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We test a conjecture to explain Turkey's decades-long 'underachievement' in early child mortality improvements. We argue that it is largely a consequence of cultural barriers to embracing available modern medical technology and healthcare practices. The empirical test rests on a reformulation of Coale's Ready–Willing–Able (RWA) framework for explaining fertility changes, which makes it suitable to understand mortality changes. We use structural equation modelling and Demographic and Health Surveys spanning 1993–2013 to estimate basic parameters of the reformulated framework. These parameters are then used to classify mothers into four groups with different configurations of RWA dimensions and different probabilities of adopting modern medical practices. We find that observed behaviours in these groups were consistent with RWA expectations. In addition, we find that an important contributor to Turkey's lagging mortality decline was a population distribution biased towards groups more reticent to adopting modern healthcare. [ABSTRACT FROM AUTHOR]

This paper argues that son preference resulted in gender-based discriminatory practices that unduly increased mortality rates for females at birth and throughout infancy and childhood in nineteenth- and early-twentieth-century Greece. The relative numbers of boys and girls at birth was extremely high and under-registration of females cannot on its own explain this result. The infanticide and/or mortal neglect of infant girls was therefore more common than previously acknowledged. Likewise, sex ratios increased as children grew older, thus suggesting that parents continued to treat boys and girls differently throughout childhood. A large body of qualitative evidence (contemporary accounts, folklore traditions, feminist newspapers, and anthropological studies) further supports the conclusion that girls were neglected due to their inferior status in society. [ABSTRACT FROM AUTHOR]

International migration has increased since 1990, with increasing numbers of migrants originating from low- and middle-income countries (LMICs). Efforts to explain this compositional shift have focused on wage gaps and other push and pull factors but have not adequately considered the role of demographic factors. In many LMICs, child mortality has fallen without commensurate economic growth and amid high fertility. This combination increases young adult populations and is associated with greater outmigration: in the poorest countries, we estimate that a one-percentage-point increase in the five-year lagged growth rate of the population of 15–24-year-olds was associated with a 15 per cent increase in all-age outmigrants, controlling for other factors. Increases in growth of young adult populations led to 20.4 million additional outmigrants across 80 countries between 1990 and 2015. Understanding the determinants of these migration shifts should help policymakers in origin and destination countries to maximize their potential positive effects. [ABSTRACT FROM AUTHOR]

Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality. [ABSTRACT FROM AUTHOR]

Previous studies have documented varying fertility responses to childhood mortality and to the sex composition of the surviving offspring during the demographic transition. We contribute to this literature by applying a mixture cure model to reproductive histories of Estonian women born 1850–99. This model, unlike standard event history models, is capable of separating the effect of the covariates on the propensity of having another birth from their effect on its timing. Child fatalities, not having sons, and to a smaller extent, not having daughters, increased the propensity to have another child and decreased the interval to it. The response was stronger among later cohorts, but only with respect to parity progression. By contrast, the accelerated childbearing response diminished over time. Our findings suggest that behavioural responses in the quantum and tempo of childbearing can occur relatively independently. [ABSTRACT FROM AUTHOR]

This research note is prompted by a paper by Kashyap (Is prenatal sex selection associated with lower female child mortality? Population Studies 73(1): 57–78). Kashyap's paper, which provides 40 original estimates of missing female births, relies on an alternative definition of missing female births, leading to estimates of about half the magnitude of other estimates. There appears, therefore, a real need to take stock of the concept of missing female births widely used by statisticians around the world for assessing the demographic consequences of prenatal sex selection. This research note starts with a brief review of the history of the concept and the difference between Amartya Sen's original method and the alternative method found elsewhere to compute missing female births. We then put forward three different arguments (deterministic and probabilistic approaches, and consistency analysis) in support of the original computation procedure based on the number of observed male births and the expected sex ratio at birth. [ABSTRACT FROM AUTHOR]

Research on early-life mortality in contemporary and historical populations has shown that infant and child mortality tend to cluster in a limited number of high-mortality families, a phenomenon known as 'mortality clustering'. This paper is the first to review the literature on the role of the family in early-life mortality. Contemporary results, methodological and theoretical shortfalls, recent developments, and opportunities for future research are all discussed in this review. Four methodological approaches are distinguished: those based on sibling deaths, mother heterogeneity, thresholds, and excess deaths in populations. It has become clear from research to date that the death of an older child harms the survival chances of younger children in that family, and that fertility behaviour, earlier stillbirths, remarriages, and socio-economic status all explain mortality clustering to some extent. [ABSTRACT FROM AUTHOR]

There is still considerable uncertainty about how reproductive factors affect child mortality. This study, based on Demographic and Health Survey data from 28 countries in sub-Saharan Africa, shows that mortality is highest for firstborn children with very young mothers. Other children with young mothers, or of high birth order, also experience high mortality. Net of maternal age and birth order, a short preceding birth interval is associated with above average mortality. These patterns change, however, if time-invariant unobserved mother-level characteristics of importance for both mortality and fertility are controlled for in a multilevel-multiprocess model. Most importantly, there are smaller advantages associated with longer birth intervals and being older at first birth. The implications of alternative reproductive 'strategies' are discussed, taking into account that if the mother is older at birth, the child will also be born in a later calendar year, when mortality may be lower [ABSTRACT FROM AUTHOR]

We examine economic inequality and social differences in infant and child mortality, and fertility responses to food price changes in North Orkney, 1855–1910, using linked vital records. This small population featured a diverse occupational structure, limited land resources, and geographic isolation from mainland Scotland. Segments of Orkney’s non-agricultural working population were living so close to the margin of subsistence in normal years that an increase in food prices in bad years cost the lives of their children. Delayed childbearing, in addition to increased labour intensity, occupational diversification, and poor relief, failed to mitigate the negative effects of unfavourable prices in this group. While previous studies for Western Europe show a strong social gradient in mortality responses to food prices, and for Eastern Asia a strong household gradient, this study shows a strong sectoral gradient, indicating low standards of living for the non-agricultural working population well into the twentieth century. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM PUBLISHER]

In many less developed countries, household surveys collect full and summary birth histories to provide estimates of child mortality. However, full birth histories are expensive to collect and cannot provide precise estimates for small areas, and summary birth histories only provide past child mortality trends. A simple method that provides estimates for the most recent past uses questions about the survival of recent births in censuses or large household surveys. This study examines such data collected by 45 censuses and shows that on average they tend to underestimate under-5 mortality in comparison with alternative estimates, albeit with wide variations. In addition, the high non-sampling uncertainty in this approach precludes its use in providing robust estimates of child mortality at the country level. Given these findings, we suggest that questions about the survival of recent births to collect data on child mortality not be included in census questionnaires. [ABSTRACT FROM PUBLISHER]

Mounting evidence suggests that early-life conditions have an enduring effect on an individual’s mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women’s life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men’s life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions. [ABSTRACT FROM PUBLISHER]

We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938-50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50-72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless. [ABSTRACT FROM AUTHOR]

This paper provides an overview of trends in mortality in children aged under 5 and adults between the ages of 15 and 60 in sub-Saharan Africa, using data on the survival of the children and siblings collected in Demographic and Health Surveys. If conspicuous stalls in the 1990s are disregarded, child mortality levels have generally declined and converged over the last 30–40 years. In contrast, adult mortality in many East and Southern African countries has increased markedly, echoing earlier increases in the incidence of HIV. In recent years, adult mortality levels have begun to decline once again in East Africa, in some instances before the large-scale expansion of antiretroviral therapy programmes. More surprising is the lack of sustained improvements in adult survival in some countries that have not experienced severe HIV epidemics. Because trends in child and adult mortality do not always evolve in tandem, we argue that model-based estimates, inferred by matching indices of child survival onto standard mortality schedules, can be very misleading. [ABSTRACT FROM PUBLISHER]

Using data from the Indian National Family Health Surveys (1992–93, 1998–99, 2005–06), this study examined how the relationship between household wealth and child health evolved during a time of significant economic change in India. The main predictor was an innovative measure of household wealth that captures changes in wealth over time. Discrete-time logistic models (with community fixed effects) were used to examine mortality and malnutrition outcomes: infant, child, and under-5 mortality; stunting, wasting, and being underweight. Analysis was conducted at the national, urban/rural, and regional levels, separately for boys and girls. The results indicate that the relationship between household wealth and under-5 mortality weakened over time but this result was dominated by infant mortality. The relationship between wealth and child mortality stayed strong for girls. The relationship between household wealth and malnutrition became stronger over time for boys and particularly for girls, in urban and (especially) rural areas. [ABSTRACT FROM PUBLISHER]

This paper presents a new method for estimating the effect of child mortality on the total fertility rate (TFR). The method is based on discrete-time survival models of parity progression that allow construction of a multivariate multidimensional life table of fertility with four dimensions: woman's age, parity, duration in parity, and number of previous child deaths. Additional socio-economic variables are included in the set of predictor variables in the underlying survival models of parity progression. The life table yields a replacement rate, which measures the effect of one additional child death on the TFR. The method is illustrated by applying it to three Indian National Family Health Surveys. Major findings are that dead children are incompletely replaced, and that the replacement rate rises as the TFR falls, reflecting women's increasing ability to control their fertility. [ABSTRACT FROM AUTHOR]

Mortality estimates for many populations are derived using model life tables, which describe typical age patterns of human mortality. We propose a new system of model life tables as a means of improving the quality and transparency of such estimates. A flexible two-dimensional model was fitted to a collection of life tables from the Human Mortality Database. The model can be used to estimate full life tables given one or two pieces of information: child mortality only, or child and adult mortality. Using life tables from a variety of sources, we have compared the performance of new and old methods. The new model outperforms the Coale–Demeny and UN model life tables. Estimation errors are similar to those produced by the modified Brass logit procedure. The proposed model is better suited to the practical needs of mortality estimation, since both input parameters are continuous yet the second one is optional. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

In the City of Montreal, 1881, the presence of three cultural communities with different profiles of economic status makes it possible to observe the way social settings affected survival over a lifetime. Regression models show culturally determined maternal factors dominant for infants, and persistent throughout childhood. For post-neonates, children aged 1-4, and adults aged 15-59 household poverty has a comparable effect. Among adults, a gender penalty differs among the three communities. Models are improved when differentiated by cause of death. Locating households using a GIS reveals high levels of residential segregation by ethnicity and income, spatial correlation of environmental hazards, and constraints on exit from zones of risk, which together produce neighbourhood effects as large as household effects. Attention to groups excluded (foundlings and inmates of institutions) confirms that models limited to full household-level information significantly underestimate the impacts of poverty and exclusion. [ABSTRACT FROM AUTHOR]

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

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. [ABSTRACT FROM AUTHOR]

According to estimates published in this journal, the number of deaths of children under 5 in Iraq in the period 1991–98 resulting from the Gulf War of 1991 and the subsequent imposition of sanctions by the United Nations was between 400,000 and 500,000. These estimates have since been held to be implausibly high by a working group set up by an Independent Inquiry Committee appointed by the United Nations Secretary-General. We believe the working group's own estimates are seriously flawed and cannot be regarded as a credible challenge to our own. To obtain their estimates, they reject as unreliable the evidence of the 1999 Iraq Child and Maternal Mortality Survey—despite clear evidence of its internal coherence and supporting evidence from another, independent survey. They prefer to rely on the 1987 and 1997 censuses and on data obtained in a format that had elsewhere been rejected as unreliable 30 years earlier. [ABSTRACT FROM AUTHOR]

When assessing the health benefits of increased education in less developed countries, many researchers have been concerned about the omission of important determinants of an individual's education from the models. The study presented here shows that one should also be concerned about the limitations of the individual-level perspective. According to a multilevel discrete-time hazard model estimated with data from the National Family Health Survey II, the average education of women in a census enumeration area has a strong impact on child mortality, in addition to the effect of the mother's own education. The lower child mortality associated with women's autonomy is taken into account in this estimation. Results from similar models for various health and health-care variables suggest that the effect of community education, like that of individual education, operates through the use of maternity services and other preventive health services, the child's nutrition, and the mother's care for a sick child. [ABSTRACT FROM AUTHOR]

This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960's to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage. [ABSTRACT FROM AUTHOR]

Though adoption in China is known to have increased as more girls were abandoned and became available for adoption following the introduction of the country's one-child policy in the 1980's, little is known about Chinese adoption practices. This paper investigates the factors affecting adoption in China in the period 1950-87 using data from the National Two-Per-Thousand Sample Survey on Fertility and Contraception of 1988. The results show that the national adoption rate was 2.3 per cent Childless women were more likely than women with children to adopt and did not show a sex preference. Women with children by birth used adoption to secure a child of the 'missing' sex. Women who had experienced the death of a child were more likely to adopt than those who had not. Women with children may have used adoption as a strategy to circumvent the strict family planning policies. [ABSTRACT FROM AUTHOR]

Despite its widespread use, the Coale-Demeny model life table system does not capture the extensive variation in age-specific mortality patterns observed in contemporary populations, particularly those of the countries of Eastern Europe and populations affected by HIV/AIDS. Although relational mortality models, such as the Brass logit system, can identify these variations, these models show systematic bias in their predictive ability as mortality levels depart from the standard. We propose a modification of the two-parameter Brass relational model. The modified model incorporates two additional age-specific correction factors (γx and θx based on mortality levels among children and adults, relative to the standard. Tests of predictive validity show deviations in age-specific mortality rates predicted by the proposed system to be 30-50 per cent lower than those predicted by the Coale-Demeny system and 15-40 per cent lower than those predicted using the original Brass system. The modified logit system is a two-parameter system, parameterized using values of l5 and l60. [ABSTRACT FROM AUTHOR]

At least three kinds of hypothesis may be invoked to interpret religious differentials in mortality. They are (i) hypotheses that refer to characteristics, (ii) those that refer to lifestyle, and (iii) those that refer to the social isolation of minorities. This paper tests all three kinds of hypothesis using data on urban child mortality from The Hague just before and during the demographic transition. A hazard analysis suggests that economic and demographic characteristics do not account for much of the variation by religion. An analysis of seasonal mortality suggests that some of the variation may be explained by differences in lifestyle. The third kind of hypothesis is presented here for the first time. We suggest that the social isolation of small religious groups lowered their exposure to certain kinds of infectious disease. We use a simulation study to show that this hypothesis could account for part of the variation. [ABSTRACT FROM AUTHOR]

India is a country with a pervasive preference for sons and one of the highest levels of excess child mortality for girls in the world (child mortality for girls exceeds child mortality for boys by 43 per cent). In this article, data from the National Family Health Survey are used to examine the effect of son preference on parity progression and ultimately on child mortality. The demographic effects of family composition are estimated with hazard models. The analysis indicates that son preference fundamentally affects demographic behaviour in India. Family composition affects fertility behaviour in every state examined and son preference is the predominant influence in all but one of these states. The effects of family composition on excess child mortality for girls are more complex, but girls with older sisters are often subject to the highest risk of mortality. [ABSTRACT FROM AUTHOR]

The net effect of fertility decline on excess mortality of girls relative to that of boys in India is influenced by two countervailing forces: the reduction in the number of higher-parity births which reduces net excess mortality, and the intensification of parity-specific discrimination, which increases it. Rising sex ratios of children between 1981 and 1991 indicate that the net effect of these forces was an increase in the excess mortality of girls during this period. An estimated one million or more were added to the excess deaths, through sex-selective abortion or infanticide. For each of these deaths, an estimated four excess deaths of girls took place after birth during 1981-91, bringing the total excess mortality resulting from discrimination to almost five per cent of female live births. The pre-existing regional differences in sex bias persist, with the Northern States showing a greater increase in excess mortality, although the pace of fertility decline has been more rapid in the South. [ABSTRACT FROM AUTHOR]

Child survival from ages one to five in Matlab, Bangladesh is related to the length of the birth-to-subsequent conception interval (BCI), family composition, health and family planning interventions, and socioeconomic conditions. The BCI relationship consists of short-term effects (related to the mother's pregnancy or the presence of a very young sibling) and long-term effects (associated with having a 6-18 month old younger sibling). Their impact is apparent at longer intervals than previously thought. Girls with at least one sister are especially vulnerable and all girls have greater risks when the next child comes along. We conclude that the health and family planning programme improves life chances of children, especially girls, directly through provision of care, and indirectly through prevention of unwanted births and longer child spacing. The differential allocation of resources to children, indicated by the strong relationship of child survival to the composition of the older sibling set, may indicate previously unrecognized receptivity to family planning. [ABSTRACT FROM AUTHOR]

The clustering of childhood mortality risk by family in Northeast Brazil is investigated. The extent of family clustering is estimated before and after controlling for observed child and family demographic, reproductive, and socioeconomic characteristics and unobserved community characteristics. The study also investigates the extent to which the coefficient estimates and standard errors are altered with better controls for unobserved heterogeneity at the family level and at the community level. These controls are achieved through the use of a multilevel nested frailty model for survival data. The variance of family frailty is overstated by a factor of four when unobserved community effects are omitted. The family-level variance is not statistically significant in the multilevel model, although it is highly significant in the model that includes only the family frailty effect. Furthermore, ignoring the full design effects results in systematic bias in parameter estimates and standard errors. [ABSTRACT FROM AUTHOR]

In this paper alternative models for testing for child death clustering are explored, using data from Punjab. Significant evidence of clustering is found only amongst the lower socio-economic and educational groups. The majority of these families succeed in avoiding child-loss despite their social and economic disadvantages, while a few experience multiple child loss. As maternal education and socio-economic status rise, the negative deviance in factors related to child mortality appears to be removed. The extent of clustering is quite high in this population, indicating substantial potential for reducing child mortality by focusing services on high-risk households. Family building factors such as short birth intervals and high parity births do not raise child mortality when families are disaggregated by level of risk. They seem to be an effect rather than a cause of clustering of child deaths. [ABSTRACT FROM AUTHOR]

This article examines ways to measure the extent of family mortality risk or the spread of the risk distribution in different populations. There is abundant evidence that risks of dying are never equally spread in populations. Differentials in bio-demographic characteristics such as mother's age, the spacing of her births, her parity, and the sex of the child, and differentials in socio-economic characteristics such as parental education show that both biological and social factors affect the distribution of risk among children and their families. Perhaps as a result of the wealth of data and this influential model, which was first conceptualized at the aggregate level of a population but lends itself more easily to individual-level analysis, the search for causal processes and pathways has been dominated by increasingly sophisticated analyses of data for individual births. Although there is considerable evidence that child survival probabilities within families are linked, only very recently has attention been given to the use of proper statistical procedures to allow for lack of independence between individual births to the same mother.

Presents a correction to an article on mortality in children which has been published in a previous edition of the journal.