The Impact of Childhood Mortality on Fertility in Rural Tanzania

Evidence From the Ifakara and Rufiji Health and Demographic Surveillance Systems

Bibliographic Data

ID10970852
AuthorsColin Baynes (0000-0001-7513-6568, University of Washington, corresponding author), Almamy Malick Kante (0000-0002-0522-8798, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA), Sigilbert Mrema (0000-0002-5128-562X, Ifakara Health Institute, Dar es Salaam, Tanzania), Honorati Masanja (0000-0002-3860-7348, Ifakara Health Institute, Dar es Salaam, Tanzania), Bryan J Weiner (0000-0002-6996-9480, University of Washington), Kenneth Sherr (0000-0002-2963-0829, University of Washington), Jonathan F Phillips (0000-0002-6720-7204, Columbia University)
Year2023
Volume60
Issue6
Pages1721-1746
Publication date2023-12-01
Open AccessYes
TypeARTICLE
VenueDemography (JOURNAL)
Journal identifiersISSN: 0070-3370 • E-ISSN: 1533-7790
PublisherDuke University Press (PUBLISHER • US)
DOI10.1215/00703370-11048233
PMID37921435
OpenAlexW4388302565
LanguageEN
Citations received3
References cited55

This manuscript examines the relationship between child mortality and subsequent fertility using longitudinal data on births and childhood deaths occurring among 15,291 Tanzanian mothers between 2000 and 2015. Generalized hazard regression analyses assess the effect of child loss on the hazard of conception, adjusting for child-level, mother-level, and contextual covariates. Results show that time to conception is most reduced if an index child dies during the subsequent birth interval, representing the combined effect of biological and volitional replacement. Deaths occurring during prior birth intervals were associated with accelerated time to conception during future intervals, consistent with hypothesized insurance effects of anticipating future child loss, but this effect is smaller than replacement effects. The analysis reveals that residence in areas of relatively high child mortality is associated with hastened parity progression, again consistent with the insurance hypothesis. Investigation of high-order interactions suggests that insurance effects tend to be greater in low-mortality communities, replacement effects tend to be stronger in high-mortality community contexts, and wealthier families tend to exhibit a weaker insurance response but a stronger replacement response to childhood mortality relative to poorer families

Child mortality · Confidence interval · Environmental health · Fertility · Geography · Hazard ratio · Infant mortality · Parity (physics · Population · Proportional hazards model · Residence · Tanzania · Demographic Trends and Gender Preferences · Demography · Global Maternal and Child Health · Medicine · Migration, Health and Trauma

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