Parity and post-reproductive mortality among U.S. Black and White women: Evidence from the health and retirement study

Population health research finds women's mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women's biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity-post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920-1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women's infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity-post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women's parity-post-reproductive mortality associations are not statistically significant. Black women's post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality.

Did the 1918 influenza pandemic cause a 1920 baby boom? Demographic evidence from neutral Europe

In 1919-20, the European countries that were neutral in the First World War saw a small baby bust followed by a small baby boom. The sparse literature on this topic attributes the 1919 bust to individuals postponing conceptions during the peak of the 1918-20 influenza pandemic and the 1920 boom to recuperation of those conceptions. Using data from six large neutral countries of Europe, we present novel evidence contradicting that narrative. In fact, the subnational populations and maternal birth cohorts whose fertility was initially hit hardest by the pandemic were still experiencing below-average fertility in 1920. Demographic evidence, economic evidence, and a review of post-pandemic fertility trends outside Europe suggest that the 1920 baby boom in neutral Europe was caused by the end of the First World War, not by the end of the pandemic.

Estimating the effect of socio-economic factors on infant mortality rates in Latin America between 2000 and 2019: a panel data analysis

OBJECTIVES

Infant mortality is a crucial indicator of socio-economic development, reflecting the conditions in which children are born and raised. Despite notable reductions in Latin America, infant mortality rates remain relatively high compared to other regions worldwide. By understanding the socio-economic factors that influence infant mortality, we not only uncover immediate causes of infant deaths but also shed light on broader socio-economic and healthcare disparities contributing to the burden of disease. This study analyzes the impact of socio-economic factors on infant mortality rates in Latin America from 2000 to 2019, estimating the speed and magnitude of the response of infant mortality rates to changes in specific socio-economic factors.

STUDY DESIGN

Longitudinal panel study.

METHODS

Panel data regression models were used to examine the influence of specific socio-economic factors on infant mortality rates in Latin America. Additionally, impulse response functions estimated by local projections were used to estimate the speed and magnitude of the impact of socio-economic factors on infant mortality rates.

RESULTS

The results highlight the importance of factors such as healthcare expenditure, female literacy, public expenditures on education, maternal mortality, physician density, total fertility rate, and tuberculosis incidence as significant determinants of infant mortality rates in the region.

CONCLUSION

This study adds to the existing literature by offering empirical evidence on the association between these socio-economic factors and infant mortality in Latin America. It also provides a foundation for future research that investigates specific cases within Latin America and examines the variations of these socio-economic factors within those countries.

Life After Loss: A Prospective Analysis of Mortality Exposure and Unintended Fertility

The relationship between mortality and fertility is a key component of demographic transition theory, placing it at the center of extensive inquiry. Among other linkages, mortality in women's communities and social networks influences their subsequent fertility. Existing demographic research assumes this is principally due to volitional mechanisms, implying that exposure to mortality consolidates women's desire to become pregnant, leading to intended fertility. Yet, insights from other disciplines suggest that mortality exposure could also increase women's unintended fertility through psychological, relational, and behavioral mechanisms. This study examines the relationships between network mortality exposure and women's hazard of pregnancy, and of unintended pregnancy specifically. We analyze two years (2009-2011) of closely spaced panel data on young Malawian women (N=1,272) enrolled in the Tsogolo la Thanzi study. Our data include information on funeral attendance and fertility desires measured weeks before conception, which is confirmed through frequent pregnancy testing. Hazard models show that the number of funerals women attend corresponds with a higher hazard of pregnancy and of unintended pregnancy specifically. These findings make clear that mortality exposure can influence fertility not by shaping women's desires but by disrupting the realization of those desires.

Disease and fertility: Evidence from the 1918-19 influenza pandemic in Sweden

What are the consequences of a severe health shock like an influenza pandemic on fertility? Using rich administrative data and a difference-in-differences approach, we evaluate fertility responses to the 1918-19 influenza pandemic in Sweden. We find evidence of a small baby boom following the end of the pandemic, but we show that this effect is second-order compared to a strong long-term negative fertility effect. Within this net fertility decline there are compositional effects: we observe a relative increase in births to married women and to better-off families. Several factors - including disruptions to the marriage market and income effects - contribute to the long-term fertility reduction. The results are consistent with studies that find a positive fertility response following natural disasters, but we show that this effect is short-lived.

Sibling loss and fertility desires in the high-mortality context of Peru

Despite demographers' long-standing preoccupation with the effects of child mortality on women's fertility desires, scholars continue to know little about the consequences of other pervasive mortality exposures. We use nationally representative data from the high-mortality context of Peru to examine whether the desire to have a(nother) child varies as a function of sibling loss and to assess heterogeneity in this association by women's current number of children and a range of conditions related to siblings' deaths. Women who have experienced sibling bereavement and have two or more children report higher odds of desiring another child. These effects are not contingent on the age or sex of the deceased sibling but are only significant if the sibling died during the respondent's lifetime (not before). These findings highlight the theoretical and empirical import of investigating the relationship between fertility desires and a wider range of familial mortality exposures beyond own child mortality.

Male fertility between biology and the socioeconomic context news from the past (Alghero, 1866-1935)

In the process of fertility decline, the role and participation of men have hardly been considered in the demographic literature. It has grown only as fertility was dropping dramatically in most Western countries, but very little has been done to analyze such an issue in historical populations. Based on individual-level data, the present paper aims at investigating, by means of hazard models, the role of males in the reproductive pattern of the pre-transitional population of Alghero, Sardinia (1866-1935). The results show a slower decrease of male fertility (-23% at 40-49 years; around -50% at 50+) compared to female fertility (about -40% already at 35-49 years), with significant differentials by socioeconomic status (SES). Wealthier men present, in fact, lower fertility than poorest ones, with a gap that, however, reduces with age and even reverses at 50+ years. The reason for such a change is likely to be partly associated with the better health conditions of the wealthy group, developed especially in adulthood, given the absence of a significant relationship between height and fertility SES differentials.

Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa

We advance a set of population-level indicators that quantify the prevalence of mothers who have ever experienced an infant, under 5-y-old child, or any-age child die. The maternal cumulative prevalence of infant mortality (mIM), the maternal cumulative prevalence of under 5 mortality (mU5M), and the maternal cumulative prevalence of offspring mortality (mOM) bring theoretical and practical value to a variety of disciplines. Here we introduce maternal cumulative prevalence measures of mortality for multiple age groups of mothers in 20 sub-Saharan African countries with Demographic and Health Surveys data spanning more than two decades. The exercise demonstrates the persistently high prevalence of African mothers who have ever experienced a child die. In some African countries, more than one-half of 45- to 49-y-old mothers have experienced the death of a child under age 5, and nearly two-thirds have experienced the death of any child, irrespective of age. Fewer young mothers have experienced a child die, yet in many countries, up to one-third have. Our results show that the mIM and mU5M can follow distinct trajectories from the infant mortality rate (IMR) and under 5 mortality rate (U5MR), offering an experiential view of mortality decline that annualized measures conceal. These measures can be adapted to quantify the prevalence of recurrent offspring mortality (mROM) and calculated for subgroups to identify within-country inequality in the mortality burden. These indicators can be used to improve current understandings of mortality change, bereavement as a public health threat, and population dynamics.

Survival and sex composition of offspring: Individual-level responses in the quantum and tempo of childbearing during the demographic transition

Previous studies have documented varying fertility responses to childhood mortality and to the sex composition of the surviving offspring during the demographic transition. We contribute to this literature by applying a mixture cure model to reproductive histories of Estonian women born 1850-99. This model, unlike standard event history models, is capable of separating the effect of the covariates on the propensity of having another birth from their effect on its timing. Child fatalities, not having sons, and to a smaller extent, not having daughters, increased the propensity to have another child and decreased the interval to it. The response was stronger among later cohorts, but only with respect to parity progression. By contrast, the accelerated childbearing response diminished over time. Our findings suggest that behavioural responses in the quantum and tempo of childbearing can occur relatively independently.

Human fertility in relation to education, economy, religion, contraception, and family planning programs

Background

The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study.

Methods

We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically.

Results

In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita.

Conclusions

These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.

The Effects of Conflict on Fertility: Evidence From the Genocide in Rwanda

Our study analyzes the fertility effects of the 1994 genocide in Rwanda. We study the effects of violence on both the duration time to the first birth in the early post-genocide period and on the total number of post-genocide births per woman up to 15 years following the conflict. We use individual-level data from Demographic and Health Surveys, estimating survival and count data models. This article contributes to the literature on the demographic effects of violent conflict by testing two channels through which conflict influences fertility: (1) the type of violence exposure as measured by the death of a child or sibling, and (2) the conflict-induced change in local demographic conditions as captured by the change in the district-level sex ratio. Results indicate the genocide had heterogeneous effects on fertility, depending on the type of violence experienced by the woman, her age cohort, parity, and the time horizon (5, 10, and 15 years after the genocide). There is strong evidence of a child replacement effect. Having experienced the death of a child during the genocide increases both the hazard of having a child in the five years following the genocide and the total number of post-genocide births. Experiencing sibling death during the genocide significantly lowers post-genocide fertility in both the short-run and the long-run. Finally, a reduction in the local sex ratio negatively impacts the hazard of having a child in the five years following the genocide, especially for older women.

Agency in Fertility Decisions in Western Europe During the Demographic Transition: A Comparative Perspective

We use a set of linked reproductive histories taken from Sweden, the Netherlands, and Spain for the period 1871–1960 to address key issues regarding how reproductive change was linked specifically to mortality and survivorship and more generally to individual agency. Using event-history analysis, this study investigates how the propensity to have additional children was influenced by the number of surviving offspring when reproductive decisions were made. The results suggest that couples were continuously regulating their fertility to achieve reproductive goals. Families experiencing child fatalities show significant increases in the hazard of additional births. In addition, the sex composition of the surviving sibset also appears to have influenced reproductive decisions in a significant but changing way. The findings offer strong proof of active decision-making during the demographic transition and provide an important contribution to the literature on the role of mortality for reproductive change.

Divorce and parity progression following the death of a child: A register-based study from Finland

Most studies that have examined whether a child's death influences parental relationship stability have used small-scale data sets and their results are inconclusive. A likely reason is that child loss affects not only the risk of parental separation, but also the risk of having another child. Hence parity progression and separation must be treated as two competing events in relation to child loss. The analysis in this paper used Finnish register data from 1971 to 2003, covering over 100,000 married couples whose durations of both first marriage and parenthood could be observed. We ran parity-specific Cox regressions in which process time started from the birth of each additional child. All marriages included women of childbearing age, none of whom had experienced any child death on entering the analysis. We find that child loss only modestly influences the divorce risk, whereas its effect on the risk of parity progression is considerable.

Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan

Background

Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world.

Methods

This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010–2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns.

Results

As a result of wars, people are under pressure to increase their family sizes and thus increase the nation’s population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility.

Conclusion

The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.

The effects of mortality on fertility: population dynamics after a natural disaster

Understanding how mortality and fertility are linked is essential to the study of population dynamics. We investigate the fertility response to an unanticipated mortality shock that resulted from the 2004 Indian Ocean tsunami, which killed large shares of the residents of some Indonesian communities but caused no deaths in neighboring communities. Using population-representative multilevel longitudinal data, we identify a behavioral fertility response to mortality exposure, both at the level of a couple and in the broader community. We observe a sustained fertility increase at the aggregate level following the tsunami, which was driven by two behavioral responses to mortality exposure. First, mothers who lost one or more children in the disaster were significantly more likely to bear additional children after the tsunami. This response explains about 13 % of the aggregate increase in fertility. Second, women without children before the tsunami initiated family-building earlier in communities where tsunami-related mortality rates were higher, indicating that the fertility of these women is an important route to rebuilding the population in the aftermath of a mortality shock. Such community-level effects have received little attention in demographic scholarship.

The determinants of low fertility in India

Using a conceptual framework focusing on factors that enhance or reduce fertility relative to desired family size (see Bongaarts 2001), we study fertility variation across time (1992-2006) and space (states) in India. Our empirical analyses use data from three waves of the Indian National Family Health Surveys. We find that this framework can account for a substantial portion of the variation in the total fertility rate (TFR) over time and across states. Our estimates focus attention on the critical components of contemporary Indian fertility, especially desired family size, unwanted fertility, son preference, and fertility postponement.

A model comparison approach shows stronger support for economic models of fertility decline

The demographic transition is an ongoing global phenomenon in which high fertility and mortality rates are replaced by low fertility and mortality. Despite intense interest in the causes of the transition, especially with respect to decreasing fertility rates, the underlying mechanisms motivating it are still subject to much debate. The literature is crowded with competing theories, including causal models that emphasize (i) mortality and extrinsic risk, (ii) the economic costs and benefits of investing in self and children, and (iii) the cultural transmission of low-fertility social norms. Distinguishing between models, however, requires more comprehensive, better-controlled studies than have been published to date. We use detailed demographic data from recent fieldwork to determine which models produce the most robust explanation of the rapid, recent demographic transition in rural Bangladesh. To rigorously compare models, we use an evidence-based statistical approach using model selection techniques derived from likelihood theory. This approach allows us to quantify the relative evidence the data give to alternative models, even when model predictions are not mutually exclusive. Results indicate that fertility, measured as either total fertility or surviving children, is best explained by models emphasizing economic factors and related motivations for parental investment. Our results also suggest important synergies between models, implicating multiple causal pathways in the rapidity and degree of recent demographic transitions.

Marital fertility decline in the Netherlands: child mortality, real wages, and unemployment, 1860-1939

Previous studies of the fertility decline in Europe are often limited to an earlier stage of the marital fertility decline, when the decline tended to be slower and before the large increase in earnings in the 1920s. Starting in 1860 (before the onset of the decline), this study follows marital fertility trends until 1939, when fertility reached lower levels than ever before. Using data from the Historical Sample of the Netherlands (HSN), this study shows that mortality decline, a rise in real income, and unemployment account for the decline in the Netherlands. This finding suggests that marital fertility decline was an adjustment to social and economic change, leaving little room for attitudinal change that is independent of social and economic change.

The Phoenix population: demographic crisis and rebound in Cambodia

The study of mortality crises provides an unusual and valuable perspective on the relationship between mortality and fertility changes, a relationship that has puzzled demographers for decades. In this article, we combine nationally representative survey and demographic-surveillance system data to study fertility trends around the time of the Khmer Rouge (KR) regime, under which 25% of the Cambodian population died. We present the first quantitative evidence to date that attests to a one-third decline of fertility during this regime, followed by a substantial "baby boom" after the fall of the KR. Further analyses reveal that the fertility rebound was produced not only by a two-year marriage bubble but also by a surge in marital fertility that remained for nearly a decade above its precrisis level. Our results illustrate the potential influence of mortality on fertility, which may be more difficult to identify for more gradual mortality declines. To the extent that until recently, Cambodian fertility appears to fit natural fertility patterns, our findings also reinforce recent qualifications about the meaning of this core paradigm of demographic analysis.

On the politics and practice of Muslim fertility: comparative evidence from West Africa

Recent popular works have represented Muslim fertility as dangerously high, both a cause and consequence of religious fundamentalism. This article uses comparative, statistical methods to show that this representation is empirically wrong, at least in West Africa. Although religion strongly inflects reproductive practice, its effects are not constant across different communities. In West African countries with Muslim majorities, Muslim fertility is lower than that of their non-Muslim conationals; in countries where Muslims are in the minority, their apparently higher reproductive rates converge to those of the majority when levels of education and urban residence are taken into account. A similar pattern holds for infant mortality. By contrast, in all seven countries, Muslim women are more likely to report that their most recent child was wanted. The article concludes with a discussion of the relationship between autonomy and fertility desires.

The effects of infant deaths on the risk of subsequent birth: a comparative analysis of DHS data from Ghana and Kenya

This paper examines the conditions under which there might be a strong or weak relationship between childhood mortality and fertility at the micro level. The premise is that as a society undergoes transition during which a conscious effort is made to space and limit birth, the effect associated with infant death on the risk of subsequent birth reduces. Using the 1998 DHS data from Ghana and Kenya, our multivariate hazard models show that women who have experienced infant deaths tend to have a higher risk of subsequent births than those without any infant deaths at all parities studied in both countries. In a comparative context, however, the magnitude of the effect associated with infant death was weaker in Kenya at all parities, corroborating the hypothesis that the effect indeed reduces in the course of transition. Besides infant deaths, other demographic, socioeconomic and sociocultural factors were also found to associate with the risk of births. The limitations and policy implications of the findings are discussed.

Demographic consequences of unpredictability in fertility outcomes

Child survival is probabilistic, but the unpredictability in family formation and completed family size has been neglected in the fertility literature. In many societies, ending the family cycle with too few or too many surviving offspring entails serious social, economic, or fitness consequences. A model of risk- (or variance-) sensitive adaptive behavior that addresses long-term fertility outcomes is presented. The model shows that under conditions likely to be common, optimal, risk-sensitive reproductive strategies deviate systematically from the completed family size that would be expected if reproductive outcome is were predictable. This is termed the "variance compensation hypothesis." Variance compensation may be either positive or negative, resulting in augmented or diminished fertility. Which outcome obtained is a function of identifiable social, economic, and environmental factors. Through its effect on fertility behavior, variance compensation has a direct bearing on birth spacing and completed fertility, and thereby on problems in demography and human population biology ranging from demographic transitions to maternal depletion and child health. Risk-sensitive models will be a necessary component of a general theory of fertility.

Risk factors and child mortality among the Miao in Yunnan, Southwest China

Environmental factors and the lifestyle of communities in developing countries as in the industrialized world have a great deal to do with their health status. This study carried out among the Miao people of southeastern Yunnan province in Southwest China has demonstrated important links between child mortality (one indicator of health status) and specific risk factors. These include lifestyle variables such as geographic mobility, the age of weaning and religious belief. In addition, the use of available health care facilities was another explanatory variable. Perhaps surprisingly, a history of tuberculosis seemed also to be empirically related to the presence or absence of child mortality. Although it was impossible to show a significant statistical relationship between traditional practices and child mortality from the study's database, the authors have observed qualitatively that birthing customs play an important role in explaining the perinatal component of child mortality. These various relationships shed some light on potential areas for intervention with a view to reducing the levels of child mortality among minority peoples in China and elsewhere.