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 of 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 neonatal 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.g. prematurity, respiratory distress syndrome), while females become more vulnerable 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 therefore 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. 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 and insect vectors, nutrient deficiency, injury (infanticide being the most extreme example) and personal illness control which includes preventive measures, medical treatment, immunization and care. Those factors can and often do interact in a myriad 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 determinants, 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.
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