MPIDR Working Paper

Fertility postponement could reduce child mortality: evidence from 228 demographic and health surveys covering 77 developing countries

Barclay, K., Myrskylä, M.

MPIDR Working Paper WP-2017-005, 39 pages (February 2017).
Rostock, Max Planck Institute for Demographic Research


Annually, 6 million children under age five die and over 80% of these deaths happen in the developing world. However, under-five mortality did decrease by 53% between 1990 and 2015. For an individual mother, having a child at an older age means placing the child into a later birth cohort in which survival should be higher due to secular declines in mortality. Using data covering 7 million births, 77 developing countries, and 228 Demographic and Health Surveys collected from 1985-2014, we implement Cox proportional hazard models and stratified Cox models to study how secular declines in child mortality offset the risks associated with reproductive ageing. We also calculate the population attributable fraction to examine how a change in the distribution of maternal age at birth would affect under-five mortality. Our results show that if fertility in the DHS countries was on average postponed by as little as 1-year, 1.4%, or more than 68,000 of all child deaths per year, could be avoided. An increase in birth spacing by 1-year would reduce child mortality by 0.9% per year. In countries with the fastest rates of decline in under-five mortality, postponing all childbearing by 1-year would reduce child mortality by 3.0%, and a 1-year increase in birth spacing would reduce child mortality by 4.3%. This study shows that secular declines in under-five mortality can counterbalance or outweigh the risks associated with reproductive ageing in developing countries. Postponing fertility is not only the expressed preference of women, but would also help save childrens lives.