Algunas distribuciones b´ asicas

Sources

Reference period

Infant Mortality Rates/1000

Male Females Both

sexes

^V aidyanathan and Gaige (1973) 1954 260 250 -

UNICEF (1990) 1960 215

^W orth and Shah (1969) 1965-66 - - 152

^G ubhaju (1974) 1961-71 200 186 - CBS (1974) 1971 - - 172 CBS, (1976) 1974-75 141 112 133 CBS, (1977) 1976 128 138 134 CBS, (1978) 1977-78 110 98 104 NFPM CH (1977) 1976 152 Gubhaju (1984) 1973-74 - 172 CBS(1985) 1981 144 New Era (1986) 1981 136 111 117 NFPM CH (1987) 1984 108

New Era; IIDS and VaRG (1992) 1989 102

The infant mortality rates estimated by Vaidyanathan and Gaige (1973: 287) for the period 1952-54 was 260 for males and 250 for females. Worth and Shah (1969, cited in CBS, 1987a: 300) estimated the infant mortality rate at 152 for the period 1965-66 based on the data collected by the Nepal Health Survey. CBS (1987a: 300) estimated the infant mortality rate at 104 per 1000 live births for the period 1974-75 based on the Demographic Sample Survey of 1977/78. Among these, estimates made by Worth and Shah and CBS are noted to be underestimate due to data limitations (CBS, 1987a: 300-301). The latest infant mortality estimate of 108 for 1984 was made by NFPMCH (1987: 80) and was based on the data collected by the Nepal Fertility and Family Planning Survey 1986.

So far there has been little information on child mortality rates in Nepal. The child mortality estimated by Goldman et al. (1979: 32) for the periods 1957-61, 1962-66 and 1967-71 are 143, 109 and 100 respectively. Both the infant and child mortality estimates made for different periods tend to suggest that infant and child mortality in Nepal has declined steadily. However, the infant mortality rate in Nepal remains one of the highest among the South Asian countries (UNICEF, 1988: 64, 78).

1.7

Rationale for the study

The Nepal Fertility Survey (NFS) 1976 and Nepal Fertility and Family Planning Survey (NFFS) 1986 data sets allow analysis of the differentials of infant and child mortality according to the demographic and socio-economic variables of interest over the two periods of time. As both surveys are nationally representative and most of the variables in both the surveys are similar, this allows an opportunity for comparative analysis. An examination of the role of socio-economic and demographic factors and their association with infant and child mortality in Nepal over two periods of time allows assessment of the extent of the effect of changes in socio-economic structure of the population on infant and child mortality as well as factors that are associated with higher level of infant and child mortality. These issues have not so far been covered in the context of Nepal.

1.8

Objectives of the study

The review of the literature showed that while there is consistency in the relationship of some socio-economic and demographic variables with infant and child mortality differentials, there is also wide variation in explanations for differences as the populations under study differ. Socio-economic factors such as education, income, occupation and place of residence, and demographic factors, such as age of mother at childbirth, birth order and birth intervals, are very important in the examination of the levels and differentials of infant and child mortality. There is very little known in the context of Nepal about how various socio-economic, health-related and demographic factors operate in influencing infant and child mortality. It is also likely that these characteristics themselves may change with time. In addition, the relationship between the socio-economic, demographic, cultural and health-related factors, and the infant and child mortality (structural difference) is also likely to differ at different time.

The earlier discussion on the level of estimated infant mortality for Nepal (section 1.6) clearly showed that infants' exposure to death in the country during recent past has declined. This decline in infant mortality can be hypothesized as an effect of either the change in the value of the explanatory variables or an effect of the structural differences. However, in the context of Nepal, it is not clear whether the decline is due to the change in the value of explanatory variables or due to the structural differences. In line with this, the broad objective of this study is to compare and analyse the infant and child mortality differentials according to demographic, socio-economic and health-related variables based on two cross-sectional fertility surveys from Nepal. This analysis is extended further to explore factors associated with the rates of change in infant and child mortality using the pooled 1976 NFS and 1986 NFFS data sets. The details of the methodology are discussed in the concerning chapters.

The specific objectives of the study are:

To assess the net effects of the age of the mother at childbirth, the birth order of the child, the preceding birth interval, the sex of the child and the child's year of birth (birth cohort) on the mortality risk during infancy (under one year of life) and childhood (one to five years of life).

To analyse the influence of selected socio-economic (mother's education, father's education, mother's work status, place of residence, size of land-holding and number of cows and buffalo possessed by a household) and health-related factors (access to health care services and ever use of contraception) on the mortality risk during infancy and childhood.

To explore whether the effects of the selected socio-economic (mother's education and place of residence) and health-related variables (ever use of contraception) on infant mortality are mediated through mother's age at childbirth and the length of the preceding birth interval (these last two variables represent one of the sub-groups of the proximate determinants described in the frame work suggested by Mosley and Chen (1984: 27-29) for the analysis of child survival prospects).

To evaluate the association between the survival status of the immediately preceding sibling and the mortality risk of the index sibling, and to examine the extent to which the influence of the length of preceding birth interval on infant and child mortality is exaggerated in the absence of control for the survival status of the preceding child.

To explore factors that explain the reasons why infant and child mortality in certain parts is higher than in other parts of the country.

To determine the extent to which the changes in infant and child mortality observed for two points in time (1960s and 1980s) are due to the change in the values of explanatory variables of interest, and so assess the impact of structural change.

1.9

Organization of the study

This study is organised into eight chapters. Chapter One has presented the

background to the study, a brief description of the demographic and socio-economic context and health care service delivery and its utilization along with a brief review of literature on determinants of and differentials in infant and child mortality. Chapter Two examines the quality of data and sets out the analytical framework and analytical approach. Chapter Three examines the effects of demographic variables on the mortality risk during infancy and childhood. Chapter Four examines the influence of socio-economic and health-related factors on the mortality risk during infancy and childhood. This chapter also explores the mechanism through which selected socio-economic and health-related factors influence infant and child mortality in Nepal. Chapter Five examines the influence of the survival status of the preceding child on the mortality risk of the index sibling. This chapter also assesses the extent of exaggeration of the effect of the length of the previous

birth interval on infant and child mortality in the absence of control for the survival status of the preceding child. Chapter Six explores factors that explain the higher infant and child mortality in certain parts of the country as against other parts of the country. Chapter Seven examines the role of change in the values of explanatory variables as against the role of change in the structure in relationship between independent and dependent variables in explaining the change in the infant and child mortality that took place between the two points of time considered in this study. Finally, Chapter Eight consists of the conclusion, future research prospects and policy implications.