The International, Secular Infant Mortality Decline

- The Dual Role of Resources

Department of Statistics Universitety of Dar es Salaam

December 2005

Gunnar Thorvaldsen Registreringssentral for historiske data

http://www.rhd.uit.no/

Estimated population size and infant mortality rate in post-war Tanzania

0

5000

10000

15000

20000

25000

30000

35000

40000

1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Pop

x 10

00

0

20

40

60

80

100

120

140

160

180

IMR

per 1

000

PopulationIMR, 5 year

Doctoral candidate Bonaventure Ngowi, studying infant mortality and parity

Infant mortality study • As is well known both from historical studies of western countries and

current developing countries that the life conditions of the mother is a crucial factor with respect to improving children's health and survival chances. Whether she has the time, resources and knowledge to breast-feed and implement other measures of proper child care has time and again been shown to affect the infant mortality rates dramatically. Doctoral student Ngowi analyzes infant mortality in Tanzania with special reference to child spacing and parity. Since the number of children ever born and surviving is a variable in the Tanzanian census, we shall be able with multivariate statistics to analyse the relationships between infant mortality and the mothers' status in different types of families and households.

Administered by SEMUT Centre for Environment and Development studies

Main source of drinking water 2002

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Pipe

d Wate

r Pr

otecte

d Well

Unp

rotec

ted W

ell Pr

otecte

d Spri

ng

Unp

rotec

ted Spri

ng R

iver/S

tream

Pond

/Dam

Lake

Rain

Wate

r W

ater V

endo

rsH

ouse

hold

sUrbanRural

Literacy by age group in Tanzania 2002

3000000 2000000 1000000 0 1000000 2000000 3000000

5 - 9

15 - 19

25 - 29

35 - 39

45 - 49

55 - 59

65 - 69

75 - 79

Illiterate menLiterate menIlliterate womenLiterate women

. . . and the superstition surrounding infant care, here magical hut for curing sick babies, Dar es Salaam Village Museum

www.whc. ki. se

Norway and Sweden

CDR and IMR: Norway and Sweden 1738-1968 from inverse projection

0,0

10,0

20,0

30,0

1738

1748

1758

1768

1778

1788

1798

1808

1818

1828

1838

1848

1858

1868

1878

1888

1898

1908

1918

1928

1938

1948

1958

1968

0

50

100

150

200

250

300

IMR

CDR inverse

IMR projected

IMRM Sweden

W Sweden

Positive effects from resources • T. McKeown (The modern rise of population, 1976): Not health, but nutrition

behind the mortality decline • E. Fure (...en besynderlig Regelmæssighed, 2004): Mothers’ health across

generations • S. Sogner: Forestry and infant mortality decline in Rendalen • T. Bengtsson et al (Life under pressure : mortality and living standards in Europe

and Asia, 1700-1900, 2004): the short-term effects of economic stress on mortality • Japan’s IMR achievement: 1960 -> 30.7 per thousand / 1988 -> 4.8 per thousand • S. Hinderaker (Perinatal Mortality and anaemia in pregnancy in Northern Rural

Tanzania, 2003): Arm circumference as proxy for infant mortality in Arusha

Deceased 0-1 years by 100 live births

Infant mortality in a number of countries 1801-1900

Infant mortality in the Nordic countries till 1998

0

50

100

150

200

250

300

350

400

450

1751 1767 1783 1799 1815 1831 1847 1863 1879 1895 1911 1927 1943 1959 1975 1991

IMR

NorwayDenmarkFinlandIcelandSwedenEng & Wales

Dead aged 0-1 in Norway 1876-1898 relative to live births

The country Rural Towns

Legitimate Illegitimate

Black: boys Red: girls

Main background factors for child mortality in the late 19th century and today

High Low

Developed countries today

Late 19th century US

High

3rd world countries today

3rd world countries in the 19th century

Low

Level of technical knowledge about health

Level of economic

development

Negative or no effect from resources • A. Perrenoud (‘La mortalité des enfant en Europe francophone: etat de la question’,

1994): Can infant mortality develop independently from the surrounding social, economic and cultural factors? Climate!

• O. Turpeinen (‘Infant mortality in Finland 1749-1865', 1979): “fluctuations from year to year showed little significant correlation with the extent of the harvest yields. The highest rates of infant mortality figures did not appear in the poorest but in relatively wealthy districts”

• R. Engelsen (Sosiale skilnader i mortalitet på landsbygda i Norge i åra 1802 og 1803, 1982): Higher mortality among farmers than among cottars

• Ó Garðarsdottir (Saving the Child, 2002): In Reykjavík, the higher social strata initially had higher infant mortality, but benefited sooner from the late 19th century improvements than the lower strata.

• England and France in the 19th century (Woods, 2000): Earlier decline for older children

than for infants • K. McQuillan (Culture, religion, and demographic behaviour : Catholics and Lutherans

in Alsace, 1750-1870, 1999): Occupational differentials in multivariate study are moderate, some effect for children of workers and servants, else little effect

• A. Brändström ("De kärlekslösa mödrarna" : spädbarnsdödligheten i Sverige under

1800-talet med särskilt hänsyn till Nedertorneå, 1984)

Infant mortality in Sweden 1848-1852

Infant mortality and social groups

Infant mortality in Nedertorneå, Sweden 1820-94 by social strata

0

100

200

300

400

500

600

1820-24

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94

IMR

Middle classPeasantsProletariat

Anders Brändström, Demographic Database, Umeå

Infant mortality in west European countries till 1998

0

50

100

150

200

25018

30

1837

1844

1851

1858

1865

1872

1879

1886

1893

1900

1907

1914

1921

1928

1935

1942

1949

1956

1963

1970

1977

1984

1991

1998

IMR

BelgiumNetherlandsNorwayFranceIrelandEng & Wales

• N. Scheper-Hughes (Death without weeping: the violence of everyday life in Brazil, 1992): The combined effect of economic and cultural factors.

• Haines & Preston, (Fatal years : child mortality in late nineteenth-century America, 1991): Relatively better child mortality among the black population.

• D. Reher: (‘Do parents really matter? Child health and development in Spain during the demographic transition’, 2003): Much greater impact from losing mother than losing father, especially educated mother.

• R Derosas (‘Watch Out for the Children! Differential Infant Mortality of Jews and Catholics in Nineteenth-Century Venice’, 2003): Poor, dense ghetto, but model mothers.

• Steady decline in infant mortality in Western Europe in the 20th century

independent of business cycles. • N. Hart (‘Famine, Maternal Nutrition and Infant Mortality: A Re-Examination

of the Dutch Hunger Winter’ 1993): Only the better-off were fecund, so perinatal mortality did not increase.

• N. Morgan (‘Infant mortality in the nineteenth-century Preston’, 2002): Industrial smoke and flies bringing contagion from horse dung affecting infant health negatively in Lancashire

• M. Federman et al (‘Industrialization and Infant Mortality’, 2005): Higher infant mortality in the areas with the most polluting industry in Indonesia

• C. Stoltenberg: Higher infant mortality among the children born to Pakistani cousins

Gross national product per person and infant mortality rates in four developing countries

GNP per person High IMR Low IMR

High ($ 7138 - 17016) Brazil (35) South Korea (8)

Low ($ 1516 - 3460) Bangladesh (70) Sri Lanka (16)

A. Kidanemariam: A Comparative Study of Infant Mortality in Four Developing Countries: Bangladesh, Brazil, South Korea and Sri Lanka. New York 2003

Infant mortality rates and key independent variables for four developing countries

Bangladesh Brazil Sri Lanka South Korea

GNP per inhabitant 1999 $ 1516 $ 7138 $ 3460 $ 17016

Gini 0.66 (1978) 0.60 (1976) 0.35 (1973) 0.34 / 0.31 (1

Female illiteracy 1980 83.3 27.2 20.5 11.2

Female illiteracy 1990 77.0 18.8 15.4 6.6

IMR 1985 per thousand 123 68 30 27

IMR 1999 per thousand 70 35 16 8

Sources: GNP and IMR 1999 from CIA World Factbook Kidanemariam A Comparative Study of Infant Mortality in Four Developing Countries: Bangladesh, Brazil, South Korea and Sri Lanka 2003

Background variables • Social equality • Welfare level • Urban / rural • Industrialization • Pollution • Medical services • Mothers’ health stations • Resourceful individuals • Politics

• Social status • Education • Nutrition • Breastfeeding • Infant care • Legitimacy • Religion • Ethnicity

References Denmark: Anne Løkke, Døden i barndommen, København: 1998 Grethe Banggaard, Befolkningsfremmede foranstaltninger og faldende barnedødelighet, Odense 2004. Iceland: Òlöf Garðarsdottir: Saving the Child. Regional, cultural and socio- economic aspects of the infant mortality decline in Iceland 1820-1940, 2002 Finland: Kari J. Pitkänen, ”Infant Mortality Decline in a Changing Society,” in Yearbook of Population Research in Finland 1983, 46-74. Sweden: Sören Edvinsson, Marie C Nelson, John Rogers: Dying Young. Swedishinfant and childhood mortality in review. Hygiea Internationalis. Norway: Rural infant mortality in nineteenth century Norway. Hygiea Internationhttp://www.liu.se/tema/inhph/journal/

Classic work on neonatology: http://www.neonatology.org/classics/

Tidsskrift for Den norske lægeforening 76 (1955), side 815-816

Dead infants (under one year) per 1000 live born

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10

20

30

40

50

60

70

80

1946-55 1946-50 1951-55 1953 1954

IMR

KautokeinoNorge

Dead infants aged 4 to 52 w eeks

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5

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15

20

25

30

35

40

45

1946-55 1946-50 1951-55 1953 1954

Per 1

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born

Kautokeino

Norw ay

Sw eden

Denmark

Dead infants in Kautokeino 1946-55

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

Children by married nomads Children by married residents Children born out of w edlock

IMR

per

100

0 bo

rn

Denmark 1850-54

Bourgeouis-Pichat's biometric test for Norway 1876-85 by sex and legitimacy

0,0

20,0

40,0

60,0

80,0

100,0

120,0

140,0

160,0

1 and 2 w eeks / 1 - 12 months / [log(days+1)]3

Cum

pr 1

000

Legitimate boys

Legitimate girls

Illeg boysIlleg girls

Biometric test - Norway

Iceland 1920

Feeding methods in selected areas 1911-20

0 %10 %20 %30 %40 %50 %60 %70 %80 %90 %

100 %

Reykjavik Hafnarfjördur Læknisherud(NorthEast)

Læknisherud(South)

BottleBreast/bottleBreast

Survival in days of breast-fed and artificially fed infants in a fishing village in Iceland 1915-1925

x

IMR 1840-52341 to 618 (52)281 to 340.9 (49)221 to 280.9 (55)161 to 220.9 (18)87 to 160.9 (10)

Causes of death Causes of death in infancy, Norway 1899-1955

0,0

100,0

200,0

300,0

400,0

500,0

600,0

700,0

800,0

900,0

1000,0

-19021899

-121909

-221919

-351931

-401936

-451941

-501946

-551951

Dea

ths

per 1

0 00

0 liv

e bi

rths

Unknown causes

Accidents

Other diseases

Diarrhoea and enterities

Bronchitis and pneumonia

Common infectious diseases

Tuberculosis

Congenital malfunction anddiseases of early infancy

IMR 1856-60NOS C No 1 Folkemengdens bevegelse

180 to 207 (1)160 to 180 (2)140 to 160 (5)120 to 140 (11)100 to 120 (15)59 to 100 (39)

Infant mortality in the deaneries 1856 to 1865

Infant mortality in Norway 1856-60

MM

M - Missing data

M

M

M

M

MM

M

M

MM

Hølen (M)

Kristiania

Sarpsborg

Son

Levanger

Steinkjer

Trondheim

Aren

dal

Kristiansand

TvedestrandLillesandKragerø Sandefjord

Moss

Mandal

Gjøvik

Kongsvinger

Fredrikstad

Fredrikshald

Farsund

Flekkefjord

Egersund

Hamar

Drøbak

Lillehammer

Kopervik

Haugesund

Skudeneshavn

Stavanger

Sandnes

Bergen

Florø

Kris

tian

sund

Molde

Mosj

øen

Bodø

Tromsø

Vadsø

Vardø

Nams

os

Hammerfest

Ålesund

IMR1876-80by 1000 births

180 to 224 (13)160 to 180 (3)140 to 160 (25)120 to 140 (38)100 to 120 (111)22 to 100 (329)

IMR in Norway 1876-80

IMR around 1920

Ålesund

Molde

Kris

tian

sund

Hamar

Kongsvinger

Drøbak

Gjøvik

Steinkjer

Levanger

Trondheim

Egersund

Stavanger

Farsund

Flekkefjord

Skudeneshavn

Lill

esan

dMandal

Sand

efjo

rd

Krag

erø

Tved

estr

and

Kristiansand

Moss

Fredrikstad

Aren

dal

Tromsø

Kristiania

Sarpsborg

Fredrikshald

Hølen

Son

Lillehammer

Vadsø

Vardø

Haugesund

Bergen

Florø

Namsos

Bodø

Hammerfest

IMR 1916-20Per 1000 births

150 to 206 (5)100 to 150 (22)80 to 100 (31)60 to 80 (168)8 to 60 (364)

Dead infants by month of year 1894-97

Percent of live births 1876-1898

Source: Johannessen (1902)

Dead 0-1 in N

orway by age in m

onths

IMR by province IMR in Norwegian Provinces 1856-1950

0,0

20,0

40,0

60,0

80,0

100,0

120,0

140,0

160,0

180,0

200,0

1856-60

1866-70

1876-80

1886-90

1896-1900

1906-10

1916-20

1926-30

1936-40

1946-50

Pr 1

000

born

NordlandTromsFinnmarkRural districtsByer Towns