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A causal model of high rates of child mortality

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  • Millard, Ann V.

Abstract

The distribution of child mortality has often been misunderstood because of insufficient attention to its context. High rates of child mortality in developing countries have variously been attributed to child neglect, cultural traditions of child care, population pressure, low maternal educational levels, lack of medical care, and insufficient basic resources. The model proposed in this article organizes factors leading to high child mortality rates onto three tiers to contextualize the medical causes of death and the debate over traditions of child care. The proximate tier includes the immediate biomedical conditions that result in death, typically involving interactions of malnutrition and infection. The intermediate tier includes child care practices and other behavior that increase the exposure of children to causes of death on the proximate tier. The ultimate tier encompasses the broad social, economic, and cultural processes and structures that lead to the differential distribution of basic necessities, especially food, shelter, and sanitation. The ultimate tier thus forms the context of causes located on the other tiers. Research from rural Mexico, Central America, and Africa supports various parts of the model, particularly concerning traditional parental behavior, which has often interpreted as child neglect but appears in many cases to result ultimately from economic scarcity. Links from tier to tier in the model especially warrant further attention from both researchers and policy makers.

Suggested Citation

  • Millard, Ann V., 1994. "A causal model of high rates of child mortality," Social Science & Medicine, Elsevier, vol. 38(2), pages 253-268, January.
  • Handle: RePEc:eee:socmed:v:38:y:1994:i:2:p:253-268
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    Cited by:

    1. Hampshire, Katherine Rebecca & Panter-Brick, Catherine & Kilpatrick, Kate & Casiday, Rachel E., 2009. "Saving lives, preserving livelihoods: Understanding risk, decision-making and child health in a food crisis," Social Science & Medicine, Elsevier, vol. 68(4), pages 758-765, February.
    2. Onarheim, Kristine Husøy & Sisay, Mitike Molla & Gizaw, Muluken & Moland, Karen Marie & Miljeteig, Ingrid, 2017. "What if the baby doesn't survive? Health-care decision making for ill newborns in Ethiopia," Social Science & Medicine, Elsevier, vol. 195(C), pages 123-130.
    3. Foggin, Peter M. & Torrance, Marion E. & Dorje, Drashi & Xuri, Wenzha & Marc Foggin, J. & Torrance, Jane, 2006. "Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau," Social Science & Medicine, Elsevier, vol. 63(9), pages 2512-2532, November.
    4. Kandala, Ngianga-Bakwin & Magadi, Monica Akinyi & Madise, Nyovani Janet, 2006. "An investigation of district spatial variations of childhood diarrhoea and fever morbidity in Malawi," Social Science & Medicine, Elsevier, vol. 62(5), pages 1138-1152, March.
    5. Augustus Kapungwe, 2005. "Quality of child health care and under-five-mortality in Zambia:," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 12(12), pages 301-322.
    6. Hatt, Laurel E. & Waters, Hugh R., 2006. "Determinants of child morbidity in Latin America: A pooled analysis of interactions between parental education and economic status," Social Science & Medicine, Elsevier, vol. 62(2), pages 375-386, January.
    7. Rothstein, Jessica D. & Caulfield, Laura E. & Broaddus-Shea, Elena T. & Muschelli, John & Gilman, Robert H. & Winch, Peter J., 2020. "“The doctor said formula would help me”: Health sector influences on use of infant formula in peri-urban Lima, Peru," Social Science & Medicine, Elsevier, vol. 244(C).

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