The determinants of infant and child survival in the Philippines.

Researchers analyzed 1988 data on 20015 index children born between January 1977 and February 1987 who were of second and higher birth orders to test a two-stage causation model of infant mortality in the Philippines and to identify direct and indirect effects of selected determinants of infant mortality. The infant mortality rate was 54.6/1000 live births. The most important predictor of survival of the preceding child was death of a subsequent (index) child. If the preceding child lived for more than 12 months the odds of the subsequent child surviving increased by 152%. If the preceding child died before 12 months of age maternal depletion and inter-sibling disease transmission contributed to an increased risk of death for the subsequent child. This finding indicates that infant death is clustered within households where poor environmental and sanitation conditions may more readily put infants at greater risk of morbidity and mortality. When mothers spaced their children more than two years apart the odds of infant death decreased by 39%. This provided strong support of the view that contraceptive use to space births greatly reduces infant mortality. Young (<25 years) urban women were 133% more likely to have a short birth interval (=or< 24 months) than older rural women indicating that they were likely to space children and to face higher infant mortality risks. Shorter birth intervals were more important than family size in predicting child survival outcomes. Infant survival increased 29% if the infant was a second order birth than a third or higher order birth suggesting the importance of family planning as a child survival intervention. Maternal age birth order death of previous child and maternal education had direct effects on infant mortality. Indirect effects of these variables operated through the birth interval to affect infant mortality. These findings indicate that family planning and maternal and child health program activities can greatly minimize the risk of infant death.