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  • Title: Birth spacing and infant mortality: evidence for eighteenth and nineteenth century German villages.
    Author: Pebley AR, Hermalin AI, Knodel J.
    Journal: J Biosoc Sci; 1991 Oct; 23(4):445-59. PubMed ID: 1939293.
    Abstract:
    Data from an historical population in which fertility control was minimal and modern health services were mostly unavailable are used to show that there appears to have been a strong association between previous birth interval length and infant mortality, especially when the previous child survived. Although only imperfect proxies for breast-feeding practices and other potentially confounding factors are available for this population, the results suggest that the association between previous interval length and infant mortality in this population is not solely, or primarily, a function of differences in breast-feeding behaviour or socioeconomic status. Other factors, e.g. maternal depletion or sibling competition, are more likely to explain the observed association. In order to untangle the relationships between maternal age, birth spacing, family size, birth order and infant and child mortality, this study selected a data set which represented minimal fertility control and had no modern health services. 14 German villages with historical data from parish and civil registers on 48,000 births and 9000 reproductive histories were selected in this study of the relationship between reproductive patterns and infant mortality. The regions of Baden, Wurttemberg, Bavaria, Waldeck, and East Friesland represented different demographic conditions. The infant morality rate was 228/1000; there was wide variation in the prevalence and duration of breastfeeding. In East Friesland villages, breastfeeding was used by a majority of mothers for an average duration of a year, there is evidence to suggest that breastfeeding patterns are related to variations in infant mortality. Factors affecting the relationship between birth interval length and level of infant mortality and the nature of their effect are identified in the discussion and in chart form. 3 hypotheses are discussed: 1) short birth intervals do not permit adequate maternal recovery time; 2) the association between previous birth interval length and child survival is due to competition for food and care between the index child and the next oldest sibling; and 3) closely space children are more likely to spread infectious diseases to each other. The results showed that infant mortality risks declined as birth interval length increased before plateauing at 24-28 months. For children whose previous sibling died in infancy, there is not consistent relationship between birth interval length and infant mortality. In the multivariate analyses of those children whose next oldest sibling survived infancy, birth interval length is divided into 2 categories in order to capture the nonlinear relationship. Infant mortality rates were higher for older women, so age of the mother 35 was a variable. Analyses were conducted by birth order separately. In the logit analysis with maternal age and paternal occupation constant, for all birth orders with probability of dying decreases consistently as birth order increases. Older maternal age has no effect on birth orders higher than 6. Little association between occupation and mortality risks exists. Region and number of infant deaths are strongly related to infant mortality, where lower regions of breastfeeding had higher mortality. Regional variations are described in different analyses to confirm that ameliorative effects of breastfeeding on child survival, but differences in breastfeeding behavior are not solely responsible for interval length and mortality. Breastfeeding effects and previous infant deaths may reflect lower birth weight, poorer parental practices, and lower living standards. The results suggest that factors (breastfeeding and use of health services and family planning) may not be adequate to explain the relationship. Further understanding is required of the factors affecting interval length in order to make conclusions about the causal mechanisms.
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