Infant and child mortality in Nepal : socio-economic, demographic and cultural factors

Abstract

This study examined the differentials in infant and child mortality in Nepal according to socio-economic, demographic, cultural and health-related determinants. It also explored factors that account for the higher infant and child mortality levels in certain parts of the country as well as the role of the change in the value of explanatory variables versus the change in the structural relationship between variables in explaining the decline in infant and child mortality from the 1960s to the 1980s. The data for this thesis came from the nationally representative sample surveys, the 1976 Nepal Fertility Survey (NFS) and the 1986 Nepal Fertility and Family Planning Survey (NFFS). The direct estimation technique for infant and child mortality levels and logistic regression were the major tools of data analysis in this study. The length of the preceding birth interval and the survival status of the preceding child from both the NFS 1976 and NFFS 1986 were the most important demographic determinants of infant and child mortality in Nepal. Most of the influence of mother's age at childbirth and birth order of the child on infant and child mortality was due to the length of birth interval. Sibling competition for mother's care, tangible resources and health care as a path through which birth spacing is likely to influence child survival prospects is not ruled out in this study. However, the correlation between the deaths of siblings in a family suggested the existence of other possible mechanisms where the influence of the survival status of the preceding child could be working through repetitive biological, behavioural, household socio-economic and environmental factors common to all children born to the same mother. Ever use of contraception emerged as an important factor in influencing infant mortality. Its role in explaining the decline in both infant and child mortality was impressive. The influence of contraceptive use on infant and child mortality, however, was mediated neither through mother's age at childbirth nor through length of birth interval. It was thus hypothesized that this effect on infant mortality was working through the maternal and child health care services delivered in conjunction with the family planning services. The important socio-economic factors influencing infant and child mortality were whether or not mothers worked outside the home, urban or rural place of residence, the number of cows possessed by households, and the size of land-holding of the households. Mother's education as a determinant of child mortality was more important for the period 1971-80 than 1961-70. The effect of maternal education on child mortality is attributed to the better position of women with some education as against women with no education in terms of resources and socio-economic situation rather than to education per se. Much of the inter-regional variation in infant and child mortality was due to the differences in the variable values rather than the difference in the structure in relationship between the regions, but this was more true for infant than child mortality. The small proportion of women with second and third order births, the small proportion of births 37 months or more after the birth of the preceding child, the low average level of education of mothers, the small proportion of ever users of contraception and the small proportion who spoke Nepali at home in the high mortality region (HMR) were factors contributing to the higher average infant mortality in the HMR. The analysis also suggested that the implied structural differences in the determination of child mortality were cultural in nature to a much greater extent than was the case in the analysis of infant mortality. It is also clear in this study that, although demographic factors were more important than socio-economic, cultural and health-related factors in explaining the cross-sectional differentials in infant and child mortality, socio-economic, cultural and health factors were much more important than demographic factors in explaining the decline in infant and child mortality over the two periods in this study. Intervention to increase spacing between births, raising the age at marriage, increasing the use of contraception, increasing the level of health knowledge and awareness among women, and dissemination of health-related messages through the media using local languages will contribute to further improvement in the child survival prospects in Nepal.