How do biological and social factors interact to determine infant and child mortality differentials within a population?

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Last updated: May 7, 2019

How do biological and social factors interact to determine infant and child mortality differentials within a population? In recent decades most countries of the world have seen substantial decline in infant and childhood mortality (UN), however a vast amount of research on this topic, a fraction of which will be presented and discussed below, suggests that the issue of infant and childhood mortality persists, particularly in countries with medium and low Human Development Index (Waldron, Mosley and Chen).In developing countries differentials in survival within a population usually stem from the interacting effects f biological and behavioural factors that influence mortality at different ages, so the data indicating principal cause of death may provide incomplete information. It is therefore important to consider the complex interplay of both biological and social factors that impact intra-population infant and child mortality variations. It is important to outline some general trends in infant and child mortality at the first place.Infant males have higher mortality rates than females in almost every country or region examined, which is particularly consistent and nearly universal for the eonatal period of one month after birth (Waldron). During later infancy sex differentials become more variable, with females infants experiencing higher mortality in some countries (Lee and Wang 1999), and for young children sex differences in mortality are even more alternating (UN). It was suggested that this happens because males have numerous inherent biological disadvantages such as slow lung maturation, which are most likely to cause death during the neonatal period (e.

. prematurity, respiratory distress syndrome), while females become more ulnerable in later infancy and childhood when behavioural factors such as son preference come into play (Sara Randall, lecture). But how exactly do these varying trends occur? Mosley and Chen (year) created a framework suggesting that child mortality should be studied more as a chronic disease with multifunctional origins than an acute and single-cause phenomenon, which led the researchers to create the index combining the level of growth faltering with the level of mortality.Growth faltering is usually considered synonymous with malnutrition, however evidence indicates that it can occur due to many factors and is herefore a nonspecific indicator of health status which can serve as a measure of the relative risk of mortality in various subgroups of a given population.

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Mosley and Chen identified five groups of proximate determinants that directly influence the risk of morbidity and mortality.These include maternal factors such as age and the length of birth interval, environmental contamination such as respiratory diseases example) and personal illness control which includes preventive measures, medical treatment, immunization and care. Those factors can and often do interact in a yriad of combinations, for example birth order interplays with medical care when Indian girls with older sisters, compared to boys of the same birth order, are less likely to be taken for medical treatment and to be fully vaccinated (Pande 2003).This particular correlation is caused by India being a country with strict patrilineal family organization, which results in daughters being of lower value to their parents (Das Gupta 1987) – here social determinant is operating through proximate variables to affect child survival.

Mosley and Chen (year) argue that all socioeconomic eterminants, examples being parental education, cultural norms and physical infrastructure, must operate through the proximate biological variables in order to impact infant and child mortality.This essay will focus on this complex interaction of biological and socioeconomic factors that determine infant and childhood mortality. One of the areas of extensive research in relation to early years mortality is the effect of parental (especially maternal) level of education. Paternal educational levels usually strongly correlate with high family income, which is suggested to results in reater access to medical services, better nutrition and living conditions and less likelihood of violence and injury (Mosley and Chen year).However, there is overwhelming evidence that mother’s education, not the household income, is a fundamental determinant of child mortality in developing countries (Fuchs et al. 2010, Mosley and Chen year). Education and wealth are usually correlated, and this is the reason why many social scientists tend to see them as interchangeable markers of social and economic status.

Fuchs et al. 2010) focuses on the importance of aternal schooling, as opposed to household income, as a primary candidate for reducing early years mortality in developing countries because in those regions mother is often the only healthcare worker for her children – she monitors health, diagnoses illnesses and treats them, as well as making important everyday decisions in relation to nutrition, exposure to hazards and hygiene, all of which are major determinants of the wellbeing of her child.For example, Jalan and Ravallion (2003) found that maternal education compensated for poverty in rural parts of India by roviding skills and knowledge related to water safety and treatment of diarrhoea. It was found that Sri-Lankan mothers of young children with high-risk symptoms were brought to hospital more frequently than those with low perceived severity (this correlation persisted across all socioeconomic groups). A good maternal skill of illness diagnosis is a plausible explanation for the low levels of childhood mortality in Sri-Lanka despite the high rates of malnutrition (de Silva et al. 2001).It is also evident that more educated women are more likely to use antenatal care during pregnancy in ore developed and less developed countries alike (Wong et al.

1987), supported by a study on women’s autonomy and health care behaviour in northern India where Bloom et al. (2001) found that higher level of education increased a woman’s freedom of movement, which in turn increased her likelihood of receiving antenatal care during pregnancy. Higher education institutions are usually located in urban areas, which means that females who attended those institutions are more likely to live in Randall, tutorial).Here access to services is another socioeconomic variable which, perating through the proximate determinant of adequate medical treatment, affects child survival. These findings suggest a reorientation of global health policies to focus on increasing female education as an important policy option for reducing child mortality rates. However, the negative effect of maternal education on gender bias is the other side of the coin (Bhan et al. 2005, Das Gupta 1987).Monica Das Gupta (1987) conducted research in rural Punjab (India) and found that in this region women’s education is associated with reduced child mortality but at the same time stronger discrimination gainst higher birth order girls.

Similarly, Bhan et al. (2005) found that gender bias is highest among highly educated mothers, and the bias is expressed by the fact that female children of uneducated mothers were significantly more likely to be hospitalized than female children of mothers who attended schools, and Bhan et al. 2005) specifically notes that economic status was not found to affect this association and that paternal education was also not influential. In general, selective discrimination against female children (especially those of higher birth order) is a ajor cause of childhood mortality of female girls in the developing countries caused by strong son preference.

This strong son preference appears to be the outcome of women’s structural marginalization in places like India (Pande 2003, Das Gupta 1987), Tibet (Levine 1987) and China (Banister 2004, Lee and Wang 1999).Those societies are marked by their rigid patrilineal kinship systems where sons make greater economic contribution to their household than daughters, and in some parts of South Asia female dowry is a great concern and major reason of daughters being undesirable Mosley and Chen year). Stronger son preference of more educated women may be due to those women being under greater pressure by reducing their fertility via contraception and still wanting those one or two sons (Das Gupta 1987).It is important to note that excess female child mortality in some parts of the world occurs in the form of other manifestations of son preference, such as abortion of female foetuses which is reflected in heavily male birth sex ratios in China (Das Gupta 2009). In China until recently sons were necessary to continue the family ineage and to perform ancestral ceremonies, moreover daughters married out and any investments made into them benefited the husband’s families rather than their own parents, which often led to maltreatment of girls in their households (Banister 2004).

Technological advancements like the Caesarean section deliveries and improved neonatal intensive care practices facilitated the substantial decline of infant mortality since the 1970s (UN). However, technologies can have a reverse effect like they did in China, where the widespread availability of ultrasound technology rom the mid-1980s facilitates high rates of sex-selective abortions (UN).Recently both China and India has put into place a number of policies to address son preference and daughter discrimination such laws promoting gender equality in inheritance, education and employment, introducing daughter benefits and making both sons and daughters responsible for the maintenance of elderly parents (Li limited due to weaknesses in design – for example, cash transfer schemes apply only to a certain number of girls in the household, excluding the most vulnerable girls of higher birth order.Many researchers have emphasized the female’s limited autonomy in some developing countries as a key barrier to improvements in their reproductive health (Bloom et al. 2001) and hence to greater survival rates of their children.

Whyte and Kariuki (1991) outline how in Western Kenya, where child malnutrition is an increasing problem, is addressed primarily through efforts to teach individual mothers how to feed their children properly. The case demonstrates how female lack of autonomy inhibits the woman’s ability to care for her child as she is highly dependent on her husband and his family.Ellis et al.

2013) reports a similar situation in Mali in relation to educating mothers to recognize severe symptoms of malaria and in a like manner notes that health education should also be addressed to husbands and grandparents. However, Mumtaz and Salway (2009) report the inadequacy of the autonomy paradigm for understanding influences on women’s reproductive health in South Asia, to the extent of rejecting the possibility of autonomy in any social setting due to every person being embedded in a web of social relationship.It is also important to consider the role of urban or rural residence of the family in etermining infant and childhood mortality.

Before World War I rural mortality tended to be much lower than urban mortality, but then improvements in water, hygiene, sanitation, child care and nutrition resulted in lower urban child mortality in the European region.However, today in slums of large cities like Nairobi (Kenya) urban residence causes high levels of child mortality operating through the proximate determinants like lack of hygiene, sanitation and medical care, emerging diseases (HIWAIDS and tuberculosis), low nutritional status and other health hazards uch as violence (Garenne year). Urban settings also allow easier transmission of “contact” diseases, which increases morbidity; on the other hand, urban residents usually have more access to healthcare services which aids the reduction of both adult and child mortality.Interestingly, in some developing countries girls have higher mortality due to infectious diseases, which was frequently explained in terms of son preference, however Aaby (1998) points out that at least measles mortality is hugely related to home overcrowding (more likely to occur in urban settings) as ortality is particularly high among secondary cases, which females are more likely to become due to cultural norms of them spending most of their time at home and taking care of the sick.To conclude, it is worth noting that it is a difficult task to reliably estimate even overall trends in childhood mortality – in developing countries researchers primarily rely upon population censuses and household sample surveys, which are subject to both sampling and non-sampling errors frequently producing different estimates for the same population and the same time period.


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