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.     

Children as insurance

This paper presents a dynamic model of fertility decisions in which children serve as an incomplete insurance good. The model incorporates uncertainty about future income and the survival of children as well as a discrete representation of the number of children. It contributes to the understanding of the negative relation between fertility and education, shows why parents may demand children even if the return is negative, and explains why fertility might rise with increasing income when income is low and decrease when income is high. Furthermore, the model can account for the decline in fertility when the risk of infant and child mortality decreases. Finally, the implications for empirical tests of the demand for children are also examined. Received: 8 September 1998/Accepted: 9 June 1999     

The uncertain lifetime and the timing of human capital investment

I examine the effects of mortality decline on fertility and human capital investment decision of parents taking into account the uncertainty about child survival. I propose a model, where parents decide on their fertility before the uncertainty is realized, but they choose to invest only in human capital of their surviving children. The model implies a positive relationship between mortality and fertility and a negative one between mortality and educational investment. It has been argued elsewhere that as, in reality, most of the mortality decline occurred in infancy, it should not affect the human capital investment decision, which comes later in life. Thus, increased survival chances should not promote growth by raising the human capital investment. This paper argues the contrary and proposes a mechanism where mortality decline at any age before the teen years can promote growth by raising human capital investment regardless of the timing of the educational investment.      

Demographic transition and economic growth: Empirical evidence from Greece

Over the past decades, due to a combination of declining fertility rates and rising life expectancies, most industrialized countries have experienced aging populations and low numbers of young populations that may pose economic problems in the future. This paper investigates the relationship first between fertility rate and infant mortality rate and second among demographic changes, real wages and real output in Greece over the period 1960–96. When we control for fluctuations in overall economic activity and the labor market on the bivariate relationship between fertility and mortality rates, the evidence suggests that Granger-causation must exist in at least one direction. The results show that in the long run a decrease in infant mortality rates, taking into consideration economic performance and the labor market, causes a reduction in fertility rates. Also, employing the vector error-correction models, the variance decomposition analysis and the impulse response functions, the empirical results support the endogeneity of fertility choice to infant mortality, the labor market and the growth process. Received: 16 May 1999/Accepted: 18 September 2000     

Endogenous fertility,mortality and growth

Economic and demographic outcomes are determined jointly in a choice-theoretic model of fertility, mortality and capital accumulation. There is an endogenous population of reproductive agents who belong to dynastic families of overlapping generations connected through altruism. In addition to choosing savings and births, parents may reduce (infant) deaths by incurring expenditures on health-care which is also provided by the government. A generalised production technology accounts for long-run endogenous growth with short-run transitional dynamics. The analysis yields testable time series and cross-section implications which accord with the empirical evidence on the relationship between demography and development. Received: 22 April 1996 / Accepted: 2 April 1998     

Parental underinvestment: A link in the fertility-mortality continuum

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

The synthesis economic fertility model: a latent variable investigation of some critical attributes

"This study uses Nicaraguan data to estimate a latent variable system of reduced-form demands for births, infant mortality, contraception, nutrition and breastfeeding. The estimates support some of the synthesis extensions to the standard fertility model, such as the concurrent increase of contraception, health, nutrition and fertility and decline in breastfeeding with income increases from initial low levels.... The initial stages of development may experience an increase in family size despite an increase in contraceptive use...as well as a profertility impact of reduced breastfeeding." Data are from a survey of women aged 15-45 that was conducted in Nicaragua from 1977 to 1978.     

Household type and the demographic transition

Demographic transition theorists postulate a post-transition steady state predicated on the nuclear family. This study reveals that other family types—community and anomic/polygynous—will, if they persist, produce different steady states at higher levels of infant mortality and fertility. Only if family type changes as countries modernize will the transition theorists' post-transition steady state be achieved.     

Mortality level,desired family size and population increase: Further variations on a basic model

A series of computer-simulation models relating mortality level to fertility behavior and to rates of natural increase assuming that couples made use of a perfect means of birth control, that they wanted to be highly certain of having at least one son survive to the father’s 65th birthday, and that all women were biologically capable of having the same number of children were reported earlier. A model identical to one presented earlier but assuming women to be of variable fecundity is presented here; the results are quite similar. Also, the results of models assuming that parents want to be highly certain of at least two surviving children regardless of sex are compared with models assuming parental desire to be highly certain of at least one surviving son. At high levels of mortality the rates of natural increase are quite similar. When mortality is at intermediate to medium-low levels, the two-surviving-children model shows a lower rate of natural increase than the surviving-son model. At very low levels of mortality, such as now experienced by the most advanced nations, the two-surviving-children model manifests a higher rate of natural increase than the surviving-son model.     

Social security and fertility: An international perspective

A number of population scholars have asserted that social security programs such as old-age programs lead to decreased fertility levels because parents need not rely on children for "security" in old age. There is, however, a paucity of empirical data on the above. This paper analyzes 67 countries and shows that social security programs have a measurable negative effect on subsequent levels of fertility. In fact, the social security programs appear to have as much of an independent impact on fertility as do the traditional correlates of fertility (infant mortality, education and per capita income).     

Factors associated with child mortality in Pakistan and implications for the national health programs

"This study attempts to establish the levels of infant and child mortality in Pakistan using an indirect estimation technique to analyze data from the 1984-85 Pakistan Contraceptive Prevalence Survey....[Results indicate] that children's survival chances have hardly improved in recent years.... Suggestions are offered on ways to improve the effectiveness of rural health programs."     

Economic development and fertility

Two schools of theorists have been concerned with the effect of economic development on fertility. One school has contended that economic development has an inhibiting effect on fertility. The demographic transition which has occurred among the non-developed countries confirms their viewpoint. Another school of thought, including in its members Thomas Malthus, has believed that economic development promoted fertility. Much empirical evidence may also be brought to bear to support this viewpoint.The present paper attempts to reconcile these viewpoints. It is hypothesized that the direct effect of economic development is to increase fertility. However, various factors which usually accompany the process of economic development serve to reduce fertility. These include an increase in the level of education and a reduction in infant and childhood mortality. Making use of data for 41 nations pertaining to the decade of the 1950's, it is found that fertility is directly associated with per capita net national product when controls for other relevant variables are in8tituted. On the other hand, per capita newspaper circulation is inversely related to fertility, and infant mortality is directly related.If the hypothesis advanced in this paper is correct, relatively large governmental expenditures on health and education will enhance the reduction in fertility obtainable from an increase in national economic level alone.     

Estimating the completeness of death registration

In this paper, U.S. data from the 1981 Child Health Supplement are used to estimate the effect of a child's disability or serious chronic illness on: (1) the risk of the parents' divorcing before the child reaches the age of 11, and (2) the mother's chances of remarriage after divorce. Divorce is significantly more common among the parents of disabled or sickly children than among those of healthy children, and these disruptive effects of a child's frailty are even stronger when children are between six and nine years old than when they are younger. Possibly, divorce only becomes a viable option for some parents once a sickly child has started to spend part of the day away from home, in school. In contrast, a child's health status does not predict the mother's waiting time to remarriage. A range of potentially confounding demographic factors are controlled in the models, and their effects on children's chances of experiencing parental divorce are as expected. For example, having a mother who married young significantly predicts parental divorce.     

Back to the Future: a Sensitivity Analysis to Predict Future Fertility Rates Considering the Influence of Family Policies—The Cases of Spain and Norway

This article analyzes the relationship between family policies focused on childcare for children under the age of three and fertility levels. In the current context of very low European fertility, it is important to understand whether public support for families can help increase fertility or if, on the contrary, existing fertility levels are the exact reflection of the reproductive desires of families, regardless of the family-support of the policies that may exist in each country. This analysis was carried out through a stochastic dynamic mathematical model that incorporates both demographic variables and family policy variables. A sensitivity analysis was carried out on Spain and Norway, two countries that have very different models of family policies. This sensitivity analysis allows establishing a relationship between the existing family policies and the total fertility rate and also the expected evolution of fertility rates in the future, if the current family policies remain constant. The results showed that the models which lead to an increase in fertility are those which are most generous and which also incorporate a gender perspective, so they allow the identification of good practices and maximum levels of policy efficiency in regards to different objectives such as increase fertility and advances towards gender equality. By contrast, models with erratic and insufficient support clearly contribute to maintaining fertility at very low levels and perpetuate unequal gender relationships. There is, therefore, space for state agency to develop more effective public policies in both dimensions.

     

The effects of infant mortality on fertility revisited: new evidence from latin america

In this paper, we examine empirical evidence for a relation between infant and child mortality and fertility in Latin American countries from 1920 to 1990. We investigate the relation at several levels of aggregation and evaluate the extent to which evidence at one level is consistent with evidence at other levels. We first examine aggregate cross-country information over several decades, a type of data typically used in past research on the topic. We also examine yearly series of births, deaths, infant deaths, and socioeconomic indicators for selected countries to track the association between short-term fluctuations in fertility and infant mortality. Finally, we use micro-level data from the Demographic and Health Surveys (DHS) to assess the relation between fertility and child mortality from individual reproductive histories. The evidence we assemble from these different data sets is remarkably consistent and suggests small positive effects of infant mortality on fertility. These effects, however, may be too small to support the hypothesis that changes in child mortality are of more than modest importance in the process of fertility decline in Latin America in the late twentieth century.     

Fertility,Education, and Development: Evidence from India

Fertility has declined significantly in many parts of India since the early 1980s. This article examines the determinants of fertility levels and fertility decline, using data on Indian districts for 1981 and 1991. The authors find that women's education and child mortality are the most important factors explaining fertility differences across the country and over time. Low levels of son preference also contribute to lower fertility. By contrast, general indicators of modernization and development such as urbanization, poverty reduction, and male literacy exhibit no significant association with fertility. En passant, the authors probe a subject of much confusion— the relation between fertility decline and gender bias.     

Fertility decline in the modern world and in the original demographic transition: Testing three theories with cross-national data

This study uses aggregate data on a large number of the world's societies to test three theories of fertility decline in the modern world and in the original demographic transition. One prominent theory relates fertility decline to the changing economic value of children. With industrialization and overall modernization the economic value of children's labor shifts from positive to negative. This interpretation has been challenged by those who claim that the flow of wealth in preindustrial societies is always from parent to child rather than from child to parent. An alternative interpretation is that fertility levels reflect people's efforts to promote their reproductive success, and that this requires the careful tracking of infant and child mortality. Fertility rates are adjusted to the rate of infant and child survival, and will be high when survival rates are low and low when survival rates are high. A third theory emphasizes female empowerment. Fertility will be high when women are highly subordinated to men, but as women gain more autonomy and control over their own lives they reduce their fertility levels because, among other possibilities, higher levels of fertility present them with serious burdens. We tested all three theories through multiple regression analyses performed on two samples of societies, the first a large sample of the world's nation-states during the period between 1960 and 1990, and the second a sample of now-developed societies between 1880 and 1940. Our findings showed that infant mortality was an excellent predictor of fertility, and that female empowerment was a good predictor. However, there was only weak support for the argument that the economic value of children's labor plays an important role in fertility decisions. The findings were discussed in the context of a broader interpretation of fertility behavior in societies with high levels of industrialization and modernization.     

Estimation of Adult Mortality From Orphanhood Before and Since Marriage

The prevalence of intentional control of reproduction increases in developing countries in which there is rapid modernization, and there are also important changes in breastfeeding practices. The effects of increased contraception and reduced breastfeeding on the pace and level of fertility and on the patterns and levels of infant and early childhood mortality are in opposite directions. In this paper we propose a technique to estimate the net effects of such changes on the natural rate of increase, and to assess the gross contribution of the various components of change. Applications of the technique to Latin American countries indicate that changes in fertility due to higher contraceptive prevalence are dominant, but that they are partially offset by the indirect effects on fertility of changes in breastfeeding. Likewise, changes in breastfeeding have the strongest direct impact on infant mortality, but are partially offset by the beneficial effects of a more favourable pace of childbearing induced by higher contraceptive prevalence.     

Mortality risks,sequential decisions on births,and population growth

The population growth rates implied by parental attempts to be highly certain of having a surviving son for old-age support are investigated. At life expectancies of 40 to 65 years, family-planning “strategies” using contraception are found to imply markedly lower growth rates (1.01.5 percent vs. 2.5 percent) than are both commonly observed and also previously derived by Heer and Smith. In contrast to strategies relying only on sterilization, contraceptive spacing of births permits parents to buy time and information. In particular, they can postpone deciding whether to have another child until they see if their infant son will survive the earliest years of childhood. These results suggest that many less developed countries might achieve a substantial reduction in birth rates, provided that family-planning programs emphasized contraception as well as sterilization and effectively communicated the idea of spacing births. Factors bearing on the range of applicability of the old-age-security hypothesis, and any results and policies derived from it, are also briefly analyzed.     

Breast feeding, fertility and infant mortality: An analysis of some early German data

Abstract Concern about high infant mortality and its suspected connection with the lack of breast-feeding stimulated the collection of statistics about the frequency of breast-feeding in several German states during the late roth and early 20th centuries. Contrary to the assumption that universal and extended breast-feeding is customary among rural agricultural populations, large regional variations existed both in the proportion of children who were breast-fed and in the average duration of the period for which they were breast-fed. An analysis of these data in connection with statistics of infant mortality and marital fertility confirms the association between high infant mortality and the absence of breast-feeding. An hypothesis linking breast-feeding and fertility, however, is not confirmed. Marital fertility appears to be much more closely associated with infant mortality than with breast-feeding.