From Death to Birth Mortality Decline and Reproductive Change (1998) / Chapter Skim
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11 Child Mortality and the Fertility Transistion: Aggregated and Multilevel Evidence from Costa Rica
11 Child Mortality and the Fertility Transistion: Aggregated and Multilevel Evidence from Costa Rica
Pages 384-410
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From page 384... ...
If improving child survival is a precondition for birth control, family planning programs in the least developed regions are unlikely to succeed, especially if these programs have a vertical organization independent of child health interventions. In turn, if reducing child mortality is a sufficient condition, family planning programs may be somewhat superfluous: "Development is the best contraceptive." In this chapter I address the issue of whether reduced child mortality is crucial for the fertility transition by examining the empirical evidence from Costa Rica, a developing country that managed to decrease both child mortality and birth rates.
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From page 385... ...
Data for European populations in the past usually do not show significant replacement effects (Knodel, 1978~. A third Costa Rican study, based on the 1976 World Fertility Survey, does not find a significant effect of child mortality in the community upon the reproductive behavior of individual women (Heer and Rodriguez, 1986~.
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From page 386... ...
Given that the analysis combines contextual or macro-level indicators of child mortality and other variables to explain individual-level reproductive behavior, this analysis is referred to as "multilevel." SECULAR TRENDS IN COSTA RICA Costa Rica experienced one of the earliest and fastest, although incomplete, fertility transitions in the developing world. The total fertility rate fell from 7.3 to 5.5 between 1960 and 1968, the year an energetic national family planning program started, and then to 3.7 by 1976, the year the decline abruptly stopped (United Nations, 1985~.
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From page 387... ...
At the fertility transition onset, the country' s infant mortality rate was 76 per 1,000 and the child mortality risk (the probability of dying before the age of 5 years) was 96 per 1,000, which are high levels at current standards but were not in the late 1950s.
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From page 388... ...
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From page 389... ...
The data in Figure 11-1 are not conclusive as to whether a certain minimal level of child survival is required for fertility transition the necessary condition thesis. If such a prerequisite exists, the Costa Rican experience indicates a child mortality rate threshold of 100 per 1,000 or higher.
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From page 390... ...
The figure's four quadrants result from combining high and low child mortality levels with high and low fertility rates. Most populations should fall in quadrants II and IV, the Low Child Mortality High l I ._ ._ IL ll Empty if sufficient condition "Development is the best contraceptive" o o o o O O O O O 0Go 0 OOcPO O o O c o o ~ O o o o o O O O 0 Go 0 OCPO o o 00 o lll o 0 0° 0 0o o Empty if necessary condition "Vertical family planning programs cannot succeed" IV FIGURE 11-2 Expected scatterplot for the causal associations of child mortality on fertility.
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From page 391... ...
How do the Costa Rican counties behave in comparison with this hypothetical association? Figure 11-3 shows the scatterplots for 1965, 1975, and 1985.
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From page 392... ...
392 ~ o ho.
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From page 394... ...
As with the bivariate correlation coefficient, the association weakens in the cross sections before and after the fertility transition. Although these estimates do control the potentially confounding effect of other variables in the model, there is no guarantee that the model is fully identified and thus that all spurious associations have been purged; there is always the possibility that the child mortality rate is picking up the effect of a confounding variable that was not included in the model.
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From page 395... ...
In 1965-1975, when most of the Costa Rican fertility transition took place, two strong and significant effects were socioeconomic development (elasticity of 7-1) and diffusionist influences from other relevant counties (elasticity of about 3~.
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From page 396... ...
In about 90 percent of Costa Rican counties, fertility started to fall between 1959 and 1968 (median is 1965) before the government established the family planning program in 1968.
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From page 397... ...
Data for the 89 Costa Rican counties do not support this expectation. The marital fertility rate fell by 56 percent in the 8 years following the transition onset independently of the child mortality rate in the county (data not shown)
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From page 398... ...
Each percent increase in the child mortality rate would decrease the likelihood of starting the fertility transition by 0.7 percent. This effect, however, is not
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From page 399... ...
To test whether this reproductive strategy influenced the fertility transition in Costa Rica, I examine the record of adoption of family planning among the agents of fertility change, women born between 1927 and 1946. Older and younger cohorts added little to the fertility decline brought about by these cohorts (Rosero-Bixby and Casterline, 1995~.
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From page 400... ...
. Bivariate and Multilevel Effects Does the pattern of adoption of family planning differ with contextual child
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From page 401... ...
For example, the median family planning adoption time varies from 21 years since first sex among the poor to 3 years among the wealthy, but the child mortality proportion also varies greatly from 1.0 o 0.8_ o Q g tt 0.6 tin Q 0.4_ o ._ Q 0.2_ IF IL 0.0 Or , C~ ~ ~1 ~ r I 1 CM 50-74r - , , r - - I CM 75-99 r ~ ~~~ CM 100-124 r - - I CM 150~ art' 1 ' ' ' ' 1 ' ' ' ' 1 l ' ' ' ' 1 ' ' ' ' 1 ' ' ' ' 1 , 1 CM 125-149 0 5 10 15 20 Years since first sexual intercourse FIGURE 11-5 Family planning adoption curve by level of contextual child mortality (CM)
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From page 402... ...
Time counted since first sexual intercourse (women aged 38-58 years in 1984, ever sexually active)
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From page 403... ...
Is a moderate contextual child mortality rate a precondition for the adoption of family planning? The cumulative adoption curves in Figure 11-6 show that a contextual child mortality rate of 125 or higher may be a serious obstacle for adopting family planning but it is not an absolute impediment: About 20 percent of couples in this category have adopted birth control after 10 years of sexual activity.
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From page 404... ...
404 AGGREGATE AND MULTILEVEL EVIDENCE FROM COSTA RICA TABLE 11-4 Rate Ratio of Adopting Family Planning Estimated with a Cox Regression Model Variable N Rate Ratio 95% Confidence Interval Contextual-level Child mortality, mothers' cohort 2125, old 109 1.00 Reference Group <125, old 122 1.51 1.00-2.27 275, young 128 1.75 1.08-2.82 <75, young 110 2.38 1.39-4.06 Family planning supplya None 527 1.00 Reference Group Moderate 158 1.76 1.20-2.60 High 176 1.59 1.09-2.34 Completed fertility 2.7-3.9 108 1.00 Reference Group 4.0-5.4 160 0.88 0.64-1.21 5.5-8.9 201 0.99 0.64-1.53 Households under poverty line <10% 309 1.00 Reference Group 10% or more 160 0.80 0.56-1.13 Individual-level Education (years) 0-2 3-6 7 or more Wealth group Poor Low Medium/high Age at first sex 11-16 17-24 25-47 Marital statusa Premarital Ever married Year first sex 135 231 103 1.00 1.19 1.33 121 216 132 2.57 1.00 1.50 98 1.00 274 1.20 97 1.13 259 602 Reference Group 0.90- 1.57 0.93-1.91 Reference Group 1.10-2.03 1.77-3.73 Reference Group 0.87-1.64 0.68-1.87 1.00 2.47 1.04 Reference Group 1.79-3.40 1.00- 1.07 NOTE: N indicates number of observed segments for these variables.
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From page 405... ...
Although these discussions focused on the diffusion of the family planning message, the child survival hypothesis was explicitly raised by the moderators in all groups. The suggestion that a decline in child mortality may have played an important role in the fertility transition did not resonate in the focus groups.
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From page 406... ...
Neither the focus group discussions nor the statistical record at the aggregate and individual levels support the claim that decreasing child mortality is critical for decreasing fertility. However, decreasing child mortality may facilitate the fertility transition, and high child mortality may delay the transition.
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From page 407... ...
Not even falling below 100 per 1,000 child deaths will generate an automatic response. In short, decreasing child mortality does not appear to be a sufficient condition for fertility decline, nor can the Costa Rican fertility transition be explained solely in terms of an adjustment process to moderate child mortality rates.
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From page 408... ...
San Jose, Costa Rica: Direccion General de EstadIstica y Censos. 1987 Health impacts of family planning.
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From page 409... ...
Ivanov 1988 The effects of improved child survival on family planning practice and fertility. Studies in Family Planning 19(3)
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From page 410... ...
1986 Infant mortality in Costa Rica: Explaining the recent decline. Studies in Family Planning 17(2)
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