Social inequality in infant mortality: What explains variation across low and middle income countries?

2020 ◽

Vol 5 (1) ◽

pp. 54-73

Author(s):

Micheal Kofi Boachie ◽

Tatjana Põlajeva ◽

Albert Opoku Frimpong

Keyword(s):

Infant Mortality ◽

Health Outcomes ◽

Health Expenditure ◽

Fixed Effects ◽

Health Sector ◽

Health Spending ◽

Middle Income ◽

Government Health ◽

Middle Income Countries ◽

Low And Middle Income

The issue of whether government health spending improves health outcomes has been a matter of contention over the years. There have been calls for governments to reduce their financing role in the health sector since such funding do not produce better health. This article examines the effect of public (i.e., government) health expenditure on infant mortality, a proxy of health outcomes, in low- and middle-income countries. We use data from the World Bank’s World Development Indicators database and employ fixed effects estimation technique, with three-stage least squares as a robustness check. The data cover the period 1995–2014. We find that public health expenditure improves health outcomes significantly, as it reduces infant mortality. The results further show that rising income and access to safe water are some of the reasons for improved health outcomes in low- and middle-income countries. Based on these results and the expected redistributive impact of government spending, governments in low- and middle-income countries may consider increasing health spending for better healthcare systems and improved health.

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Early-life exposure to ambient fine particulate air pollution and infant mortality: pooled evidence from 43 low- and middle-income countries

International Journal of Epidemiology ◽

10.1093/ije/dyz090 ◽

2019 ◽

Vol 48 (4) ◽

pp. 1125-1141 ◽

Cited By ~ 9

Author(s):

Nihit Goyal ◽

Mahesh Karra ◽

David Canning

Keyword(s):

Air Pollution ◽

Infant Mortality ◽

Neonatal Mortality ◽

Early Life ◽

Middle Income ◽

Middle Income Countries ◽

Particulate Air Pollution ◽

Fine Particulate ◽

Early Life Exposure ◽

Low And Middle Income

Abstract Background Many low- and middle-income countries are experiencing high and increasing exposure to ambient fine particulate air pollution (PM2.5). The effect of PM2.5 on infant and child mortality is usually modelled using concentration response curves extrapolated from studies conducted in settings with low ambient air pollution, which may not capture its full effect. Methods We pool data on more than half a million births from 69 nationally representative Demographic and Health Surveys that were conducted in 43 low- and middle-income countries between 1998 and 2014, and we calculate early-life exposure (exposure in utero and post partum) to ambient PM2.5 using high-resolution calibrated satellite data matched to the child’s place of residence. We estimate the association between the log of early-life PM2.5 exposure, both overall and separated by type, and the odds of neonatal and infant mortality, adjusting for child-level, parent-level and household-level characteristics. Results We find little evidence that early-life exposure to overall PM2.5 is associated with higher odds of mortality relative to low exposure to PM2.5. However, about half of PM2.5 is naturally occurring dust and sea-salt whereas half is from other sources, comprising mainly carbon-based compounds, which are mostly due to human activity. We find a very strong association between exposure to carbonaceous PM2.5 and infant mortality, particularly neonatal mortality, i.e. mortality in the first 28 days after birth. We estimate that, at the mean level of exposure in the sample to carbonaceous PM2.5—10.9 µg/m3—the odds of neonatal mortality are over 50% higher than in the absence of pollution. Conclusion Our results suggest that the current World Health Organization guideline of limiting the overall ambient PM2.5 level to less than 10 µg/m³ should be augmented with a lower limit for harmful carbonaceous PM2.5.

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Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013

Health Economics Policy and Law ◽

10.1017/s1744133118000269 ◽

2018 ◽

Vol 14 (2) ◽

pp. 249-273 ◽

Cited By ~ 2

Author(s):

Peter Baker ◽

Thomas Hone ◽

Aaron Reeves ◽

Mauricio Avendano ◽

Christopher Millett

Keyword(s):

Infant Mortality ◽

Health Expenditure ◽

Fixed Effects ◽

Government Expenditure ◽

Health Expenditures ◽

Mortality Rates ◽

Demographic And Health Surveys ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

AbstractInequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of −2.468 [95% confidence intervals (CIs): −4.190, −0.746] and RII of −0.026 (95% CIs: −0.048, −0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

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The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2011-000226 ◽

2011 ◽

Vol 1 (2) ◽

pp. e000226-e000226 ◽

Cited By ~ 80

Author(s):

J. E. Finlay ◽

E. Ozaltin ◽

D. Canning

Keyword(s):

Infant Mortality ◽

Maternal Age ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study

PLoS Medicine ◽

10.1371/journal.pmed.1001985 ◽

2016 ◽

Vol 13 (3) ◽

pp. e1001985 ◽

Cited By ~ 40

Author(s):

Arijit Nandi ◽

Mohammad Hajizadeh ◽

Sam Harper ◽

Alissa Koski ◽

Erin C. Strumpf ◽

...

Keyword(s):

Experimental Study ◽

Infant Mortality ◽

Maternity Leave ◽

Middle Income ◽

Middle Income Countries ◽

Quasi Experimental ◽

Low And Middle Income

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Lower infant mortality and access to contraception reduce fertility in low- and middle-income nations

10.1101/2021.12.16.21267946 ◽

2021 ◽

Author(s):

Corey J. A. Bradshaw ◽

Claire Perry ◽

Chitra Maharani Saraswati ◽

Melinda Judge ◽

Jane Heyworth ◽

...

Keyword(s):

Family Planning ◽

Infant Mortality ◽

Maternal Education ◽

Explanatory Power ◽

General Linear ◽

Middle Income ◽

Middle Income Countries ◽

Access To Contraception ◽

Low And Middle Income

Although average contraceptive use has increased globally in recent decades, an estimated 222 million (26%) of women of child-bearing age worldwide face an unmet need for family planning - defined as a discrepancy between fertility preferences and contraception practice, or failing to translate desires to avoid pregnancy into preventative behaviours and practices. While many studies have reported relationships between availability of contraception, infant mortality, and fertility, these relationships have not been evaluated quantitatively across a broad range of low- and middle-income countries. Using publicly available data from 46 low- and middle-income countries, we collated test and control variables in six themes: (i) availability of family planning, (ii) quality of family planning, (iii) maternal education, (iv) religion, (v) mortality, and (vi) socio-economic conditions. We predicted that higher nation-level availability/quality of family-planning services, maternal education, and wealth reduce average fertility, whereas higher infant mortality and religious adherence increase it. Given the sample size, we first constructed general linear models to test for relationships between fertility and the variables from each theme, from which we retained those with the highest explanatory power within a final general linear model set to determine the partial correlation of dominant test variables. We also applied boosted regression trees, generalised least-squares models, and a generalised linear mixed-effects models to account for non-linearity and spatial autocorrelation. On average among all countries, we found an association between all main variables and fertility, with reduced infant mortality having the strongest relationship with reduced fertility. Access to contraception was the next-highest correlate with reduced fertility, with female secondary education, home health visitations, and adherence to Catholicism having weak, if any, explanatory power. Our models suggest that decreasing infant mortality and increasing access to contraception will have the greatest effect on decreasing global fertility. We thus provide new evidence that progressing the United Nation's Sustainable Development Goals for reducing infant mortality can be accelerated by increasing access to any form of family planning.

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