Infant and child mortality: the implications for fertility behaviour.

ABSTRACT

PIP In developing countries, infant and child mortality affect fertility through biological or involuntary mechanisms operating through shortened breastfeeding, and more rapid return of ovulation following upon an infant death. Fertility is also affected through volitional responses of couples to perceived mortality levels in the community (insurance effect) or experience of earlier child loss (replacement effect) as well as through societal responses to high probability of child loss. In return, fertility affects infant and child mortality through birth to very young mothers, due to physiological immaturity of teenaged mothers and low birth-weight, as well as through birth to old mothers in high birth orders, due to maternal depletion syndrome. Trussel and Pebley estimated that the elimination of 4th and higher order births, along with the limitation of reproduction within the age of 20 to 34 years old, would reduce infant mortality by about 12%. A large number of studies show strong evidence that the timing and spacing of birth have a significant impact on both maternal and child health. According to Maine and McNamara (1985), who analysed data from 25 developing countries, if all children were born 2 years apart, 1/5 of infant deaths could be avoided. Mother's ill-health, maternal mortality, mother's malnutrition and its consequences in low quality breast milk and short breastfeeding, reduce sharply the new child's chances of survival. Many of these adverse biological and physiological conditions for childbearing can be compensated for by the provision of health care of high quality, including family planning, as well as education and good nutritional status of the mother and her children. Unfortunately, in many societies and for large segments of the population, such conditions are still a dream.^ieng