This study examines the changes over time of the twinning rate and infant and child mortality across 17 rural villages in the province of Zaragoza (Spain) over a span of 200 years. The aim is to understand how the twinning rate evolved in conjunction with the processes of economic and social modernization, as well as the demographic transition. During the period analyzed, the twinning rate increased by 10%, rising from 1.26 per 1000 births in the second half of the 18th century to 1.38 per 1000 births in the first half of the 20th century. This rate varied due to hereditary issues, biological factors such as the mother’s age and parity, and socioeconomic features like family occupation and the mother’s education level. In terms of child mortality, twins historically faced a significantly higher mortality rate. However, they benefited greatly from the mortality transition, at least in absolute numbers. While nearly 60% of twins did not survive beyond 5 years of age in earlier periods, the mortality rate for twins decreased to 40% by the first half of the 20th century. The excess mortality was particularly severe for girls, driven by a widespread preference for sons, which led to higher mortality rates for girls in the first 5 years of life, especially in the earliest months. These findings help us understand the improvements in uterine and childhood survival rates for contemporary twins, which can be attributed to the socioeconomic and medical advancements of the 20th century.

Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

This study assessed the trends in twin births and their survival in Bangladesh by analyzing over a quarter million live births during 1970–2018, pooled from all eight rounds of the Bangladesh Demographic and Health Survey. In these five decades, the twinning rate increased by 1.5 times, from 5.8 to 8.6 twins per 1000 maternities. The decadal twinning rates varied across maternal age, parity, body mass index, household wealth index, and geographic region. The gap in decadal neonatal, infant, and under-five cumulative survival probability between singleton and multiple births was found to be closing, using Kaplan-Meier curves. Child mortality decreased by 80% and 60% in singleton and multiple births respectively. However, the absolute size of child mortality in multiple births remained six times higher than in singletons and was concentrated in the neonatal period. The share of multiple births surged in all types of child mortality. We predict a further and faster rise in multiple births in the coming decades in the face of upward trends in maternal age overlapping with higher parities, education, career prospects, contraceptive use, and the future demand-supply of assisted reproductive technology. A particular focus on the improvement of perinatal and neonatal care with wider availability is warranted. Otherwise, increased multiple births might raise child mortality and create public health challenges.

This is a history of the creation of the book Fatal Years: Child Mortality in late-Nineteenth-Century America (1991) by the authors. The data were a sample of households from the 1900 United States Census manuscripts. The primary method used was indirect estimation of child mortality (approximately ages 0–4) using information on the age and marriage duration of women. Among the findings were overall lower overall mortality than in the 1900/1902 Glover life tables for the Death Registration Area, and very large variations in mortality by race and size of place of residence.

This paper takes, as its starting point, Preston and Haines’ observation in Fatal Years that social class was the most important influence on infant and child mortality in England and Wales in the early twentieth century. A subsequent study suggested that this could in part be due to the spatial distribution of the different classes across different types of place, and that some of the mortality differences by social class might actually reflect the contextual effects of healthy and unhealthy places. Although this line of argument has received a considerable amount of attention in health geography literature, it has rarely been examined for a specific historic period, and then only within particular urban areas. In this paper, we apply multi-level models to a complete count individual-level dataset of the 1911 census of England and Wales, comparing influences on infant and child mortality at the level of the individual couple and for two spatial levels. We find that although most variation in infant and child mortality operates at the individual level, there is also important variation at the two spatial levels and part of the mortality differences between social classes is better explained by the areas in which people lived rather than by their social class. A consideration of independent variables at all three levels suggests that different spatial scales capture different sorts of influences on early age mortality.

This article appraises kin availability and migration timing on French-Canadian child mortality in an early twentieth-century North American industrial city. The analysis is based on the exploitation of an original dataset constructed by linking the 1910 census data (IPUMS-Full Count) for Manchester, New Hampshire to Quebec Catholic marriage records (BALSAC) and geocoding census data at the household level (Sanborn Fire Insurance Maps). Our results suggest that the presence of maternal and paternal grandmothers in the city living in different households were associated with reduced child mortality and that French-Canadian women who arrived in the United States as children or young adults experienced higher child mortality compared to second-generation French Canadians and those who migrated at a later age.

In the first half of the twentieth century, deaths from infectious disease, especially among the very young, fell dramatically in American cities. However, as infant mortality fell and life expectancy rose, racial inequality in urban infectious disease mortality grew. In this paper, we show that the fall in mortality and the rise in racial inequality in mortality reflected two countervailing processes. The dramatic decline in infant mortality from waterborne diseases drastically reduced the total urban infectious disease mortality rate of both Black and white Americans while having a comparatively small effect on the total racial disparity in urban infectious disease mortality. In contrast, the unequal fall in tuberculosis mortality, particularly in the prime of life, widened racial inequality in infectious disease mortality in US cities.

This study proposes a measure of reproductive losses starting from conception to age 15 as an assessment of childbearing ‘efficiency’. It is suggested that losses are due to miscarriages, abortions, stillbirths and deaths to age 15. Data were drawn from various sources for seven regions embracing 129 developing countries. Mortality is an important loss in severely disadvantaged regions, especially in sub-Saharan Africa, but the abortion rates are lower there. This is reversed in the more advanced regions, where mortality is low but abortion rates are higher. Total losses numerically depend upon the rates in combination with the numbers of conceptions. The general ‘efficiency’ in moving from conception to a surviving child aged 15 was estimated. The abortion component of wastage has apparently not improved over time, but the mortality component has done so. Abortion rates are found to drive reproductive efficiency downwards; but efficiency is positively correlated with contraceptive use once abortion is controlled for. This implies that as efficiency is improved more couples gain confidence to turn to contraceptive use to avoid unplanned pregnancies and births.

Despite an overall downward trend in child sex ratios in India, some of the most imbalanced districts in 2001 (fewer girls than boys) showed signs of becoming more balanced in 2011. This analysis looked in depth at these districts to better understand the nature of the improvement in the child sex ratio using two rounds of data from the Census of India from 2001 and 2011. Data were used from the 153 districts that showed improvement in their child sex ratio between 2001 and 2011. The improvement was decomposed into: (1) less sex-selective abortion and (2) improved girl compared with boy mortality. Most of the improvement in child sex ratios were shown to be due to reductions in sex-selective abortion, although this still made up the majority of the cause of imbalanced sex ratios in 2011. Child sex ratio improvement has been happening in both rural and urban areas of India, and there is evidence of stagnation in mortality decline for urban girls.

This paper investigates the extent to which being born to a single mother affects a child’s survival rate in Senegal, a context where girls’ premarital sexual relationships are still widely stigmatized. It also examines whether any negative effect persists up to affecting the survival rate of children of higher birth order born after the mother has married. Using data from Demographic and Health Survey, we find that the mortality rate is higher for first-born boys, but not for first-born daughters, whose mother was single at the time of their birth, and lower for second-born children whose sister, but not brother, was born out of wedlock. The latter effect is actually driven by children from older cohorts of women. Therefore, strategies to mitigate the negative consequences of the stigma associated with a premarital birth seem to exist but vary with the gender of the child born premarital in Senegal. In addition, persisting negative effects appear to have decreased over time. Potential channels through which boys born from a single mother are at a higher risk of death in the country are discussed. Overall, our findings indicate that social programs targeting single mothers, especially when they gave birth to a boy, would help avoiding dramatic events as the death of a child.

The effects of childhood mortality and morbidity on the fertility decision-making process are analyzed using longitudinal micro data from a Senegalese rural community, for the period 1984–2011. I attempt to identify the effect of individual child mortality, and also that of community child mortality and morbidity, on subsequent fertility choices. The results provide consistent support for both the child-replacement hypothesis and the precautionary demand for children. I find that community child mortality and morbidity attributable to malaria, which capture changes in the epidemiological context, exert a joint influence on fertility behaviors. Community-level malaria incidence among children has a positive effect on subsequent fertility choices, and this positive effect is stronger the more the disease is fatal to children who are infected. This study highlights the role of morbidity, acting through the relative risk of dying from the disease, on the slow fertility transition in sub-Saharan Africa.

National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.

We examined whether there are sex differences in the effect of vitamin supplements on birth outcomes, mortality and morbidity by 2 years of age among children born to HIV-infected women in Tanzania. A randomised placebo-controlled trial was conducted among 959 mother–infant pairs. HIV-infected pregnant women were randomly assigned to receive a daily oral dose of one of four regimens: multivitamins (vitamins B-complex, C and E), vitamin A plus β-carotene, multivitamins including vitamin A plus β-carotene or placebo. Supplements were administered during pregnancy and continued after delivery. The beneficial effect of multivitamins on decreasing the risk of low birth weight was stronger among girls (relative risks (RR) = 0·39, 95 % CI 0·22, 0·67) than among boys (RR = 0·81, 95 % CI 0·44, 1·49; P for interaction = 0·08). Maternal multivitamin supplements resulted in 32 % reduction in mortality among girls (RR = 0·68, 95 % CI 0·47, 0·97), whereas no effect was found among boys (RR = 1·20, 95 % CI 0·80, 1·78; P for interaction = 0·04). Multivitamins had beneficial effects on the overall risks of diarrhoea that did not differ by sex. Vitamin A plus β-carotene alone increased the risk of HIV transmission, but had no effects on mortality, and we found no sex differences in these effects. Sex differential effects of multivitamins on mortality may be due to sex-related differences in the immunological or genetic factors. More research is warranted to examine the effect of vitamins by sex and better understand biological mechanisms mediating such effects.