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.     

Demographic Determinants of Infant and Early Child Mortality: A Comparative Analysis

In this paper we examine the relative importance of a number of demographic determinants of infant and early child mortality using information from 39 World Fertility Survey countries. We include sex of the child, age of the mother at the time of the birth, birth order, mother's educational level and a number of indicators of spacing of adjacent births among the correlates of chances of survival for children below the age of five years. Mortality of firstborn children and of those born to teenage mothers is shown to be higher than average; that of later children and those of older mothers was not much higher than average, once other factors are controlled. Effects of poor birth-spacing persist even after other factors have been controlled, and are similar where a sib was born during the two years preceding the birth of the child, regardless of the survival status of that sib; however, mortality was higher when that sib had died, due to increased familial risks of mortality. Rapid subsequent births also raise mortality for their earlier sibs. The findings are generally remarkably consistent in a wide range of countries and associated mortality conditions, although attention is drawn to a few interesting geographically clustered exceptions which deserve further investigation. The study leaves little room for doubt that poor child-spacing is clearly linked to decreased survival chances.     

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.     

Child Mortality in Beirut: Six Indirect Estimates Based on Data Collected at the Time of a Birth

Six indirect techniques for estimating child mortality were applied to information on survival status of all children ever born, provided by a sample of 1,252 women delivered at the Maternity Unit of the American University of Beirut Hospital. The results were compared, using as a reference the estimate derived from partial birth histories (ages of surviving children, ages at death of children who have died). Their dispersion is minimal for the probability of dying between birth and fifth birthday, estimated at 48 per thousand. For each mother, the ratio of the observed number of children who have died, to that expected given the lengths of exposure of the children to the risk of mortality, was used as a dependent variable in a multiple regression analysis. Educational level of mothers had a significant effect, but not occupational status of father, religion or consanguinuity.     

The impact of the HIV/AIDS epidemic on kinship resources for orphans in Zimbabwe

The extended family has been recognized as a major safety net for orphans in sub-Saharan Africa. However, the mortality crisis associated with HIV/AIDS may drastically reduce the availability of relatives and thus undermine traditional forms of mutual support. In this article, the microsimulator SOCSIM is used to estimate and project quantities such as the number of living uncles, aunts, siblings, and grandparents available to orphans. The model is calibrated to the setting of Zimbabwe, using data from demographic and Health Surveys and estimates and projections of demographic rates from the United Nations. The article shows that there is a lag of more than ten years between the peak in orphanhood prevalence and the peak in scarcity of grandparents for orphans. The results indicate that a generalized HIV/AIDS epidemic has a prolonged impact on children and orphans that extends well beyond the peak in mortality. A rapid increase in the number of orphans is followed by a steady reduction in the number of living grandparents for orphans. Consequently, the burden of double orphans (both of whose parents have died) is likely to shift to uncles and aunts. In Zimbabwe, the number of living uncles and aunts per double orphan decreased between 1980 and 2010, but it is expected to increase progressively during the next few decades. Changes in kinship structure have important social consequences that should be taken into account when seeking to address the lack of care for orphans.     

The Optimal Trade-Off Between Quality and Quantity with Unknown Number of Survivors

In a model of endogenous fertility where individuals know the probability of child survival but not the final number of survivors, parents do not always formulate a precautionary demand for children. For some utility functions, parents have fewer children than what they would have in a situation in which the number of survivors is known earlier. The properties of the optimal economic policy depend on the degree to which the social welfare function takes ignorance into account. If social welfare is evaluated after parents know how many children survived, the parental response to uncertainty is socially inefficient. Individual decisions then should be corrected through tax or transfer on both births and education. This property helps determine the optimal public response to mortality crisis in the presence of educational externalities.     

Reproductive patterns and child mortality in guatemala

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

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.     

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.     

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.      

The effect of female migration on infant and child survival in Uganda

This article uses data from the 1996 Uganda Demographic and Health Survey to examine whether migration of women improves the survival chances of their children to age five. We expand on prior research by testing not only the hypothesized positive effect of rural-urban migration, but also the effects of other migration stream behaviours on child survival. Results show that up to 10% of children die before age five and within-group differences in mortality exist among urban and rural children depending on their mother's migration status. Only urban-urban migration was significantly related to child survival, compared to rural non-migrants, after controlling for other factors, although other streams of migration (rural-urban, urban-rural, rural-rural) were positively related to child survival. Generally, migration explains a small component of the variance in child survival. Several other factors, including parents' education, household size, household headship, mother's age at birth, duration of breastfeeding, and place of delivery have a significant predictive power on child survival.     

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.     

Death Clustering,Mothers' Education and the Determinants of Child Mortality in Rural Punjab,India

In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled. It is argued that this clustering of deaths is partly due to the poor basic abilities of some mothers and other carers.     

Fertility decisions when infant survival is endogenous

There is evidence that fertility is positively correlated with infant mortality, and that a child‘s chance of surviving to maturity increases with the level of nutrition, medical care, etc. received in the early stages of life. By modelling parental decisions as a problem of choice under uncertainty, the paper shows that fertility and infant mortality are most likely to move in opposite directions if, as implicitly assumed by existing economic theories, parents believe that there is nothing they can do to improve the survival chances of their own children. By contrast, if parents realize that those chances improve with the amount they spend for the health, nutrition, etc. of each child that they put into the world, then fertility and infant mortality may move in the same direction. Under such an assumption, the model has the strong policy implication that directly death-reducing public expenditures are most effective, but stimulate population growth, at low levels of development. By contrast, at high levels of development, such expenditures tend to crowd out parental expenditures, and are a factor in fertility decline. Received: 14 October 1996 / Accepted: 28 July 1997     

中国城市家庭的代际情感交流--基于独生子女生命历程视角的实证分析

情感交流是家庭代际关系中较难衡量、研究也相对薄弱的一个层面,父母子女间的亲密交往和情感沟通不仅有利于增进家庭成员的健康,也有助于家庭和社会的和谐稳定。文章利用全国抽样调查数据,基于独生子女的生命历程视角,从方式、强度、内容和方向四个维度,实证分析中国城市家庭的代际情感交流状况,特别关注独生子女和非独生子女的差异,以及子女生命历程中重要事件的影响。本研究发现,总体而言独生子女与父母的代际情感交流更密切,但交流方式与强度受到居住距离和流动特征的影响;就业、婚育事件虽会降低青年与父母同住的可能性,但也会增加见面和通讯频率。父母的资源和需求等特征对代际情感交流有显著影响。     

Death and schooling decisions over the short and long run in rural Madagascar

This paper provides strong evidence that adult mortality has a negative impact on children educational outcomes, both over the short and the long run, in rural Madagascar. The underlying longitudinal data and the difference-in-differences strategy used overcome most of the previous cross-sectional study limitations, such as failure to control for child and household pre-death characteristics and unobserved heterogeneity. This paper also pays special attention to the heterogeneity, robustness, and long-run persistence of effects. Results show that orphans are on average 10 pp less likely to attend school than their nonorphaned counterparts, this effect being even more pronounced for girls and young children from poorer households. Results on adults further show that those orphaned during childhood eventually completed less education. These findings suggest that not only do households suffering unexpected shocks resort to schooling adjustments as an immediate risk-coping strategy, but also that adversity has long-lasting effects on human capital accumulation.     

“The Luggage that isn’t Theirs is Too Heavy…”: Understandings of Orphan Disadvantage in Lesotho

In Southern Africa, high adult HIV prevalence has fueled concern about the welfare of children losing parents to the epidemic. A growing body of evidence indicates that parental, particularly maternal, death is negatively associated with child outcomes. However, a better understanding of the mechanisms is needed. In addition, the way orphan disadvantage and the mechanisms giving rise to it are understood on the ground is essential for the successful translation of research into policies and programs. This study employs data from 89 in-depth interviews with caregivers and key informants in Lesotho, a setting where approximately one-quarter of adults is infected with HIV, to elaborate understandings of orphan disadvantage. Our analysis focuses on two questions: (i) Do local actors perceive orphans to be disadvantaged compared to non-orphans, and if so, in what ways; and (ii) How do they explain orphans’ differential disadvantage? Analyses suggest that orphans were widely perceived to be disadvantaged; respondents described this disadvantage in material as well as affective domains. Thematic analyses reveal five broad categories of explanation: poverty, love and kin connection, caregiver character, perceptions of orphans, and community norms related to orphan care. These results underscore the need for research and policy to address (i) multiple types of disadvantage, including deficits in kindness and attention; and (ii) the social embeddedness of disadvantage, recognizing that poverty, kinship, and community interact with individual attributes to shape caregiving relationships and child experiences. The findings suggest limited success for programs and policies that do not address the emotional needs of children, or that focus on child or caregiver support to the exclusion of community outreach.     

Family Contexts and Schooling Disruption among Orphans in Post-Genocide Rwanda

This study examines the relationship between orphan status and schooling disruption in post-genocide Rwanda. The results indicate that while non-orphans have more favorable schooling outcomes in two-parent than in single-parent families, the reverse is true among Rwandan orphans. In single-mother households, paternal orphans, i.e. orphans with only a living mother, have better outcomes than their orphan and non-orphan counterparts. In contrast, paternal orphans have worse outcomes than other children in two-parent households, especially in households headed by males. Maternal orphans are more likely to experience schooling disruptions than non-orphans regardless of family structure. The maternal-orphan disadvantage is nevertheless greater in female-headed than in male-headed households. As expected, non-related orphans are more disadvantaged than orphans related to their household heads. However, non-related orphans have a greater disadvantage in two-parent than in single-parent households. The results also suggest that within households, the provision of childcare to children below schooling age is an impediment to orphan’s schooling. These impediments are, however, greater for double-orphans than paternal or maternal orphans.     

The impact of class,education, and health care on infant mortality in a developing society: The case of rural Thailand

Demographic and social factors affecting infant mortality in rural northern Thailand are examined using log-linear modifiedmultiple regression models and data drawn from a representative sample of married couples in Chiang Mai and Chiang Rai provinces. Demographic factors do not account for the effects of variations in parental ability or willingness to provide adequate infant care. The final model estimated incorporated both these social dimensions of child care. Parental ability, measured by father’s social class, mother’s health information, and local community development levels, continued to have significant independent effects upon infant survival. Parental willingness, measured by parent’s beliefs about intergenerational wealth transfers, no longer had a significant effect net of other social variables, but infant survival was still affected by whether both parents wanted a birth.