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  • Title: The effect of previous child death on infant and child mortality in rural Nepal.
    Author: Gubhaju BB.
    Journal: Stud Fam Plann; 1985; 16(4):231-6. PubMed ID: 4035724.
    Abstract:
    Data from the Nepal Fertility Survey 1976, which was carried out by the Nepal Family Planning and Maternal-Child Health Project in collaboration with the World Fertility Survey, is used to explore the interrelationships of sibling mortality. Even when demographic variables are considered, the risk of infant and child death is considerably higher among children of mothers whose previous child died than among those whose previous child survived. An attempt is also made to examine whether it is because of close birth spacing or because of the family environment that the previous child loss puts the subsequent children at an excessive risk of dying during infancy and childhood. This paper examines whether the effect of the survival of the previous birth on infant and child mortality operates independently or through such demographic factors as birth order, maternal age at birth, and previous birth interval using data from the 1976 Nepal Fertility Survey. Infant mortality for a cohort of live births is measured as the probability of the infant dying before reaching 1 year of age; child mortality is measured as the probability of dying before age 5 years. The present analysis includes only those children born between 5 and 15 years before the survey. Even when demographic variables are taken into consideration, results indicate that the effect of previous child loss on infant and child mortality is quite apparent. Irrespective of the length of the preceding birth interval, the probability of the index child dying during infancy is considerably higher among children of mothers whose previous child died. This finding reinforces the belief that the older sibling's death presents an even higher risk to the recently born child during infancy than does the competition for maternal attention and household resources between 2 closely spaced living siblings. This phenomenon may be termed the family environment effect. The study also shows that whether the previous child survived or died, the effect of the birth interval length on infant mortality is present. Among children of mothers whose older child survived, the risk of death during infancy for the index child is 3 times higher in short (18 months) than in long intervals (36+ months); but among the children of mothers whose older child died, the risk of infant death for the index child is only about twice as high. From this it can be concluded that the effect of the birth interval is stronger among those who, with respect to the family environment effect, are low-risk children. Interestingly, the competing child effect appears to operate when the risk of child death is high. Among the children born in an interval of less than 18 months, the risk of child death was lower when the previous child died. This may be due to the fact that when the previous child dies, there is no competition; the short birth interval does not represent an additional risk, presumably because the competing child effect is removed. However, at favorable to survival interbirth intervals (18-23 months, 24-35 months, and 3 years or more), the death of the older sibling increases the risk to the index child (family environment effect). Loss of an earlier child may suggest inadequate living conditions and/or care that might overpower the otherwise favorable effect of the birth interval. A major factor that needs to be addresses is the effect of son preference on differential mortality.
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