Contraception and Reproduction Health Consequences for Women and Children in the Developing World (1989) / Chapter Skim
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5 Reproductive Patterns and Children's Health
5 Reproductive Patterns and Children's Health
Pages 53-75
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From page 53... ...
. Other indicators of poor child health, such as the incidence of infectious disease and malnutrition, also remain high in many developing coun~ies, particularly in the poorer countries in sub-Saharan Africa and South Asia.
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From page 54... ...
Certain infections, such as neonatal tetanus, are also particularly prevalent during the first month, and other infectious diseases, such as pneumonia, are significant neonatal health risks. Mortality and illness after the neonatal period, which are usually associated with infectious or parasitic diseases and poor nutrition, are more directly influenced by the environment in which a child lives than mortality and illness during the first month of life.
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From page 55... ...
usually show that infant and child~mortality rates are higher for those who are: the firstborn, born to a young mother, or a combination; a higher-order birth, born to an older mother, or a combination; · born into a family with a large final number of children ever born; · born before or after a short interbirth interval. It has also been hypothesized that · children born as a result of unwanted pregnancies are likely to be in poorer .
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From page 56... ...
First, reporting errors common to retrospective fertility histories may exaggerate the relationships observed between birth spacing and child survival.2 Second, most of the surveys contain only limited information on breastfeeding, length of gestation, birthweight, and other biomedical characteristics of the mother and child that may be important factors in the relationship between child health and reproductive patterns. Third, many of the surveys collected only limited information on socioeconomic status and other family characteristics, which may independently affect both fertility and children's health.
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From page 57... ...
First, the reproductive variables of interest are likely to be highly correlated. For example, higher child mortality observed among children born to teenage mothers may actually be a consequence of the fact that a large proportion of these births are first births.
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From page 58... ...
We have examined variations in the sizes of the relative risks for fast births across countnes and found no systematic relationship between the relative risks and either total fertility rates or infant mortality rates. 4 The figures given in the text are the relative odds of dying for firstborn children compared with children who were of second or third births with favorable birth spacing (more than 24 months)
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From page 59... ...
Research in sub-Saharan Africa indicates that women having their first pregnancy have twice the rate of placental malaria as women who have already been pregnant before (Bray and Anderson, 1979; McGregor et al., 1983~. However, more evidence is needed before we can assess the role of malaria in differences in infant mortality rates by birth order.
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From page 60... ...
Furthermore, evidence from several studies in developing countries suggests that the association between higher risks of child mortality and young maternal age persists even when socioeconomic status is held constant. However, it may be that the measures of socioeconomic status and living conditions used in these studies do not adequately capture characteristics common to teenage mothers in developing countries that affect child survival, such as inadequate use of prenatal care.
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From page 61... ...
EFFECTS OF SHORT BIRTH INTERVALS The evidence concerning the effects of birth spacing on child survival and health is more consistent than that concerning the effects of high parity and maternal age. Studies based on very different types of data from culturally and socially diverse populations consistently find a negative association between short birth intervals and a child's chances of survival.
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From page 62... ...
There is considerably less evidence on the association between length of previous birth interval and other health indices such as birthweight and growth. Low birthweight may be due to intrauterine growth retardation, defined as birthweight less than the 10th percentile for gestational age, or preterm delivery, defined as gestational age less than 37 weeks.5 Studies of the relationship between birth interval length and birthweight are complicated by the fact that preterm births, by their nature, have shorter periods of gestation and thus shorter birth intervals.
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From page 63... ...
However, several studies that have attempted to link indices of maternal health to short birth spacing have not produced persuasive evidence that so-called maternal depletion accounts for the association between birth spacing and child survival except in extremely malnourished populations (Winikoff and Sullivan, 1987; Ferraz et al., 1988; Costello, 1986; Pebley and DaVanzo, 1988~. A; second possible mechanism is that in families with closely spaced births, there may be greater competition among children of approximately the same age for scarce family resources.
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From page 64... ...
Finally, despite attempts to control for confounding factors in recent multivariate analyses, part of the observed relationship may result from spurious associations or unobserved heterogeneity, making it appear that close spacing increases the risks of poor child health. One hypothesis about the association between very short previous interbirth intervals and poor child survival is that pregnancies of shorter gestation are more likely to be associated with short previous birth intervals than full-term pregnancies, and these pregnancies of shorter gestation are more likely to result in the birth of babies who are at greater risk of dying.
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From page 65... ...
Tabulations from survey data, using retrospective reports of the wontedness status of births, do not show a consistent association between unwanted pregnancies and higher mortality risks. However, there is limited evidence from other sources suggesting that children born as a result of unwanted pregnancies are likely to experience greater health and psychological problems.
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From page 66... ...
It is difficult to determine how applicable the findings of these last two studies are to families in contemporary developing countries. Nonetheless, this evidence suggests that children born as a result of unwanted pregnancies may be at higher risk.
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From page 67... ...
Even a congenital infection that is not itself a direct cause of infant deaths may leave the infant more susceptible to later infection. MINIMIZING THE RISKS OF CHILD DEATH As discussed above, assessing the potential impact of changes in reproductive patterns for child survival is complicated because there is not yet sufficient evidence to determine how much of the observed association is actually causal.
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From page 68... ...
are not common in many countries, as we discuss further in Chapter 6. The estimates described here apply to risks for individual children, not to population-level mortality rates, which are affected by the distribution of maternal age, birth order, and birth spacing In the population.
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From page 69... ...
. TABLE 53 Estimated Average Number of Child Deaths Expenenced by Families Under Different Conditions, Per 100 Families Baseline Child Mortality Rate Number of 50/1,000 Deaths 1OO/l,OOO Deaths lSO/l,OOO Deaths Children Closely Well Closely Well Closely Well Ever Bom Spaced Spaced Spaced Spaced Spaced Spaced 4-child family 45 23 92 45 142 68 6-child family 70 33 144 65 222 98 9-child family 112 50 232 100 358 150 Source: Calculations based An figures in Hobcraft (1987:Table 1)
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From page 70... ...
APPENDIX TABLE 5.A Studies of Infant and Child Health Location and Dependent Study Type of Data Variable Type of Analysis, Controls Aaby, Bukh, Guinea-Bissau; Incidence and Tabulations by HHC, A, CC, Lisse, and census and ease fatality; NS,E, SES Smits, 1984 health data rate of measles Bean, United States; Infant modality Digit regression; controls: Mineau, and nineteenth- PBI, PCS,hIA, Anderton, 1987 century Monnons, MAM, PD, PSBI, BO, R population -based longitudinal data Bijur, Great Britain; Accident Logit regression; controls: Golding, and longitudinal frequency HHC, SES,MMI, CHC Kurzon, 1988 data Boenna and van Kenya; Mortality during Log-linear regression; Vianen, 1984 population-based first week, controls: PBI, BO,MA. longitudinal data after the first Lifetable by SBI and week to 11 tabulations of BW and months, 12-23 mean weight and height months; binh- by PBI and SBI weight; mean weight and height at selected ages Cantrelle and Senegal; Duration of Tabulations by SSC, S
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From page 71... ...
FB, MA, AM, PSBI, PBI, fertility history SES, ON, R E, YB Doyle, Morley Nigeria; Birth interval; Tabulations by BO, PCS, Woodland, and population-based birthweight; PCCS, SCS, PBI, SBI, K Cole, 1978 longitudinal data mean growth D'Sooza and Bangladesh; Infant and child Tabulations by YB, S
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From page 72... ...
Project, longitudinal data neming and India; Birthweight; Logit regression; Gray, 1988b Narangwal Nutrition infant end controls: S,C, PBI, BO, and Health later- child growth. PCS vexation Project, longitudinal data Fortney and Iran; Infant modality Digit regression; Higgins, 1984 hospital-based before the controls: PBI,BO,MA data mother's dis charge from the hospital; binhweight Gubhaju, 1986 Nepal; Infant and Logit regression; WFS—retrospective child mortality controls: BO, MA, S
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From page 73... ...
WFS—retrospective months, ~11 MB, SB, BO, BF, PBI, SBI fertility histories months, 12-59 months Pebley, Knodel, Germany; Infant modality Logit regression; and Hermalin, nineteenth-century by birth rank controls: PCS, PBI,MA, 1988 German villages, SES, R PD population -based longitudinal data Pebley and Guatemala; Infant and Hazard model; Stupp, 1987 femalelifo history child mortality controls: MA, BO, S
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From page 74... ...
Key to Abbreviations AM BE BO BW C CC CD CHC D DD DN DP E FB HB HDFP HE HFP HHC age group mother's age at menarche breastfeeding birth or pregnancy order birth weight caste clustering of cases cause of death child characteristics, such as aggression, overactivity, independence type of delivery number of months pregnant before mother consulted a doctor or nurse distance to nurse number of doctors and OB-GYNs per capita ethnicity first birth hospital beds per capita number of health departments with family planning services per capita local government health and hospital expenditures number of hospitals with family planning services per capita household composition percentage of persons employed in manufacturing, service, or government jobs history of kwashiorkor currently breastfeeding month of birth maternal age M MA MAM mother's age at marriage MB multiple births ME menstruating MG presence of malaria or gonorrhea MH mother's height
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From page 75... ...
REPRODUCTIVE PATTERNS AND CIlI=REN'S IlEALTH 75 ML months breastfeeding MM:I maternal malaise inventory, a measure of the psychological well-being of the mother MP months pregnant MS marital status MW mother's weight NS nutritional status currently pregnant PAR number of live births bom to mother PBI previous birth or pregnancy interval PCCS survival of a child prior to the preceding child PCS survival of previous child PI prior interval (birth interval immediately prior to the preceding interval) PD previous infant deaths PL months breastfeeding/months exposed to conception PP months pregnantimonths exposed to conception PR cigarette and mills prices PSBI R S SB SBI SCS SES SP SM SS SSC ST UE YB proportion of other pregnancy intervals that are short or average of birth intervals urban/rural residence or region sex of child proportion or number of stillbirths subsequent birch interval survival of subsequent child education, income, occupation, housing characteristics supplementary food number of cigarettes smoked per day by mother while pregnant sibship size survival status of the index child sales tax on cigarettes general and female unemployment rate year of birth
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