Abstract
Infant and child mortality rates have decreased substantially in Matlab, Bangladesh, as they have in many developing areas. We use data from the Matlab Demographic Surveillance System on nearly 94,000 singleton live births that occurred between 1987 and 2002 to investigate the extent to which the change in mortality over this period can be explained by changes in reproductive patterns and socio-economic characteristics. We estimate Cox proportional hazards models for four subperiods of infancy and childhood. Changes over time in reproductive patterns (maternal age, parity, and pregnancy spacing) and in the socio-economic characteristics we consider (e.g. maternal education, SES) explain between 10 and 40% of the decline in mortality rates. Changes in maternal education explain the largest portion of the reduction in infant and child mortality over time that we are able to explain, followed by reductions in the incidence of short interpregnancy intervals. In the other direction, decreases in fertility over time led to increases in the proportion of births that were first births, putting upward pressure on mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
While our decomposition analysis focuses primarily on the relative importance of reproductive and socio-economic factors on the change in infant and child mortality over this time period, we are not able to identify the important interrelationships occurring between these groups of variables. For example, socio-economic factors such as increases in maternal education are associated with delays in age at marriage and first birth (Ahmed 1986; Gangadharan and Maitra 2003; Breierova and Duflow 2004). In the other direction, women who get pregnant early may be less likely to complete their education. In addition, maternal and child health and family planning programs may be contributing to changes in socio-economic status. Regular household family planning visits were shown to increase the status of women between 1988 and 1993 (Phillips and Hossain 2003). It is beyond the scope of this paper to disentangle whether changes in socio-economic factors are causing changes in reproductive factors, if it is the other way around, or if their simultaneous changes are caused by another factor.
References
Ahmed, A. U. (1986). Socioeconomic determinants of age at first marriage in Bangladesh. Journal of Biosocial Science, 18(1), 35–42.
Ahmed, M. F. (1991). Infant mortality in Bangladesh: A review of recent evidence. Journal of Biosocial Science, 23(3), 327–336.
Amin, S. (1990). Infant mortality and breastmilk supplementation in Bangladesh. Bangladesh Development Studies, 18(4), 15–31.
Bhatia, S. (1983). Contraceptive users in rural Bangladesh: A time trend analysis. Studies in Family Planning, 14(1), 20–28.
Bongaarts, J. (1987). Does family planning reduce infant mortality rates? Population and Development Review, 13(2), 323–334.
Breierova, L., & Duflo, E. (2004). The impact of education on fertility and child mortality: Do fathers really matter less than mothers? NBER Working Paper 10513. Cambridge MA: National Bureau of Economic Research.
Chowdhury, M. E., Botlero, R., Koblinsky, M., Saha, S. K., Dieltiens, G., & Ronsmans, C. (2007). Determinants of reduction in maternal mortality in Matlab, Bangladesh: A 30-year cohort study. Lancet, 370(9595), 1320–1328.
Cleland, J. G., & Sathar, Z. A. (1984). The effect of birth spacing on childhood mortality in Pakistan. Population Studies, 38(3), 401–418.
Cleland, J. G., & Van Ginneken, J. K. (1988). Maternal education and child survival in developing countries: The search for pathways of influence. Social Science and Medicine, 27(12), 1357–1368.
DaVanzo, J., & Habicht, J. P. (1986). Infant mortality decline in Malaysia, 1946–1975: The roles of changes in variables and changes in the structure of relationships. Demography, 23(2), 143–160.
DaVanzo, J., Hale, L., Razzaque, A., & Rahman, M. (2008). 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. Population Studies, 62(2), 131–154.
Gangadharan, L., & Maitra, P. (2003). The effect of education on the timing of marriage and first birth in Pakistan. Journal of Quantitative Economics, 1(1), 114–133.
Greenspan, A. 1993. Family planning’s benefits include improved child health and nutrition: New data from Bangladesh. Asia-Pacific Population and Policy No.26.: Honolulu: East-West Center.
Hale, L., DaVanzo, J., Razzaque, A., & Rahman, M. (2006). Why are infant and child mortality rates lower in the MCH-FP area of Matlab, Bangladesh? Studies in Family Planning, 37(4), 281–292.
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). (2000). Health and Demographic Surveillance System-Matlab: Registration of demographic and contraceptive use 1998. Scientific Report No. 87. Dhaka.
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). (2008). Matlab demographic workbook. Available at http://www.icddrb.org/activity/index.jsp?activityObjectID=2878.
Jamil, K., Bhuiya, A., Streatfield, K., & Chakrabarty, N. (1999). The immunization programme in Bangladesh: Impressive gains in coverage, but gaps remain. Health Policy and Planning, 14(1), 49–58.
LeGrand, T. K., & Phillips, J. F. (1996). The effect of fertility reductions on infant and child mortality: Evidence from Matlab in rural Bangladesh. Population Studies, 50(1), 51–68.
Majumder, A. K., May, M., & Pant, P. D. (1997). Infant and child mortality determinants in Bangladesh: Are they changing? Journal of Biosocial Science, 29(4), 385–399.
Mitra, S., Ali, M., Islam, S., Cross, A., & Saha, T. (1994). Bangladesh Demographic and Health Survey, 1993–1994. Dhaka: National Institute of Population Research and Training.
Montgomery, M., & Cohen, B. (Eds.). (1998). From death to birth: Mortality decline and reproductive change. Washington DC: National Academy Press.
National Institute of Population Research and Training (NIPORT), Mitra and Associates (MA), and ORC Macro (ORCM). (2001). Bangladesh Demographic and Health Survey 1999–2000. Dhaka, Bangladesh and Calverton, USA: National Institute of Population Research and Training, Mitra and Associates, and ORC Macro.
Phillips, J. F., & Hossain, M. B. (2003). The impact of household delivery of family planning services on women’s status in Bangladesh. International Family Planning Perspectives, 29(3), 138–145.
Phillips, J. F., Stinson, W. S., Bhatia, S., Rahman, M., & Chakraborty, J. (1982). The demographic impact of the family planning—health services project in Matlab, Bangladesh. Studies in Family Planning, 13(5), 131–140.
Sathar, Z. A. (1992). Child survival and changing fertility patterns in Pakistan. Pakistan Development Review, 31(4 Pt 2), 699–711.
Swenson, I. (1977). Expected reductions in fetal and infant mortality by prolonged pregnancy spacing in rural Bangladesh. Bangladesh Development Studies, 5(1), 1–16.
Van Ginneken, J., Bairagi, A., De Francisco, A., Sarder, A. M., & Vaughan, P. (1998). Health and demographic surveillance in Matlab: Past, present, and future. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Special Publication No. 72. Bangladesh.
Zenger, E. (1993). Siblings’ neonatal mortality risks and birth spacing in Bangladesh. Demography, 30(3), 477–488.
Acknowledgments
Support provided by the Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development under the terms of Cooperative Agreement No. HRN-A-00-00-00003-00 awarded to Catalyst Consortium. The consortium, which ended in 2005, was a partnership between Pathfinder International and the Academy for Educational Development, the Centre for Development and Population Activities, Meridian Group International, Inc, and PROFAMILIA/Colombia. The views expressed are those of the authors and do not reflect the opinions of the staff of the United States Agency for International Development, RAND, ICDDR,B, nor Pathfinder International. An earlier version of this paper was presented at the annual meeting of the Population Association of America, in New York, in 2007. Some of DaVanzo’s work on this paper was done while she was a visiting fellow at the Australian Demographic and Social Science Research Institute at the Australian National University. Some of Hale’s work was done while she was an NICHD-funded post-doctoral fellow at the RAND Corporation. ICDDR,B acknowledges with gratitude the commitment of USAID and CATALYST consortium to the Centre’s research efforts.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hale, L., DaVanzo, J., Razzaque, A. et al. Which factors explain the decline in infant and child mortality in Matlab, Bangladesh?. J Pop Research 26, 3–20 (2009). https://doi.org/10.1007/s12546-008-9003-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12546-008-9003-0