnancy outcomes. Controlling for pre-famine fertility, we find that women who were pregnant during the famine experienced a higher number of stillbirths in the post-famine years. This increase appears to be driven by an excess number of male stillbirths.     

The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval

Using high-quality longitudinal data on 125,720 singleton live births in Matlab, Bangladesh, we assessed the effects of duration of intervals between pregnancy outcomes on infant and child mortality and how these effects vary over subperiods of infancy and childhood and by the type of outcome that began the interval. Controlling for other correlates of infant and child mortality, we find that shorter intervals are associated with higher mortality. Interval effects are greater if the interval began with a live birth than with another pregnancy outcome. In the first week of the child's life, the effects of short intervals are greater if the sibling born at the beginning of the interval died; after the first month, the effects are greater if that sibling was still alive. Many relationships found are consistent with the maternal depletion hypothesis, and some with sibling competition. Some appear to be due to correlated risks among births to the same mother.     

Infant mortality,birth order,and sibship size: The role of heterogeneous risk and the previous‐death effect

This paper derives an analytic model to study biases in infant mortality estimates by birth order and sibship size, which occur when the death of an infant tends to shorten the next birth interval and mortality risk varies among families. We find that order‐specific and sibship‐size‐specific estimates are biased by a selection for high‐risk women across birth orders, since women with higher risk will tend to have shorter intervals, and more births, within a given period of time. Sibship‐size‐specific estimates are, in addition, biased by a selection of women who have experienced deaths, even if there is no heterogeneity in risk. Numerical examples based on data from Matlab, Bangladesh, are used to illustrate the possible magnitude of these biases. The results resemble patterns of infant mortality by birth order and sibship size which are often observed empirically.     

The cocos-keeling islands: A demographic laboratory

The Cocos Islands, which are situated in the Indian Ocean approximately halfway between Colombo and Fremantle, were first peopled early in the nineteenth century and were gradually developed as a very isolated coconut plantation with a labour force consisting partly of persons of Malay stock descended from the original group of settlers and partly of Bantamese contract labourers from Java. As the Cocos-born population increased in size, the dependence on contract labour decreased and, before the end of the century, all immigration ceased. The 1947 Malay population of the islands was about 1,800.

The islands are fascinating from a demographer's point of view because there was a virtually complete registration of live births, deaths and marriages and a partial registration of stillbirths. With these registration records it was possible to construct the life history of every individual from birth, through infancy and childhood to marriage, and thence through fatherhood or motherhood to death.

The picture revealed by an analysis of these records is that of a population with very high fertility and with mortality at a high level before the first World war and at a medium level after that war. Crude birth rates varied between 50 and 60 per thousand population during the period 1888 to 1947. Crude death rates were between 30 and 40 per thousand population until 1912 but under 2.0 per thousand population after 1918.

Most Cocos girls married before reaching the age of 20 and there were an average of between eight and nine live births per woman living through the childbearing period. There was a steady decline in the average number of live births with advancing age at marriage from age 16 onwards. A significantly high proportion of those dying in the middle of the childbearing period had never married, but the fertility of those marrying at an early age (14, 15 and 16) and dying before reaching the age of 36 was slightly higher than that of those who married at a similar age and survived. Women who survived to the age of 55 were of higher fertility than those who died between the ages of 40 and 55. An analysis of birth intervals revealed significant differences (a) between birth intervals after a stillbirth or after a live birth in which the child died in early infancy, and birth intervals after a live birth in which the offspring survived for longer than 0.4 years, and (b) between the interval from first to second birth and the subsequent birth intervals. There was a difference of almost exactly a year between the average birth interval after a stillbirth or live birth ending in a neo-natal death and the average birth interval after the birth of a child surviving to age 2; there was a similar difference of a year between corresponding median birth intervals.

From 1888 to 1912 infant mortality was well above 300 per thousand. After 1918 infant mortality averaged rather under 100 infant deaths per 1,000 live births. The reduction in infant mortality rates was accompanied by an increase in the mortality of children aged 1 to 4, and the heavy incidence of mortality at these ages after 1918 is the most striking feature of the analysis of mortality by age. Whilst mortality in infancy fell much more heavily on males than on females, early childhood mortality was much higher in Cocos for girls than for boys. The life table computed for the period 1918 to 1947 indicated a life expectancy of about 50 years for males and 47 years for females.     

Mortality in Ghana: Evidence from the cape coast project data

This paper deals with the estimation of mortality for a rural community of about 20,000 persons in the rain-forest area of south-west Ghana. Specifically, infant, child and adult mortality estimates have been obtained by the application of a wide range of direct and indirect methods of measuring mortality from the different statistics collected by a longitudinal mortality and fertility project conducted during 1974–7. It was noted that infant and childhood mortality rates obtained from death registrations were consistent with those rates yielded by pregnancy histories and child survival statistics. However, the adult mortality estimates derived from orphanhood statistics tended to be lower than those suggested by death registrations. The analysis revealed an infant mortality rate of 100 for boys and 84 for girls, equal childhood mortality rates for boys and girls (85–6), a lower expectation of life at birth for men (45.8 years) than for women (52.8), and a much more severe incidence of mortality among men aged over 40 than for women at the corresponding ages.     

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.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.