Socioeconomic inequalities in childhood mortality: the 1970s to the 1980s
Cleland, J.; Bicego, G.; Fegan, G.
Health Transition Review the Cultural Social and Behavioural Determinants of Health 2(1): 1-18
1992
ISSN/ISBN: 1036-4005 PMID: 10148663 Document Number: 320215
World Fertility Survey (WFS) and Demographic Health Survey (DHS) data are the basis for the description of declines in mortality between 1965-85 and the examination of the extent to which declines are attributed to improvement in socioeconomic structure in Senegal, Egypt, Indonesia, Peru, Morocco, Dominican Republic, Ecuador, Tunisia, Sudan (North), Thailand, Mexico, and Colombia. The analytical design is briefly described as the calculation of measures of mortality at the national level and for subgroups and defined in terms of maternal education, paternal occupation/education, and rural/urban residence. Trends were calculated from estimates for different periods. Trends were calculated form estimates for different periods. Absolute and relative differences for subgroups were assessed at several points in time to express differential mortality. The consistency and reliability of WFS and DHS data are discussed and conclusions drawn that only general patterns are expressed; mortality trends are not known with certainty and caution is urged in the interpretation. Results are presented for national levels and trends in childhood mortality, socioeconomic composition and national trends, and socioeconomic inequalities in childhood mortality: convergence and polarization. The main findings are that all but 1 of the 12 countries experienced mortality declines of around 50% from 1965 to 1985. The declines in mortality at 1-5 years was steeper than for infant mortality at 1-5 years was steeper than for infant mortality. The level of mortality in 1965 was not a factor in the improvement in child survival over the 20-year period; i.e., countries such as Thailand, Mexico, and Colombia with low levels of mortality in 1965 had proportionate increases equal to high mortality countries such as Egypt and Indonesia. The pace of decline has accelerated since the mid-1970s. Compositional change in, for instance, educational attainment, occupational structure, or level of urbanization, had not contributed substantially to mortality decline in the 12 countries, i.e., 20-35% of national decline could be attributed to improvements in maternal education in all but 1 country. Huge inequalities have persisted throughout the decades, although all socioeconomic levels have benefited form the improvement in survival. Other literature suggests that response to illness may be more important than prevention in explaining survival differentials in different socioeconomic subgroups, and future detailed analysis is warranted.