Infant death clustering in families: Magnitude, causes, and the influence of better health services, Bangladesh 1982–2005

Abstract

This analysis of infant mortality in Bangladesh focuses on explaining death clustering within families, using prospective data from a rural region in Bangladesh, split into areas with and without extensive health services (the area covered by the International Centre for Diarrhoeal Disease Research and the comparison area, respectively). The modelling framework distinguishes between two explanations of death clustering: (observed and unobserved) heterogeneity across families and a causal ‘scarring’ effect of the death of one infant on the survival chances of the next to be born. Keeping observed and unobserved characteristics constant, we find scarring in the comparison area only. There the likelihood of infant death is about 29 per cent greater if the previous sibling died in infancy than otherwise. This effect mainly works through birth intervals: infant deaths are followed by shorter birth intervals, which increases the risk of infant death for the next child.

Keywords:

• child mortality
• millennium goals
• death clustering
• dynamic panel-data models
• scarring
• Bangladesh
• ICDDR,B

Notes

1. Unnati Rani Saha is at Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands, and at the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. E-mail: [email protected], [email protected]. Arthur van Soest is at Tilburg University. E-mail: [email protected]

2. We are grateful to Dr. Radheshyam Bairagi, former Senior Scientist, ICDDR,B and Dr. Nurul Alam, Associate Scientist, ICDDR,B for helpful discussions. For their useful comments, we thank three anonymous referees, Sonia Bhalotra, Walter Omariba, and seminar participants in Tilburg. We also wish to thank Dr. Peter Kim Streatfield, Head of the Health and Demographic Surveillance Unit (HDSU), ICDDR,B, Dhaka, Bangladesh for providing the data for this research, and the programmers of HDSS and GIS (sub-unit of HDSU) for their comments on data clarification at different phases of data manipulation. ICDDR,B acknowledges with gratitude the commitment of donors to support of the Centre's research.