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  • Title: Reproductive and socioeconomic determinants of child survival: confounded, interactive, and age-dependent effects.
    Author: Kost K, Amin S.
    Journal: Soc Biol; 1992; 39(1-2):139-50. PubMed ID: 1514117.
    Abstract:
    Studies of infant and child mortality have evolved to distinguish between two sets of explanatory variables-factors related to reproductive or maternal characteristics and socioeconomic factors, generally described as characteristics of the family or household. Almost all multivariate analyses include variables from each of these two sets, but there has been little consideration of the relationship between them. We examine how these two sets of variables jointly affect mortality. We test first for confounded effects by examining socioeconomic effects while excluding and then including reproductive variables in nested multivariate models. Next, we look for age-dependent effects among the explanatory variables and find that reproductive and socioeconomic factors affect mortality at differing ages of children. Finally, we examine interactive effects of the two sets of variables. We conclude that the higher mortality observed among the low status groups is not a result of greater concentration of poor reproductive patterns in those groups. Instead, higher status groups probably have more resources available for combating the negative effects of the same high-risk reproductive patterns. Data on 9185 births that occurred between 1958-73 in 26 villages in Ludhiana District in Punjab state, India were analyzed to determine how reproductive and socioeconomic factors influence child mortality. Specifically confounded, interactive, and age-dependent effects were examined. Overall, only reproductive factors were associated with neonatal mortality. These factors included maternal age (p.05 for 20 year old mothers and p.1 for 35 year old mothers) and =or 15 month birth interval (p.05). =or 15 month birth interval also affected 2-6 month old mortality (p.05) as well as mother's education ([.05). The socioeconomic factors of being a girl (p.05), lower caste Sikh (p.05), and having a low income (p.05) were all positively associated with child mortality beginning at 7 months. The nutrition, medical, and family planning interventions of the Narangwal project (1968-74) improved child survival for only =or 7 month old children born during or after 1963 (p.05). 0-36 month old children born to mothers with no education were less likely to surmount the negative effects related to a young mother, high birth order, short previous birth intervals, and a previous sibling death (p.05). The low status groups were just as likely to exhibit poor reproductive patterns as were the high status groups, but the low status groups tended to experience higher mortality because they did not have access to the resources needed to over come the negative effects of the same high risk reproductive patterns as did the high status groups.
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