Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
1 Introduction Barney Cohen and Mark R. Montgomery BACKGROUND The twentieth century has witnessed a remarkable expansion in the average length of human life. Significant differentials in mortality remain, to be sure, and these testify to the continued presence of political and socioeconomic barriers to effective health care. The differentials should not, however, obscure the larger achievement. In developed countries, the oldest generation living today was born in an era in which nearly one child in five failed to survive to his or her fifth birthday. In developing countries, for the most part, mortality risks are now far lower than they were at the turn of the century in the wealthier societies of the West. This profound change in the human condition has had far-reaching implica- tions, unsettling long-established habits of thought and behavior. As early as mid-century, Notestein (1945, 1953) recognized and began to emphasize one particular implication: the effects of mortality decline on the motivation for high fertility. The initial formulations of demographic transition theory gave promi- nence to this theme and it continues to serve as a unifying feature in models of fertility and related demographic behavior (Mason, 1997~. Even when first ar- ticulated, the mechanisms by which mortality reduction might bring about fertil- ity decline were understood to be complex, involving both individual- and soci- etal-level responses. Subsequent demographic research has done much to clarify the individual-level relationships, and in so doing has added new considerations. In 1975, a scientific meeting organized by the Committee for International Coordination of National Research in Demography synthesized and codified what had been learned. The resulting volume, The Effects of Infant and Child Mortal 1
2 INTRODUCTION ity on Fertility (Preston, 1978a), stands as a landmark in demographic research. It enumerated four mechanisms by which child mortality might affect fertility. First, parental expectations of child loss might be expressed in insurance or "hoarding" behavior, causing fertility to be higher than if survival were assured. In the event of an infant or child death, two additional mechanisms could come into play: lactation interruption effects and behavioral replacement strategies. Fourth, the Preston volume made a place for societal-level effects, those having to do with institutional forces that had long served to maintain high fertility in the face of high mortality, and which would therefore continue to shape the fertility response to mortality decline. Having summarized the key mechanisms, the 1978 volume went on to refine the methodological tools with which the strength of the individual-level effects might be measured. The volume also presented an array of applications to both aggregate- and individual-level data, which provided evidence on the likely mag- nitude of the fertility response. These theoretical and methodological develop- ments were set out in compelling, lucid, and vivid terms. Interestingly, the net effect was to dissipate much of the momentum for further research. In retrospect, the ensuing lull in research appears all the more curious. Preston's introduction to the 1978 volume pointed toward new intellectual terri- tory into which demographers had not yet ventured (Preston, 1978b). He argued for a deeper consideration of the societal-level mechanisms, including the place of nuptiality, and emphasized the role of mortality perceptions. Yet neither line of research was pursued. The new tools of hazard-rate modeling were just then coming onto the demographic scene, accompanied by a dramatic expansion of individual-level data in the form of World Fertility Surveys and the later Demo- graphic and Health Surveys. Armed with these tools and new resources, re- searchers were soon much better equipped to understand the multiple determi- nants of birth interval dynamics and to explore the effects of high fertility and close birth spacing on mortality. Yet relatively little attention was given to the possibility that earlier estimates of the effects of mortality on fertility might be contaminated by reverse causation. Continued advances in the availability of historical demographic data also invited a reexamination of the Western experi- ence, but on this front, too, progress was slow (although see Chesnais, 1992~. New theoretical and empirical research in economics began to underscore the importance of health to economic productivity and growth and put increasing emphasis on the trade-off between such investments in human capital and the level of fertility (Becker et al., 1990; Mincer, 1996~. Apart from the review by Lloyd and Ivanov (1988), however, no systematic effort was mounted to draw together such important but rather disparate lines of research. In the early l990s, a spirited debate broke out in which the long-term ben- efits produced by child health programs were brought into question. In a series of provocative articles, King (1990, 1991, 1992) argued that in certain cases, pro
BARNEY COHEN AND MARK R. MONTGOMERY 3 grams aimed at reducing infant and child mortality might do no more than exac- erbate the problems of sustainable development. For the poorest countries in the world, King said, the rapid increase in population generated as a direct result of saving lives had the potential to undermine biological support systems to the point that death rates might begin to climb. King termed this phenomenon a "demographic trap" (see King, 1990, 1991; Hammarskjold et al., 1992~. Other writers sharply disagreed, arguing in the first place that health pro- grams can and should be justified on their own terms (Taylor, 1991; UNICEF, 1991~. Moreover, it was said, policies and programs aimed directly at high fertility will tend to be more effective when parents can be confident that their children will survive (Freedman, 1963; Taylor et al., 1976~. In addition, the potential feedback benefits of fertility decline were cited, these having to do with the role of lower and better-spaced fertility in reducing the risks of maternal, infant, and child mortality. In the view of King's critics, health and family planning programs have the potential to set off a series of responses that could culminate in a more-than-compensating fertility decline over the long term. The possibility of such responses in fertility can be glimpsed in recent cross-country analyses of mortality-fertility relations in low-income countries (Schultz, 1994a,b)i and in new analyses of the historical record (Galloway et al., in this volume). To be sure, if attention were to be confined to the lactation interruption and behavioral replacement effects, such overcompensating fertility responses could be dismissed as implausible on empirical grounds. Citing numerous early studies that found the responsiveness of individual fertility to the loss of a child to be much less than one-for-one, Preston (1978b) concluded that, on average, an additional child death in a family would lead to something less than an additional birth. If the lactation interruption and replacement effects were indeed the only mechanisms at work, then reductions in infant and child mortality would, by themselves, tend to increase the rate of population growth. The possibility of more-than-compensating effects thus rests on the insurance motivation and on a longer-term series of feedbacks whose causal basis is yet to be fully understood. iSchultz used data from 62 low-income countries in 1972, 1982, and 1988 to investigate the relationship between fertility and mortality at the macro level. In his analysis (Schultz, 1994b:27): Declines in the level of child mortality in developing countries are not associated with increases in population growth, because coordinated fertility decline fully offset this de- mographic effect of improvements in child nutrition and survival. In this time period, improvements in child health are associated with slower population growth. Schultz found that female educational attainment was the most important determinant associated with both lower child mortality and lower fertility.
4 INTRODUCTION THE NEED FOR REASSESSMENT The recent policy debate, and more generally the lack of systematic research over the past 20 years, would suggest that a thorough reassessment of the theory and evidence is in order. This volume is based on a set of papers presented at a scientific meeting organized in November 1995 by the U.S. National Academy of Sciences' Committee on Population and convened in Washington, D.C. It at- tempts to contribute to the debate by advancing the demographic literature on three fronts: theoretical, methodological, and empirical. Given the current state of the research and policy debate, several tasks faced the authors of this volume. The first imperative was simply to document, more precisely than had previously been possible, the various pathways that have been taken by mortality and fertility in the developing countries and in selected histori- cal settings. When the full empirical record is assembled, it is seen to encompass a remarkable diversity of experience. Many countries have adhered to the simple scheme of demographic transition in which mortality declines first and fertility decline then follows with a lag. Even here, however, the lags in response are highly variable and are themselves worthy of consideration. Some countries (e.g., Costa Rica, see Rosero-Bixby, in this volume) experienced decades of profound mortality decline without any apparent fertility response. In a few others, fertility decline seems to have preceded mortality decline. The very diversity of developing country mortality and fertility declines suggests that there can be nothing automatic or self-sustaining about the effects of mortality decline on fertility. This diversity should also put to rest the notion that mortality decline can be linked to fertility decline by way of simple neces- sary or sufficient conditions. It seems that a particular configuration of social, political, and economic forces may be required for any given country to embark on transition, but the outlines of that configuration may be difficult to discern in advance. A second task facing the authors was to assess, with new data and tech- niques, the robustness of the lactation interruption and replacement effects that Preston had described earlier. Given the debate within the policy community, it was important to determine whether, taken together, these effects could not rea- sonably be expected to induce more-than-compensating fertility responses. In this volume, a considerable amount of statistical and methodological ingenuity is expended in securing precise estimates of the lactation and replacement effects. The conclusion reached by this new research is that the earlier findings are indeed robust. This brings to the forefront the remaining task that faced the authors: to better understand the role played by insurance (or hoarding) effects. If the lacta- tion and replacement effects are less than compensating, the net reproduction rate will fall in response to mortality decline only if the insurance effects are power- ful. Such insurance effects are very difficult to detect with aggregate data, or
BARNEY COHEN AND MARK R. MONTGOMERY s indeed, with any demographic data that are routinely collected. Something of their influence is presumably expressed in the coefficients of community mortal- ity measures employed in individual fertility regressions, but even this is too crude a measuring device. The essence of the insurance effect resides in the combination of individual experience and social structure that shapes individual perceptions of mortality and forms the basis of their expectations. It is closely linked to the perceived potency of human agency as against fatalistic views of the world, and likewise to the transition from family building by fate to family building by design that Lloyd and Ivanov (1988) have emphasized. Remarkably little demographic research has addressed these fundamental concerns. In the remainder of this introductory chapter, we review the research devel- opments since the landmark Preston (1978a) volume. We offer our views as to why the relationship linking mortality decline to fertility is likely to resist simpli- fication and easy generalization. We then document the astonishing diversity of mortality and fertility transitions that have taken place in developing countries over the past 40 years. The penultimate section of this chapter previews the contribution of the remaining chapters in the volume. The final section offers brief conclusions and draws out some implications for policy. THE RECENT RESEARCH RECORD Since the 1978 Preston volume, research on the effects of mortality on fertil- ity has proceeded in three directions. First, some researchers have continued to search for statistically significant thresholds of life expectancy or socioeconomic development that, when attained, provide motivation for couples to limit their fertility (see, for example, Cutright, 1983; Cutright and Hargens, 1984; Bulatao, 1985~.2 Such studies have generally failed to identify meaningful thresholds for fertility decline, although measures of social development often appear to be more closely associated to declines in fertility than are measures of economic development (Cleland, 1993~. Second, the emergence of detailed m~cro-level data from developing coun- tries has supported a new generation of studies of both the lactation interruption and replacement effects (A.I. Chowdhury et al., 1992; A.K.M.A. Chowdhury et al., 1976; Balakrishnan, 1978; Park et al., 1979; de Guzman, 1984; Mauskopf and 2Cutright and Hargens (1984) analyzed a pooled regression of crude birth rates from 20 Latin American countries for four points in time. They found statistically significant threshold levels of literacy and life expectancy that are independent of lagged measures of literacy and life expectancy, measures of economic and family planning program development, and period controls. Bulatao (1985) analyzed data from 124 developing countries and concluded that no fertility transition has been observed in any developing country until life expectancy has reached 53 years. In a similar analysis, Ross and Frankenberg (1993) concluded that fertility is unlikely to decline until life expect- ancy rises to 50-60 years.
6 INTRODUCTION Wallace, 1984; Mensch, 1985; Santow and Bracher, 1984; Nur, 1985; Rao and Beaujot, 1986; Johnson and Sufian, 1992~.3 These micro-level studies have confirmed that women who experience the death of one or more of their children tend to have higher subsequent fertility than women whose children survived. Birth intervals tend to be considerably shorter following the death of a child, with much of this due to the interruption of lactation and the removal of its contracep- tive protection. When adjustments are made for duration of exposure and other demographic and socioeconomic factors, the residual replacement effect esti- mates have tended to be rather small. In marked contrast to studies of lactation and replacement effects, relatively few micro-level analyses have attempted to link fertility change to community-level changes in mortality, although Pebley et al. (1979) and Rashad et al. (1993) are exceptions. Economists, interested in both conceptual and statistical issues, have pursued two related lines of research. Wolpin (1984) and Sah (1991) further refined the dynamic theory that underlies modern economic models of insurance and re- placement effects. Others developed multivariate techniques to circumvent some of the problems that plague bivariate analyses (Schultz, 1976; Williams, 1977; Olsen, 1980; Trussell and Olsen, 1983; Wolpin, 1984; Yamada, 1985; Chowdhury, 1988; Pitt, 1994~. Subsequent empirical work, often using linked macro- and micro-level data, generated a set of estimates of both the breastfeeding and behavioral effects that are similar in magnitude and range to those reported in the studies mentioned above (Hashimoto and Hongladarom, 1981; Lee and Schultz, 1982; Anderson, 1983; Olsen and Wolpin, 1983; Okojie, 1991; Benefo and Schultz, 1996; Panis and Lillard, 1993; Maglad, 1993, 1994~. As noted above, surprisingly few attempts have been made over the past two decades to weave these diverse strands of research into a coherent whole. A notable exception is the comprehensive 1988 review by the United Nations Popu- lation Division (United Nations Secretariat, 1988; Lloyd and Ivanov, 1988~. This thoughtful synthesis clarified much about the evolution of the relationship be- tween mortality and fertility over the course of the demographic transition. As Lloyd and Ivanov argued, the demographic transition is in essence a transition in family strategies: the reactive, largely biological family-building decision rules appropriate to highly uncertain environments come eventually to be supplanted by more deliberate and forward-looking strategies that require longer time hori- zons. We take up several of the themes raised by Lloyd and Ivanov in the following sections. 3Most such studies have used data that were collected under the World Fertility Survey program, although some rely on census, panel, or ad hoc demographic surveys. Surprisingly, until the publica- tion of this volume, analyses of data from the Demographic and Health Surveys on this question have been almost nil.
BARNEY COHEN AND MARK R. MONTGOMERY THE DIFFICULTIES IN ANALYZING THE MORTALITY-FERTILITY RELATIONSHIP Perceptions and Agency 7 Women in pretransitional societies often express no clear personal prefer- ence about the number of children they will bear (see, for example, Knodel et al., 1987; van de Walle, 1992~. This lack of preference is sometimes termed "fatal- istic," but on closer inspection can be understood as a rational stance vis-a-vis an uncertain and contingent environment. Child survival is only one of many uncer- tainties that must be faced in deciding family productive and reproductive strate- gies (Castle, 1994~. As improvements in child survival begin to occur in such settings, they may reshape parental views in subtle but profound ways. Parents may begin to con- ceive of the possibility of influencing the size of their own families, instead of leaving such matters to chance or to the higher powers. Lloyd and Ivanov (1988) termed this a "transitional effect," whereas UNICEF refers to it as the "confi- dence factor" (UNICEF, 1991~. Demographers know the concept as Coale's first precondition for fertility transition, that fertility behavior must lie within the "calculus of conscious choice" (Coale, 1973~. In their review, Lloyd and Ivanov hypothesized that the emer- gence of conscious family planning, and the speed of its diffusion, depends on both the age pattern of mortality in childhood and the degree to which risks can be reduced by parental actions. Heavy infant but light child mortality makes child survival more secure and predictable following infancy. When new health behaviors are adopted, and these innovative health decisions are shown to exert a perceptible influence on mortality risks, parents may be led to consider new, more self-conscious strategies of family building in general. The standard methods of economic and demographic inquiry are not at all well suited to measuring such fundamental changes in psychological context. Perceptions of mortality risks and of the efficacy of health interventions are doubtless very difficult to elicit. Parents may not be able to articulate precisely why they feel as they do, or be able to connect logically mortality risks to fertility decisions in the schematic fashion that social scientists would prefer (see Knodel et al., 1987, and Castle, 1994 for examples). In pretransitional settings, it would surely prove difficult to extract meaningful information about the long-standing preferences, beliefs, and modes of behavior that the participants themselves have taken as given and not much examined. Some evidence on these matters is available in the historical record for the United States. For the period from the late eighteenth to the early twentieth centuries (Preston and Haines, 1991; Dye and Smith, 1986; Vinovskis, 1991) there are fascinating qualitative accounts of both continuity and change in mortal- ity perceptions. The materials of Dye and Smith, largely drawn from women's
8 INTRODUCTION diaries, attest to an ever-present concern throughout the period with the possibil- ity of child death. Adults also seemed to be intensely aware of the risks facing themselves. Indeed, Vinovskis argues that adult mortality perceptions were much inflated in relation to the empirical realities, in part because of the interests of religious institutions in keeping their members focused on the afterlife. Dye and Smith (1986) show that over the course of the nineteenth century, childrearing came to be increasingly child centered in nature and became a task increasingly assigned to mothers rather than one distributed among siblings, kin, and other caretakers. Until the very end of the nineteenth century, however, this transition in the definition of the quality of child care presented mothers with a dilemma: They were being entrusted with safeguarding their children, and yet, where mortality was concerned, lacked any effective means of doing so. The result was an increasing tension between socially defined responsibilities and technically constrained options. When the necessary medical breakthroughs were finally made, according to Dye and Smith, women responded in both personal and political terms. In personal terms, they enthusiastically adopted the new medical techniques and adhered to advice; in political terms, they channeled their pent-up energies to the creation of the Children's Bureau and other government and public health institutions. Although this account of the U.S. experience is only impressionistic, it raises certain themes that have otherwise received very little research attention in demo- graphic circles. There is the issue of perceptions of mortality risks as against the empirical risks themselves. There is the distinction between high risks and risks that, although high, might be controlled. There is an evolving definition and redefinition of child quality, in which parental health investments, newly per- ceived to be effective, eventually come to play a role. Finally, the decisive actions are played out not only at the individual level, but also at the level of political and public health institutions. All these factors figure into the develop- ment of family-building strategies that stress design over fate, emphasize deeper investment in child quality, and lead ultimately to lower fertility. The particular circumstances were perhaps unique to one historical era in the United States, but in broad outline have parallels elsewhere (e.g., Caldwell, 1986; Caldwell et al., 1983; Caldwell and Caldwell, 1987~. Preferences and Unwanted Fertility The fertility response to mortality decline cannot be easily disentangled from other factors that affect fertility preferences in general (whether for the number of children, their sex composition, or their spacing) and the costs (whether mon- etary, health related, or linked to spousal bargaining) that are associated with the means of fertility control. Although debate continues about the measurement, meaning, and depth of fertility preferences, one aspect is clear: Child replace- ment effects are likely to be stronger among families that have not yet exceeded their ideal family size and weaker among families that have already experienced
BARNEY COHEN AND MARK R. MONTGOMERY 9 at least one unwanted birth. A notable feature of demographic research over the past decade is the increasing appreciation of unwanted and unintended fertility (see Bongaarts, 1997, for a review). The emergence of replacement effects is thus linked, directly or indirectly, to the factors that shape fertility preferences, govern the costs of fertility regulation, and thereby affect the proportion of fami- lies that have yet to reach, or have already exceeded, their desired family sizes. To a lesser extent, perhaps, insurance strategies are also affected by these factors. Alternative Strategies Can Coexist A further consideration is that the strategies of insurance and replacement behavior, although conceptually distinct, have common roots in household con- straints, preferences, and perceptions (see Wolpin, in this volume). A range of such strategies can coexist within any given community or be adopted by a given family at different points in its reproductive career (Preston, 1978b; Lloyd and Ivanov, 1988~. Moreover, by constraining the options that are open to parents, the program environment may affect their mix of strategies. For example, par- ents might seek to combine replacement and insurance behavior where reversible methods of contraception are unavailable (Bhat, in this volume). The Nature of the Relationship Changes Over Time In an earlier era, differences in fertility levels among developing countries seem mainly to have reflected differences in social customs concerning such matters as age at first marriage, divorce and remarriage, the length of breast- feeding, sanctions on postpartum abstinence, and coital frequency. These social and cultural influences in pretransition settings served to restrain fertility to lev- els well below its biological maximum (Bongaarts, 1975~. The ensuing decline in fertility can be viewed as a shift away from such "natural" fertility regimes toward more self-conscious, parity-specific birth control, although changes in age at first marriage associated with the rising educational achievements of women have also played a significant role (Cleland, 1993~. Not surprisingly, therefore, the relative importance of mortality effects also varies over the course of the transition (Preston, 1975; Park et al., 1979; Frankenberg, in this volume; Lloyd and Ivanov, 1988~. Preston (1975) suggests that the extent to which dead children are replaced in a family is approximately U-shaped, with populations at the highest and lowest developmental levels exhibiting the strongest effects. Over the course of devel- opment, he argues, the importance of the lactation interruption effect tends to be reduced in relative terms, and the significance of behavioral responses propor- tionately enhanced, as societies increasingly adopt parity-specific controls over childbearing. Furthermore, as mortality conditions improve and the demand for surviving children falls, parents are more likely to abandon pure insurance strat- egies and substitute for them various forms of replacement behavior. Hence,
10 INTRODUCTION over the course of the demographic transition, the dominant mechanism changes from a biological relationship associated with the truncation of breastfeeding to behavioral replacement, passing through an intermediate stage in which insur- ance strategies could be expected to hold sway.4 The Link to Human Capital Investments We noted above the role that could be played in demographic transitions by redefinitions of the norms governing child care and investments in the human capital of children, with the emerging norms helping to reduce mortality and, in addition, to raise the costs of continued high fertility. Among several forms of human capital investment, the potential link between mortality and the motiva- tion for investments in children's schooling merits special consideration. Why might high mortality risks threaten children's schooling? The demo- graphic reality is that the great majority of deaths occurring under age 20 are those that occur before school age. Even in high-mortality environments, the death of a school-age child is a relatively rare event. It would thus be unusual for parental investments to be rendered fruitless by the death of a school child. Unless there is a decided mismatch between parental perceptions of mortality and the demographic realities, the roots of an association would need to be sought elsewhere. One possibility is that the conditions producing high infant and child mortal- ity are also responsible for significant morbidity among school-age children. Such morbidities would undermine children's energies and abilities to learn, thereby reducing the payoffs that parents could expect to receive from their schooling investments. Another possibility is that when higher parental fertility is occasioned by higher child mortality, school-aged children are more often called upon to serve as caretakers for their younger siblings or to assist their mothers in household tasks. These additional duties may reduce the time that children have available for schoolwork or even for school attendance, which again could erode learning abilities and reduce the expected returns to additional parental investments. The perceived risks of adult mortality may play a role as well. Looking to the future, and perhaps exaggerating the risks that they face, parents may fear that they may not be able to sustain the resource flows needed to embark on what might be, in context, an ambitious program of human capital investment in their children. Not willing to risk the returns for themselves over the near term, and being reluctant to raise their children's hopes only to have them later dashed, parents might well conclude that a less ambitious strategy is in order. Moreover, 4In China, an extreme variant of the replacement mechanism sex-selective abortion is emerg ing as a result of widespread availability of ultrasound and other diagnostic techniques (Zen" Yi et aL, 1993; Goodkind, 1996).
BARNEY COHEN AND MARK R. MONTGOMERY 11 one would expect that parental discount factors those subjective utility param- eters that summarize how all future events are downweighted in salience by comparison to the present would themselves be lower in highly uncertain envi- ronments. The link between high mortality, environmental uncertainty in gen- eral, and time orientation deserves serious study. Ainsworth et al. (in this vol- ume) take up the issues in connection with mortality from AIDS. Statistical Estimation Problems In addition to the conceptual problems that have been described above, at- tempts to isolate the effects of improved child survival on fertility face numerous methodological difficulties (Schultz, 1976; Williams, 1977; Brass and Barrett, 1978~. For example, unmeasured third factors may well affect both fertility and mortality, thus obscuring the true relationship between them. When micro-level data are used, the discreteness of fertility measures and the nonlinearity of the replacement effect induce an artificial correlation between fertility and child mortality that can also affect estimates of behavioral relationships (Williams, 1977~. When macro-level time series data are used, the time dimension of the analysis raises questions of autocorrelation (Brass and Barrett, 1978), which would threaten the basis for inference. Furthermore, in many developing coun- tries, estimates of fertility and mortality rates have been adjusted using indirect estimation techniques that contain implicit assumptions about the nature of other demographic conditions embedded within them (Brass and Barrett, 1978~. Perhaps the most difficult estimation issue, however, is that causality be- tween improved child survival and fertility runs in two directions (Galloway et al., in this volume). It is now well established that the probabilities of survival are lower for children born to teenagers, to older women, and to women of high parity or closely spaced births (Hobcraft et al., 1983, 1985; Hobcraft, 1992~. Hence, reductions in the number of births, particularly high-risk births, can be expected to affect infant and child mortality rates.5 To circumvent this problem, economists have long argued for the use of structural equations models (Schultz, 1988~. Such models require researchers to impose crucial identifying restric- tions. Except in unusual cases, however, neither theory nor specific knowledge of the relevant processes is sufficient to guide the choice of instruments (Schultz, 1988; Bhat, in this volume). Estimates of the effects of child mortality on fertility tend to be disturbingly sensitive to such key details of model specification.6 5The direction of effect, however, is not always obvious (see the exchanges in Trussell and Pebley, 1984; songaarts, 1987, 1988; Trussell, 1988). 6When put to the test, structural models often fail to reject the hypothesis that child mortality is exogenous (see, for example, senefo and Schultz, 1996; Maglad, 1993; Panis and Lillard, 1993). This may well reflect the low power of the tests involved, but could also indicate that fears of statistical endogeneity have been exaggerated.
2 INTRODUCTION MORTALITY AND FERTILITY TRENDS OVER THE PAST 40 YEARS With all this as background, we now turn to a review of the empirical evi- dence. Figure 1-1 presents a graphical representation of the varied evolution of fertility-mortality pathways over some 40 years (1950-1990) in specific countries in Latin America, sub-Saharan Africa, Asia, and the Middle East. Conversion of these data into rates of population growth is not always straightforward, as one must also take into account the age structure of the population, changes in mortal- ity at other ages, and population momentum. Figure 1-2 depicts changes in population growth rates for these countries over the same period. Latin America Two recent reviews of fertility and mortality transitions have concluded that no single dominant pattern of population change in Latin America exists, and, indeed, "to invoke the image of a unique experience, even if only for descriptive purposes, is highly misleading" (Palloni, 1990:128; see also Guzman, 1994~. Population trends in the region are the product of a complex set of historical, social, and economic forces (Palloni, 1990~. This rich social context includes marked differences between countries in (1) the official ideology toward popula- tion issues; (2) the extent of influence of the Catholic Church; (3) the prevalence of consensual unions; (4) the extent of international migration flows, particularly after World War II; (5) the timing of the introduction of modern family planning services; (6) levels of female education and rates of labor force participation between countries; and (7) ethnic composition. Mortality decline preceded fertility decline across Latin America. Mortality decline in some countries was already well under way during the 1930s, that is, before the introduction of medical innovations to the region, thanks to general improvements in living standards (Palloni, 1990~. After World War II, and particularly between 1945 and 1965, life expectancy in the region increased dramatically as socioeconomic development complemented the introduction of medicines such as sulfa drugs and penicillin to treat infectious diseases and the introduction of vaccines against measles, diphtheria, tetanus, and typhoid (Palloni, 1981; Merrick, 1991~. Fertility began to decline throughout Latin America at approximately the same historical moment in the 1960s despite quite different prevailing levels of mortality. At the onset of fertility decline, the rate of infant mortality ranged from under 65 per 1,000 in Paraguay and Panama to over 150 per 1,000 in Haiti and Bolivia (Guzman,1994~. Mexico and Bolivia were the only two notable late starters, with fertility declines that began in the early 1970s (Guzman,1994~. The Latin American decline in fertility resulted almost entirely from a decline in
BARNEY COHEN AND MARK R. MONTGOMERY 13 marital fertility associated with increased use of modern contraception, although later marriage and abortion also played a role (Palloni, 1990; Merrick, 1991~. Although fertility has fallen across the region, the speed of decline has varied dramatically. In some countries, the fertility transition is now almost complete; in others, meanwhile, it seems to have barely begun. By analyzing the specific experiences of individual Latin American countries, Guzman (1994) identified no fewer than four distinct patterns of fertility decline. These range from coun- tries that have completed or almost completed their transition to low fertility (Argentina, Uruguay, Chile, and Cuba) to countries where the fertility transition has been delayed and childbearing remains high, with more than five children per woman in 1985-1990 (Bolivia, Guatemala, Honduras, and Nicaragua). In his review of fertility and mortality decline in Latin America, Pallon (1990) concluded that exogenous changes in socioeconomic development and family planning program efforts are less than adequate as explanations for mor- tality and fertility decline. In his view, future analysis of demographic change in the region should specifically allow for endogenous mortality-fertility interaction effects (Palloni, 1990:144~. Although the relatively short duration of breast- feeding in the region implies that the lactation interruption effect must be small, analyses of pooled cross-sectional time series data reveal a surprisingly strong correspondence between infant mortality and fertility in Latin America, a rela- tionship that is diluted as the length of time considered is increased (Palloni, 1989, cited in Palloni, 1990~. 11 Sub-Saharan Africa Fertility in sub-Saharan Africa remains the highest in the world. The slow speed with which sub-Saharan African countries have adopted family planning has led to a great deal of debate as to whether Africa is more resistant to fertility change than are other parts of the world. A few countries, notably Kenya, Botswana, and Zimbabwe, began their transitions toward lower fertility in the early l990s. More recently, Demographic and Health Surveys (DHS) have re- corded apparent declines in fertility in a variety of countries across the continent, including Cote d'Ivoire, Ghana, southern Malawi, southern Namibia, southwest Nigeria, Rwanda, Senegal, northern Tanzania, and Zambia. From his comprehensive review of published studies on mortality-fertility dynamics in Africa, Kuate Defo (in this volume) concludes that aggregate-level studies have usually failed to document any clear effect of mortality decline on fertility whereas individual-level studies have consistently found a significant fertility response to child loss. Nevertheless, Caldwell et al. (1992) have noted that Botswana, Kenya, and Zimbabwe all enjoy infant mortality rates below 70 per 1,000 whereas most countries in the region face rates of over 100. Arguing that African parents are more sensitive to the risk of losing a child because of an extreme fear of family extinction, Caldwell et al. suggest that achieving these
14 a) a: to 400 300 ZOO 100 c O - 400 ~ 4~ 300 200 ~iOO 0-, INTRODUCTION A Bangladesh [] Pakistan 0 India + Sri Lanka E1 ~ Am_ a Mexico Columbia - I 6 4 Total Fertility Rate 0 Brazil + costa Rica d;~ OF i 6 Total Fertility Rate 2 FIGURE 1-1 Alternative mortality-fertility pathways, 1950-1990. NOTE: Each line depicts one country's experience over the period from 1950 to 1990. Because the transi- tion has been from high to low levels of mortality and fertility, time is represented by
BARNEY COHEN AND MARK R. MONTGOMERY Q Indonesia ~3 Philippines 400 a' Cl: ,, rim 4J o 300 200 100 O - 400 o ~300 cc ~200 4~ lo 100 O - 15 o Mat aysia + Thai land .t b it, Icy ~z91 lo, - -A [Kenya Botswana Q ..I . Total Fertility Rate 0 Cameroon + Senegal . A. 4 2 I = 6 Total Fertility Rate 2 going from left to right along any line. Hence the far left point of any line represents the period 1950-1955. Each subsequent point represents the country's position in the next period. The far right-hand point represents a country's position in 1985-1990.
16 o CD o 4~ o al i 4J a: ~3 o ~2 . - o CL i - o INTRODUCTION Bangladesh ~ Pakistan 3 2 o O - 0 India ~ Sri Lanka ~A ~ \ -1 _ ! 50 1g60 11970 1980 ~ to - - Mexico Columbia 0 Brazil ~ Costa Rica ~~:X,: lg ;0 1960 1970 1980 Time FIGURE l -2 Rates of population growth, l 950- l 990.
BARNEY COHEN AND MARK R. MONTGOMERY Indonesia ~ Philippines o 3 o ~2 } o _ o em O 4= ~3 o o w _~ CL o ILL i - o 03 TIC 0- . 17 o Malaysia f Thailand / - i== 1' 50 1g60 1970 1980 Time ~ Kenya [3 Botswana o~: 0 Cameroon ~ Senegal 950 i960 lg70 1980 Time
18 INTRODUCTION minimum goals for child survival may prove to be "the necessary condition for African fertility decline" (Caldwell et al., 1992:212~. Mortality rates in West Africa have long been higher than those of East or southern Africa (Hill, 1991,1993), and indications of incipient decline in fertility at the national level have been fewer. Yet recent data have revealed the first signs of fertility decline in Senegal. Here, child mortality has been falling rapidly, but it is not yet low; female education remains low; and the national family planning program is as yet quite weak (Pison et al., 1995~. The apparent relationship between mortality and fertility decline in Senegal can be questioned, not least because Senegal's fertility decline appears to be atypical. Fertility decline has been concentrated almost entirely among women under age 30, the result of a trend toward later marriage and later first birth (Pison et al., 1995~. Little of this decline appears to be attributable either to an increase in the use of modern contraception or to a decrease in ideal family size (Pison et al., 1995~. Any investigation into the association between fertility and mortality in Af- rica must take into account the consequences of the AIDS epidemic, whose widespread and severe consequences are becoming increasingly apparent through- out much of society. There is a staggering amount of literature being generated on AIDS in Africa, yet almost none of it has addressed the epidemic's impact on birth rates (but see Ainsworth et al., in this volume). After reviewing the effects of testing and counseling programs on subsequent reproductive behavior, Setel (1995) concludes that little or no evidence indicates that women who are HIV positive will accelerate childbearing upon learning of their diagnosis. A few studies indicate that HIV-positive women, particularly those closer to completing their reproductive goals and those who receive counseling as part of a couple, have somewhat lower fertility than do women who are told that they are HIV negative. The only other published study to date, which suggests that HIV epidemics are most likely to exert downward pressure on fertility, fails to account for the possibility that couples can make compensating adjustments to their de- sired family size or to decisions regarding the timing or spacing of children (Gregson, 1994~. This latter effect already appears to be evident in Tanzania (Ainsworth et al., in this volume) and should be of increasing importance as levels of contraceptive use rise across the continent. Asia and the Middle East Asia has been described as "more diverse than . . . any other region in the world" (Rele and Alam, 1993~.7 Fertility decline in Asia has occurred under a variety of economic, political, and sociocultural regimes and under quite differ 7As evidence of this, pretransition fertility levels have varied widely across the region, with total fertility rates ranging from 5.5 to 7.0, as a result of differences in nuptiality patterns, postpartum practices, and other unspecified factors (see Casterline, 1994; Caldwell, 1993, and references therein).
BARNEY COHEN AND MARK R. MONTGOMERY 19 ent infant and child mortality environments. The changes have been complex and, for the most part, are explainable only in hindsight. Most of the fertility decline in the region has been associated with increases in the use of modern contraception within marriage, although some of the decline has also been linked to changes in marriage patterns (Casterline, 1994~. Since the late 1970s, the decline in fertility in Asia has been sufficiently great to offset the contemporane- ous decline in mortality, resulting in a slowdown in the region's rate of popula- tion growth. In East Asia, fertility declines in China, South Korea, and Taiwan began in the 1960s, a point in time when all three countries remained predominantly rural, although the circumstances under which the declines occurred differed a great deal. In China, an aggressive government policy was among the major factors inducing fertility decline (Tien, 1984; Wolf, 1986; Rele and Alam, 1993~. In South Korea and Taiwan, fertility transitions were more spontaneous, as rapid economic modernization and social transformation gave couples the motivation to restrict fertility and governments played significant supporting roles by pro- viding family planning information and subsidized services (Gunnarsson, 1992; Coale and Freedman, 1993~. In Southeast Asia, the fertility transition began in earnest in the early 1970s.8 Once again, the onset of fertility transition appeared in different countries under quite different conditions and did not always evolve in the manner predicted by demographic transition theory. Several countries' fertility transitions seem to have commenced in advance of significant social and economic development. For example, in Thailand fertility rates began to decline even as much of the country remained at only a modest level of economic development; subsequent changes in reproductive behavior do not correlate closely with socioeconomic or sociocultural changes, which have evidently occurred at a substantially slower pace. The change in reproductive behavior and attitudes in Thailand has been so rapid and so pervasive that it has permeated almost all broad segments of Thai society within a period of some 15 years (Knodel et al., 1987~.9 In the Philippines, after a fall from 6.5 children per woman in 1960 to 5.2 children per woman in 1975, the decline in fertility slowed. In 1984, women in the Philippines were still having 4.8 children, a level well above what might have been predicted on the basis of earlier trends, the relatively high educational 8The one major exception to this generalization is Singapore. In Singapore, fertility began to decline in the mid-1950s and by the late 1970s had fallen below replacement levels, where it has remained ever since (Rele and Alam, 1993). In other countries, such as Vietnam, the fertility transition is still under way (Goodkind, 1995; Phai et al., 1996). 9Summarizing the evidence, Knodel et al. (1987:120) conclude that "It is difficult to imagine that had infant and child mortality remained at the levels of several decades ago that fertility would have fallen to the current levels.... Nevertheless, direct evidence of improved child survival contribut- ing to the decline of fertility in Thailand is largely lacking."
20 INTRODUCTION attainments of Filipino women, and other improvements in socioeconomic condi- tions. Part of the explanation lies in the fact that the Filipino government has long been reluctant to take an aggressive approach to family planning, perhaps be- cause political leaders have felt themselves hindered by the strongly pronatalist influence of the Roman Catholic Church (slam and Leete, 1993a). In Malaysia, life expectancy at birth was considerably higher than in much of the region by the early 1950s, and fertility decline began relatively early in the late 1950s and continued at an increasingly rapid pace for almost 20 years. By 1975, fertility in Malaysia had fallen to some 67 percent of its pretransition level (Hirschman, 1980~. But, just at the point when most demographers would have predicted that Malaysian fertility would further decline to replacement levels, fertility among the majority Malay community began instead to rise. Such was not the case among either the Chinese or the Indian community, and ethnic differences in fertility in Malaysia have thus become increasingly pronounced (Hirschman, 1986; Leete and Ann, 1993~. Instead of falling predictably in re- sponse to increased education, urbanization, and living standards, the Malaysian fertility decline effectively stalled at around four children per woman. The expla- nations that have been proposed for this phenomenon include a resurgence in Islamic values and marked shifts in government policy (Leete and Ann, 1993; Cleland, 1993~. South-central Asia has recorded major differences in the timing of fertility transitions both between and within countries. In Sri Lanka, for example, where late age at first marriage for women has traditionally kept fertility rates relatively low, fertility declined rapidly in the late 1960s and early 1970s. By 1974, the total fertility rate stood at some 3.4 children per woman (slam and Leete, 1993a). Within India, quite possibly the world's most heterogeneous country in regard to ethnic diversity, economic status, religious beliefs, and class divisions, the fertil- ity transition is at quite different stages in different states within the country. In Bangladesh, fertility has been falling dramatically over the past two decades even though it is a country that "appears to possess no features that are conducive to fertility decline, except for a strong, persistent government commitment to reduc- ing population growth" (Cleland et al., 1994:xi).~° By contrast, the fertility transition in Pakistan and Nepal has barely begun (Shah and Cleland, 1993~. The Middle East provides a final example of a region where the pace of the transition from high to low mortality and fertility varies enormously among {OAccording to the latest World Development Report, Bangladesh is the 12th poorest country in the world (World Bank, 1995). The vast majority of the rural population is engaged in agriculture (principally at the subsistence level), mortality in the country remains relatively high, and the status of women is relatively low; levels of female literacy and participation rates for females outside of the home are both low. By most economic and social indicators, Pakistan could be said to be ahead of Bangladesh (Cleland, 1993), and it enjoys slightly lower levels of child and infant mortality than Bangladesh (Mitra et al., 1994; National Institute of Population Studies [Pakistan], 1992).
BARNEY COHEN AND MARK R. MONTGOMERY 21 countries, urban and rural populations, and different ethnic groups (Omran and Roudi,1993~. Despite rapidly declining mortality, fertility appears to have fallen only slightly from its 1950s levels in Jordan, Oman, Syria, and Yemen. Else- where, such as in Saudi Arabia, Qatar, or the United Arab Emirates, oil revenues have raised standards of living and ushered in high-quality medical care, but these changes have translated into only modest declines in fertility. Where fertil- ity is declining, it is declining at much higher levels of socioeconomic develop- ment than in Latin America or Asia. Possible explanations for this phenomenon include the region's unique political and cultural context in which reproductive decisions are made (Weeks, 1988; Cleland, 1993~. In the Middle East, issues of politics, religion, national security, and economics are all inextricably linked, and population policies vary widely across the region (Cleland, 1993~. THE SIGNIFICANCE OF THE RESEARCH IN THIS VOLUME The chapters in this volume contribute to the theoretical, methodological, and empirical literature on three broad fronts: by refining the mechanisms through which mortality decline can affect fertility; by providing a reassessment of the historical record; and by supplying new evidence from detailed case studies in developing countries. Theory and Evidence on the Strength of Various Mechanisms Lactation Interruption Effects Until now, demographers have not systematically exploited the largest de- mographic database from developing countries the Demographic and Health Surveys to examine the strength of the lactation interruption and replacement effects. The chapter by Laurence Grummer-Strawn, Paul Stupp, and Zuguo Mei effectively fills this gap. The authors use proportional hazard models to examine whether the length of the interval between two births is affected by whether or not an index child was alive at the time of the next child's conception. They find that mean birth intervals are some 32 percent longer if the index child survives than if he or she dies in infancy. Premature truncation of breastfeeding explains, on average, about 65 percent of this difference, with other mechanisms, such as reduced coital frequency or differences in contraceptive use, presumably ac- counting for the residual. Interestingly, intensive breastfeeding appears to influ- ence both the time to resumption of menses and the length of the period from their resumption to the next conception, the latter reflecting the presence of anovulatory cycles after the return of menses or reduced fecundability. These results add weight to earlier studies, confirming that breastfeeding is an important factor affecting differences in birth interval lengths in both populations that use contraception and in those that do not. Using better and more sophisticated
22 INTRODUCTION techniques, and applying them to a wider array of data, the authors have strongly reinforced earlier conclusions about the strength of this effect. Insurance and Replacement Effects Kenneth Wolpin's chapter reviews recent theoretical insights into micro- level decision making from the field of economics. Economic models of repro- ductive behavior have progressed considerably from the static lifetime formula- tions to complex sequential decision-making models. These advances have enabled economists to estimate increasingly more sophisticated and realistic models of human behavior. Wolpin's chapter underscores a point that has been insufficiently appreciated that insurance and replacement effects have common roots in individual preferences, perceptions, and constraints and guides the reader through an illuminating dynamic formulation. In addition to summarizing the potential contributions of such models to demographic research, Wolpin care- fully analyzes the statistical problems that researchers face when trying to esti- mate replacement and insurance effects. Economic models of rational decision-making behavior typically assume that parents know within some bounds the likelihood of their children' s survival. Such an assumption may be untenable for rural semiliterate populations in many developing countries. For example, Mark Montgomery argues that in a changing demographic environment, parents may not be equipped with any direct knowl- edge of the probabilities of their children's survival. This suggests the need to understand how mortality perceptions are formed. Are perceptions influenced principally by direct experience or observed experience; or is the decisive factor the knowledge acquired in school, through the media, or from health personnel in the community? What time lags are involved? What psychological weight do people place on extreme cases of mortality as compared with the norm? Montgomery' s review of the cognitive and social psychological literature on Judgment and belief updating casts doubt on the hypothesis that people act as if they were Bayesian statisticians. Rather, they tend to depart in systematic ways from Bayesian predictions. For example, they adhere too closely to preconceived notions, resist change, give insufficient weight to certain types of information, and allow negative events to exert an undue influence. Montgomery's chapter points to the need to make use of psychological models of how people learn and make decisions in environments of pervasive uncertainty. One of the mechanisms about which very little is yet known is the insurance or hoarding mechanism. One approach is to investigate environments where mortality conditions are changing very rapidly. Martha Ainsworth, Deon Filmer, and Innocent Semali take this approach in their chapter in which they examine the impact of AIDS mortality on individual fertility in Tanzania, where the adverse consequences of the epidemic are becoming increasingly apparent. Their effort -
BARNEY COHEN AND MARK R. MONTGOMERY 23 is notable in attempting to link adult mortality, as well as child mortality, to fertility decisions. For the most part, models of the demographic impact of the AIDS epidemic have ignored the possibility that individuals might alter their fertility in response to deteriorating mortality conditions. This is clearly a dubious assumption. Us- ing data from one high-prevalence region and two national surveys of Tanzania, the authors find that higher community levels of child mortality are associated with higher fertility, whereas higher community levels of adult mortality are associated with lower fertility aspirations and lower recent fertility. Reassessment of Historical Events Casual observation of the demographic transition in nineteenth century Eu- rope suggests that the mortality decline preceded the fertility decline, leading researchers to theorize a causal link between the two. Mortality declined sharply, largely because of improvements in living standards, sanitation, and medical progress. Fertility also fell, mainly as a result of the termination of childbearing within marriage. Methods such as coitus interruptus or withdrawal, together with periodic abstinence and some abortion, accounted for much of the decline. Detailed analyses of European data from the Princeton European Fertility Project showed that high levels of development and low levels of child mortality were sufficient to initiate a decline in marital fertility, but that no single threshold level of development or mortality could be identified. Empirical evidence from Eu- rope indicated that fertility declined under a wide variety of social, economic, and demographic conditions. The transition also appeared to move quickly through areas with common dialects or similar cultural characteristics, regardless of so- cioeconomic or demographic conditions, suggesting that diffusion or cultural factors must have played a key role (Knodel and van de Walle, 1986~. In some cases the declines in fertility were gradual, whereas in others, they were remark- ably rapid (Coale and Treadway, 1986~. The decline in mortality usually, but not always, preceded the onset of family limitation (Coale, 1973; van de Walle, 1986~. As Chesnais (1992) and others have emphasized, conclusions about timing depend on the measure of mortality that is employed. Infant mortality declined before marital fertility in only about half the administrative districts in Germany and in all but one province in Bel- gium (Knodel, 1974; Lesthaeghe, 1977~. In the case of Belgium, Lesthaeghe concludes "Emiost probably, other factors were already conditioning marital fer- tility in the direction of a decline before the weight of an infant mortality reduc- tion could be felt" (1977:176~. In England, while child mortality was in decline from the 1860s, infant mortality began to decline after 1900, several decades after the onset of the decline in marital fertility (Teitelbaum, 1984~. Thus, the histori- cal evidence suggests that declines in infant mortality rate do not always precede declines in fertility (van de Walle, 1986~. Instead, both declines appear to have
24 INTRODUCTION occurred over the course of modernization. At the same time, however, replace- ment effects probably strengthened as family limitation spread (Knodel, 1982~. In their chapter, Patrick Galloway, Ronald Lee, and Eugene Hammel argue that previous studies have often failed to account explicitly for the fact that mortality and fertility are jointly determined. The formulation of an appropriate causal model is difficult, requiring both unusual care and richer data than needed in other areas of demographic research. Galloway and colleagues argue that the complications necessitate the use of two-stage estimation techniques. Using data from Prussia over the period 1875-1910, the authors find that declines in infant mortality are positively associated with declines in fertility. In reanalyzing the European macro evidence, Galloway et al. stress two additional points. First, the time frame for the analysis is critical: In the long term, macro-economic or macro-societal mechanisms operate to ensure that fertility and mortality are more or less in equilibrium. In the very short run such mechanisms are ineffective. Conditions that produce short-run high mortality probably also produce short-run low fertility. Hence, the key question is what happens over the medium term, which Galloway et al. define as 5-30 years. Second, levels of fertility and mortal- ity are less informative than are changes in these variables over time. Studies of changes are less vulnerable to contamination by persistent unobserved heteroge- neity. To date, very little work on this topic has been focused on the United States, perhaps because macro-level time series data indicate that fertility decline pre- ceded mortality decline by at least 70 years. Thus, declines in mortality could not have prompted the onset of family limitation, although mortality could well have influenced the subsequent speed and depth of the transition. In his chapter, Michael Haines examines the strength of replacement and hoarding effects in the United States in the early twentieth century, using public-use micro samples from the 1900 and 1910 censuses. Haines finds that between 10 and 30 percent of all child deaths in the United States at the turn of the century were directly replaced by subsequent births; high death rates also induced considerable hoarding behav- ior. These findings resemble those reported in studies of contemporary popula- tions in developing countries at low levels of socioeconomic development (see Preston, 1975~. iiNote that even in cases in which the direction and strength of the effect can be identified, this might not determine the net effect of health improvements on total fertility. This is because the underlying level of natural fertility cannot be assumed to remain constant over time. Hence, as shown by the authors in a related paper, improvements in child mortality had little net effect on fertility in Prussia over the period 1875-1910. Improvements in general health increased the level of natural fertility at the same time as the desired number of births decreased (Lee et al., 1994).
BARNEY COHEN AND MARK R. MONTGOMERY 25 Further Evidence from Developing Countries The past 40 years or so have witnessed a remarkable trend in the demogra- phy of many developing countries unprecedented declines in infant and child mortality throughout the world and, in most places, a dramatic shift from high fertility and little parity-specific control to a situation in which family limitation has come within the "calculus of conscious choice." The factors responsible for fertility decline are still not fully understood. As we have seen, heterogeneity between and within the various regions of the world has been conspicuous in several dimensions: the initial levels of fertility; the socioeconomic and demo- graphic conditions prevailing at the onset of fertility declines; the date of the onset and the speed of the declines once under way; the extent of the declines (i.e., the ultimate levels of fertility achieved); the role of government policy toward population and family planning; and, most important in the context of this volume, the role of prior mortality declines. The four case studies in this volume are drawn from three continents and four countries at very different stages of their fertility transitions. Collectively, they confirm the importance of social, political, and economic context. The history of the family planning programs in these countries appears particularly important. Cameroon Fertility in sub-Saharan Africa remains the highest in the world. Many women are unable to articulate their desired family size and, when they do, their answers often imply a demand for children that exceeds or presses close on the biological limits. Significant advances have been made over the past 20 years in the availability of solid demographic data from the region as well as in methods of demographic analysis. Barthelemy Kuate Defo's chapter takes advantage of both developments. Kuate Defo proposes a semiparametric multistate duration methodology that uses hazard models to estimate a reduced-form birth process. The elegant aspect of the methodology is that it allows for the possibility of testing for the signifi- cance of woman-specific unobservables. Not surprisingly, given the low preva- lence of contraception in Cameroon, Kuate Defo finds that maternal characteris- tics exert weak effects on fertility outcomes, and the strongest differences in reproductive behavior associated with a child death are found among women at high parities. On further inspection, Kuate Defo finds that the parity-specific effects on timing to conception operate through the timing of the first child's death. By separating the effects of a death at each successive parity, Kuate Defo shows that the death of a first child has a differentially large, lasting, and signifi- cant influence over the remainder of a woman's reproductive life. The author attributes this to the special significance of the first born in traditional Camer- oonian culture.
26 Indonesia INTRODUCTION Fertility has been declining in Indonesia for more than two decades from some 5.6 births per woman in the late 1960s to 2.9 births per woman in 1991- 1994 (Indonesia/DHS, 1995~. The decline began at a time when levels of child mortality were still relatively high and economic development, school atten- dance, and rates of urbanization relatively low. Significantly, however, the gov- ernment of Indonesia switched from firm opposition to fertility control to a recognition of the disadvantages of continued rapid population growth and made a strong commitment to reducing fertility (slam and Leete,1993b).l2 Observers of this period of Indonesian history express little doubt that the government family planning program was a central ingredient in the country' s fertility transi- tion and that it speeded the process of decline, especially among the rural poor (Freedman et al., 1981; McNicoll and Singarimbun, 1983; Sanderson and Tan, 1995~. 13 This is the context for Elizabeth Frankenberg' s chapter and her meticulous analysis of the effect of improved child survival under a regime of falling fertil- ity. Frankenberg finds that replacement has been less than complete in Indonesia but that the effect has strengthened over time. Frankenberg's chapter also con- tributes to the methodological debate by proposing a difference-in-differences approach to analyzing birth intervals so as to control for unobserved heterogene- ity due to family-specific fixed effects. Using this model, she finds evidence that the death of a child leads to small changes in the length of subsequent birth intervals relative to when the child does not die. The size of the changes are conditional on the sex composition of surviving children. India India is the second most populous country in the world and probably the most heterogeneous with respect to its inhabitants' ethnic diversity, economic status, religious beliefs, linguistic divisions, cultural heritage, class divisions, and beliefs and traditions (International Institute for Population Sciences [Bombay], 1995~. The sheer size of the country allows macro-level relationships to be 12In the late 1960s, the Indonesian government initiated a vigorous family planning program that created a network for the distribution of subsidized contraceptives, ran campaigns to promote their use, and maintained strong links with local government and community groups in an effort to pres- sure couples to regulate their fertility (McNicoll and Singarimbun, 1983; Warwick, 1986; Cleland, 1993). 13During the mid-1980s fertility decline resulted from increased contraceptive use induced prima- rily by economic development and by improved education and economic opportunities for females (Gertler and Molyneaux, 1994).
BARNEY COHEN AND MARK R. MONTGOMERY 27 examined at the state and district levels. Given such vast cultural diversity, it should not be surprising to learn that fertility transition is at quite different stages in different Indian states. For example, in states such as Goa in the west or Kerala in the south, fertility is already below replacement; elsewhere in the country, such as in Uttar Pradesh, fertility remains close to five children per family. About 10 percent of the variation in fertility between northern and southern Indian states can be attributed to differences in levels of child survival. Examining data at various levels of aggregation, Mari Bhat argues for a structural shift in the relationship between mortality and fertility in India in the 1970s, indicating that family-building strategies probably changed as fertility began to decline. Bhat shows how the speed at which reproductive behaviors adjust to changing mortality environments is determined partly by the nature of family planning programs. In India, the government' s near-exclusive reliance on sterilization as a family planning method prevented couples from adopting a pure replacement strategy and forced a dependence on the insurance mechanism. Nevertheless, the strength of the replacement effect increased over time. Costa Rica The case study of Costa Rica provides further evidence that at the macro level, declines in mortality can be only weakly connected to declines in fertility. Rather, the strength of the relationship in Costa Rica varies over time and over the course of the transition. Using county-level data from 89 counties, Luis Rosero-Bixby finds that, once one has controlled for other indicators of socioeco- nomic development, there is little indication that low infant mortality rates exert much influence on fertility rates. Consequently, Rosero-Bixby concludes that although improved child survival may facilitate fertility declines, and low sur- vival chances may delay the transition, there is no critical mortality threshold to be overcome. During focus group interviews, women in Costa Rica who had lived through the fertility transition indicated that the prevailing level of child mortality was not at the forefront of their thinking. Nevertheless, other comments suggested that improved child survival could have been a key reason leading such women to question culturally determined reproductive behavior. For example, for many women the first exposure to family planning came at health centers. Perhaps, apart from learning about birth control at these clinics, favorable experiences with modern medicine predisposed women to make use of other health services, such as contraception. Furthermore, the time and labor burden associated with having larger families as a result of improved child survival made Costa Rican women more likely to question earlier culturally determined reproductive norms.
28 INTRODUCTION DISCUSSION Twenty years ago, the most recent data available to assess the relationship between mortality and fertility were from 1975. Since then, substantial improve- ments in life expectancy have been recorded, state-sponsored family planning programs were initiated and grew toward maturity, and fertility began to fall across Latin America and Asia. In this chapter, we have described the recent demographic situation with our principal focus being on the demographic changes of the past two decades. The recent empirical record provides an outer core of knowledge on the complex interrelationship between mortality and fertility. Outside West Africa, virtually all developing countries have by now experi- enced some order of joint decline of mortality and fertility. Their fertility de- clines are the product of diverse social, economic, political, and cultural changes and are shaped as well by a response to programs and mortality change. The precise nature and specific contribution of each of these factors varies from one society to another. Thus, at the macro level, a search for a simple and universal rule linking the timing of mortality and fertility declines would seem to be futile. At the micro level, what effect do mortality experiences and expectations have on reproductive behavior? Numerous empirical studies have documented that the death of a child reduces the probability that its parents will adopt contra- ception and increases the likelihood of additional births. This is because deaths and the expectation of deaths produce both behavioral and biological fertility responses. Investigations of such effects depend crucially on the level (family versus aggregate) and time frame of the analysis (Casterline, 1995~. Further- more, as the chapters in this volume clearly demonstrate, the nature of the mortal- ity-fertility relationship changes over the course of the demographic transition as couples take greater control of their reproductive decisions and outcomes. More has been learned about some mechanisms than about others. The lactation interruption effect of a child' s death on fertility is now far better under- stood than are the behavioral effects. The lactation mechanism is most important in populations where breastfeeding is practiced widely but it remains important even in populations that use modern contraception (Lloyd and Ivanov, 1988~. As for the behavioral effects, most is known about replacement behavior, whether studied by way of parity progression ratios or simultaneous equation models. The chapters in this volume focus mainly on such replacement effects. These studies strongly second the conclusion of the original Preston volume, that re- placement is less than complete (Knodel, 1995~. The mechanisms about which we continue to know the least are the insur- ance effect and the "transition" or "confidence" effect. As noted above, research into these mechanisms has been hampered by serious problems of conceptual- ization and measurement, as well as by a lack of data. Progress in understanding the insurance effect will require linking fertility change to community-level changes in mortality; it will also require better models of individual decision
BARNEY COHEN AND MARK R. MONTGOMERY 29 making and social learning. These were areas that Brass and Barrett (1978) regarded as being out of reach in the mid-1970s, but ones that may benefit from recent work on diffusion theory (see, for example, Casterline et al., 1987; Mont- gomery and Casterline, 1996~. To learn more about the onset of fertility declines, it is vital to understand the transitional effect. Much of the pretransition literature points to the lack of parity-specific control; either parents were unaware of the means to regulate their fertility, saw little point in such regulation, or were constrained by social institu- tions. Lloyd and Ivanov (1988) hypothesized that differences in the age pattern of improvements in child survival could affect the size of the fertility response; this important hypothesis remains untested. Perhaps the most important policy implication of this work is for the interac- tions among mortality, fertility, and family planning services. Twenty years of lively debate in the demographic literature have yet to lay to rest the question of whether family planning programs make an important independent contribution to fertility decline (see, for example, Freedman and Berelson, 1976; Mauldin and Berelson,1978;CutrightandKelly,1981;LaphamandMauldin,1987;Bongaarts et al., 1990; Pritchett, 1994a,b; Bongaarts, 1994; Knowles et al., 1994~. The research on mortality-fertility relationships reported in this volume shows that the strength of the behavioral response can be affected by the extent and quality of family planning services. For example, Bhat (in this volume) demonstrates how the lack of reversible contraception has dampened the responsiveness of fertility to improvements in child survival in India. In Costa Rica, Rosero-Bixby (in this volume) found that, even in settings with moderately high levels of infant mortality, the greater the supply of family planning services, the greater the likelihood of fertility-limiting behavior. There is no evidence to suggest either that child survival programs must precede family planning programs or vice versa. Rather, the research discussed here suggests that child survival and family planning programs play important complementary roles. ACKNOWLEDGMENTS This chapter has benefited from the discussion of participants at a seminar entitled "Reevaluating the Link between Infant and Child Mortality and Fertil- ity," which was organized by the Committee on Population in November 1995. Nevertheless, the views and opinions in this chapter are solely those of the au- thors and are not meant to reflect those of the National Research Council or the other seminar participants. We are grateful to Caroline Bledsoe, Patrick Gallo- way, John Haaga, Ken Hill, Bill House, Carolyn Makinson, and Faith Mitchell for their comments on an earlier draft.
30 INTRODUCTION REFERENCES Alam, I., and R. Leete 1993a Pauses in fertility trends in Sri Lanka and the Philippines? Pp. 83-95 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, England: Clarendon Press. 1993b Variations in fertility in India and Indonesia. Pp. 148-172 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, En gland: Clarendon Press. Anderson, K.H. 1983 The determinants of fertility, schooling, and child survival in Guatemala. International Economic Review 24(3):567-589. Balakrishnan, T.R. 1978 Effects of child mortality on subsequent fertility of women in some rural and semi-urban areas of certain Latin American countries. Population Studies 32(1):135-145. Becker, G., K. Murphy, and R. Tamura 1990 Human capital, fertility and economic growth. Journal of Political Economy 98(5, part 2):S 12-S37. Benefo, K., and T.P. Schultz 1996 Fertility and child mortality in Cote d'Ivoire and Ghana. The World Bank Economic Review 10(1):123-158. Bongaarts, J. 1975 Why high birth rates are so low. Population and Development Review 1(2):289-296. 1987 Does family planning reduce infant mortality rates? Population and Development Review 13(2):323-334. 1988 Does family planning reduce infant mortality? Reply. Population and Development Review 14(1):188-190. 1994 The impact of population policies: Comment. Population and Development Review 20(3):616-620. 1997 Trends in Unwanted Childbearing in the Developing World. Paper presented at the Annual Meetings of the Population Association of America, Washington, D.C., March 27-29. Bongaarts, J., W.P. Mauldin, and J.F. Phillips 1990 The demographic impact of family planning programs. Studies in Family Planning 21(6):299-310. Brass, W., and J.C. Barrett 1978 Measurement problems in the analysis of linkages between fertility and child mortality. Pp. 209-233 in S.H. Preston, ea., The Effects of Infant and Child Mortality on Fertility. New York: Academic Press. Bulatao, R.A. 1985 Fertility and Mortality Transition. World Bank Staff Working Paper no. 681. The World Bank, Washington, D.C. Caldwell, J.C. 1986 Routes to low mortality in poor countries. Population and Development Review 12(2):171 220. 1993 The Asian fertility revolution: Its implications for transition theories. Pp. 299-316 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, England: Clarendon Press. Caldwell, J.C., and P. Caldwell 1987 The cultural context of high fertility in sub-Saharan Africa. Population and Development Review 13(3):409-437.
BARNEY COHEN AND MARK R. MONTGOMERY 3 Caldwell, J.C., P. Reddy, and P. Caldwell 1983 The social component of mortality decline: An investigation in South India employing alternative methodologies. Population Studies 37(2):185-205. Caldwell, J.C., I.O. Orubuloye, and P. Caldwell 1992 Fertility decline in Africa: A new type of transition? Population and Development Review 18(2):211-242. Casterline, J.B. 1994 Fertility transition in Asia. Pp. 69-86 in T. Locoh and V. Hertrich, eds., The Onset of Fertility Transition in Sub-Saharan Africa. Liege, Belgium: Derouaux Ordina Editions for International Union for the Scientific Study of Population (IUSSP). 1995 Remarks made at National Academy of Sciences' Workshop on Reevaluating the Effects of Infant and Child Mortality on Fertility, Washington, D.C., November 6-7. The Popula tion Council, New York. Casterline, J.B., M.R. Montgomery, and R.L. Clark 1987 Diffusion Models of Fertility Control: Are There New Insights? Population Studies and Training Center (PSTC) Working Paper Series 87-06. Providence, R.I.: PSTC, Brown University. Castle, S. 1994 The Effect of Repeated Child Deaths on Child Care Practices among the Malian Fulani and the Implications for Demographic Research. Paper presented at the 1994 Annual Meetings of the Population Association of America, Miami, Fla., May 5-7. Chesnais, J.-C. 1992 The Demographic Transition: Stages, Patterns and Economic Implications. Oxford, England: Clarendon Press. Chow&ury, A.I., V. Fauveau, and K.M.A. Aziz 1992 Effects of child survival on contraceptive use in Bangladesh. Journal of Biosocial Sci- ences 24(4):427-432. Chow&ury, A.K.M.A., A.R. Khan, and L.C. Chen 1976 The effect of child mortality experience on subsequent fertility: In Pakistan and Bangladesh. Population Studies 30(1):249-261. Chow&ury, A.R. 1988 The infant mortality-fertility debate: Some international evidence. Southern Economic Journal 54(3):666-674. Cleland, J. 1993 Different pathways to demographic transition. Pp. 229-247 in F. Graham-Smith, ea., Population-The Complex Reality. London: The Royal Society. Cleland, J., J.F. Phillips, S. Amin, and G.M. Kamal 1994 The Determinants of Reproductive Change in Bangladesh: Success in a Challenging Environment. Washington, D.C.: The World Bank. Coale, A.J. 1973 The demographic transition. Pp. 53-72 in International Union for the Scientific Study of Population (IUSSP) Proceedings, Vol. 1. International Population Conference, Liege, 1973. Liege, Belgium: IUSSP. Coale, A.J., and R. Freedman 1993 Similarities in the fertility transition in China and three other East Asian populations. Pp. 208-238 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, England: Clarendon Press. Coale, A.J., and R. Treadway 1986 A summary of the changing distribution of overall fertility, marital fertility, and the pro- portion married in the provinces of Europe. Pp. 31-181 in A.J. Coale and S.C. Watkins, eds., The Decline of Fertility in Europe. Revised Proceedings of a Conference on the Princeton European Fertility Project. Princeton, N.J.: Princeton University Press.
32 INTRODUCTION Cutright, P. 1983 The ingredients of recent fertility decline in developing countries. International Family Planning Perspectives 9:101-109. Cutright, P., and L. Hargens 1984 The threshold hypothesis: Evidence from less developed Latin American countries, 1950 to 1980. Demography 21 (4) :459-473. Cutright, P., and W.R. Kelly 1981 The role of family planning programs in fertility declines in less developed countries, 1958-1977. International Family Planning Perspectives 7(4): 145-151. de Guzman, E.A. 1984 The effects of infant mortality on fertility in the Philippines. Pp. 123-130 in L.T. Engracia, C. Mejia-Raymundo, and J.B. Casterline, eds., Fertility in the Philippines: FurtherAnaly- sis of the Republic of the Philippines Fertility Survey 1978. Voorburg, Netherlands: International Statistical Institute. Dye, N., and D. Smith 1986 Mother love and infant death, 1750-1920. Journal of American History 73:329-353. Freedman, R. 1963 Norms for family size in underdeveloped areas. Proceedings of the Royal Society 159(B): 220-245. Freedman, R., and B. Berelson 1976 The record of family planning programs. Studies in Family Planning 7(1): 1-40. Freedman, R., S. Khoo, and B. Supraptilah 1981 Use of modern contraceptives in Indonesia: A challenge to conventional wisdoms. Inter- national Family Planning Perspectives 7(1):3-15. Gertler, P.J., and J.W. Molyneaux 1994 How economic development and family planning programs combined to reduce Indone- sian fertility. Demography 31(1):33-63. Goodkind, D.M. 1995 Vietnam's one-or-two child policy in action. Population and Development Review 21(1): 85-111. 1996 On substituting sex preference strategies in East Asia: Does prenatal sex selection reduce postnatal discrimination? Population and Development Review 22(1):111-125. Gregson, S. 1994 Will HIV become a major determinant of fertility in sub-Saharan Africa? Journal of Gunnarsson, C. Development Studies 30(3):650-679. 1992 Economic and demographic transition in East Asia: Economic modernization vs family planning in Taiwan. Pp. 81-101 in M. Hammarskjold, B. Egero, and S. Lindberg, eds., Population and the Development Crisis in the South: Proceedings for a Conference in Bastad, April 17-18, 1991. Lund, Sweden: University of Lund, Programme on Popula- tion and Development in Poor Countries (PROP). Guzman, J.M. 1994 The onset of fertility decline in Latin America. Pp. 43-67 in T. Locoh and V. Hertrich, eds., The Onset of Fertility Transition in sub-Saharan Africa. Liege, Belgium: Derouaux Ordina Editions for the International Union for the Scientific Study of Population (IUSSP). Hammarskjold M., B. Egero, and S. Lindberg 1992 Population and the Development Crisis in the South: Proceedings from a Conference in Bastad, April 17-18, 1991. Lund, Sweden: University of Lund, Programme on Popula- tion and Development in Poor Countries (PROP). Hashimoto, M., and C. Hongladarom 1981 Effects of child mortality on fertility in Thailand. Economic Development and Cultural Change 29(4):781-794.
BARNEY COHEN AND MARK R. MONTGOMERY 33 Hill, A. 1991 Infant and child mortality levels, trends, and data deficiencies. Pp. 37-74 in R.G. Feachem and D.T. Jamison, eds., Disease and Mortality in Sub-Saharan Africa. New York: Ox ford University Press for the World Bank. 1993 Trends in childhood mortality. Pp. 153-217 in K.A. Foote, K.H. Hill, and L.G. Martin, eds., Demographic Change in Sub-Saharan Africa. Committee on Population, National Research Council. Washington, D.C.: National Academy Press. Hirschman, C. 1980 Demographic trends in peninsular Malaysia, 1947-1975. Population and Development Review 6(1):103-125. 1986 The recent rise in Malay fertility: A new trend or a temporary lull in a fertility transition? Demography 23(2):161-184. Hobcraft, J. 1992 Fertility patterns and child survival: A comparative analysis. Population Bulletin of the United Nations 33:1-31. Hobcraft, J., J.W. McDonald, and S. Rutstein 1983 Child-spacing effects on infant and early child mortality. Population Index 49(4):585- 618. 1985 Demographic determinants of infant and early child mortality: A comparative analysis. Population Studies 39(3):363-385. Indonesia/DHS Demographic and Health Survey 1994. Jakarta, Indonesia: Central Bureau of Statistics (CBS) [Indonesia], State Ministry of Population/National Family Planning Coordinating Board (NFPCB) and Ministry of Health (MOH). Calverton, Md.: Macro International, Inc. International Institute for Population Sciences [Bombay] 1995 National Family Health Survey (MCH and Family Planning), India, 1992-93. Bombay: International Institute for Population Sciences (IIPS). Johnson, N.E., and A.J.M. Sufian 1992 Effect of son mortality on contraceptive practice in Bangladesh. Journal of Biosocial Sciences 24(1):9-16. King, M. 1990 Health is a sustainable state. Lancet 336:664-667. 1991 The demographic trap. Lancet 337:307-308. 1992 Escaping the demographic trap. Pp. 38-44 in M. Hammarskjold, B. Egero, and S. Lind berg, eds., Population and the Development Crisis in the South: Proceedings for a Conference in Bastad, April 17-18, 1991. Lund, Sweden: University of Lund, Programme on Population and Development in Poor Countries (PROP). Knodel, J. 1974 The Decline of Fertility in Germany, 1871-1939. Princeton, N.J.: Princeton University Press. 1982 Child mortality and reproductive behavior in German village populations in the past: A micro-level analysis of the replacement effect. Population Studies 36(2):177-200. 1995 Remarks made at National Academy of Sciences' Workshop on Reevaluating the Effects of Infant and Child Mortality on Fertility, Washington, D.C., November 6-7. Knodel, J., and E. van de Walle 1986 Lessons from the past: Policy implications of historical fertility studies. Pp. 390-419 in A.J. Coale and S.C. Watkins, eds., The Decline of Fertility in Europe. Revised Proceed- ings of a Conference on the Princeton European Fertility Project. Princeton, N.J.: Princeton University Press.
34 INTRODUCTION Knodel, J., A. Chamratrithirong, and N. Debavalya 1987 Thailand's Reproductive Revolution: Rapid Fertility Decline in a Third-World Setting. Madison: University of Wisconsin Press. Knowles, J.C., J.S. Akin, and D.K. Guilkey 1994 The impact of population policies: Comment. Population and Development Review 20(3):611-615. Lapham, R.J., and W.P. Mauldin 1987 The effects of family planning on fertility: Research findings. Pp. 647-680 in R.J. Lapham and G.B. Simmons, eds., Organizing for Effective Family Planning Programs. Committee on Population, National Research Council. Washington, D.C.: National Acad- emy Press. Lee, B.S., and T.P. Schultz 1982 Implications of child mortality reductions for fertility and population growth in Korea. Journal of Economic Development 71(1):21-44. Lee, R.D., P.R. Galloway, and E.A. Hammel 1994 Fertility decline in Prussia: Estimating influences on supply, demand, and degree of control. Demography 31(2):347-373. Leete, R., and T.B. Ann 1993 Contrasting fertility trends among ethnic groups in Malaysia. Pp. 128-147 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implica- tions. Oxford, England: Clarendon Press. Lesthaeghe, R.J. 1977 The Decline ofBelgianFertility, 1800-1970. Princeton,N.J.: Princeton University Press. Lloyd, C.B., and S. Ivanov 1988 The effects of improved child survival on family planning practice and fertility. Studies in Family Planning 19(3): 141-161. Maglad, N.E. Socioeconomic Determinants of Fertility and Child Mortality in Sudan. Economic Growth Center Discussion Paper no. 686. New Haven, Conn.: Yale University. 1994 Fertility in rural Sudan: The effect of landholding and child mortality. Economic Devel- opment and Cultural Change 42(4):761-772. Mason, K. 1997 Explaining Fertility Transitions. Presidential address to the 1997 Annual Meetings of the Population Association of America, Washington D.C., March 27-29. Mauldin, W.P., and B. Berelson 1978 Conditions of fertility decline in developing countries, 1965-1975. Studies in Family Planning 9(5):89-147. Mauskopf, J., and T.D. Wallace 1984 Fertility and replacement: Some alternative stochastic models and results for Brazil. Demography 21(4):519-536. McNicoll, G., and M. Singarimbun, eds. 1983 Fertility Decline in Indonesia: Analysis and Interpretation. Committee on Population and Demography report no. 20, National Research Council. Washington, D.C.: National Academy Press. Mensch, B.S. 1985 The effect of child mortality on contraceptive use and fertility in Colombia, Costa Rica, and Korea. Population Studies 39(2):309-327. Merrick, T. 1991 Population pressures in Latin America. Population Bulletin 41(3). Mincer, J. 1996 Economic development, growth of human capital, and the dynamics of the wage struc- ture. Journal of Economic Growth 1:29-48.
BARNEY COHEN AND MARK R. MONTGOMERY 35 Mitra, S.N., M.N. All, S. Islam, A.R. Cross, and T. Saha 1994 Bangladesh Demographic and Health Survey, 1993-1994. Dhaka, Bangladesh: National Institute of Population Research and Training (NIPORT) and Mitra and Associates. Calverton, Md.: Macro International, Inc. Montgomery, M.R., and J.B. Casterline 1996 Social influence, social learning, and new models of fertility. Population and Develop- ment Review 22(Suppl.): 151-175. National Institute of Population Studies [Pakistan] 1992 Pakistan Demographic and Health Survey, 1990/1991. Islamabad: National Institute of Population Studies. Columbia, Md.: IRD/Macro International, Inc. Notestein, F. 1945 Population the long view. Pp. 37-57 in T.W. Schultz, ed. Foodfor the World. Chicago, Ill.: University of Chicago Press. 1953 Economic problems of population change. Pp. 13-31 in Proceedings of the Eighth Inter- national Conference of Agricultural Economists. London: Oxford University Press. Nur, O.E.M. 1985 An analysis of the child survival hypothesis in Jordan. Studies in Family Planning 16(4):211-218. Okojie, C.E.E. 1991 Fertility response to child survival in Nigeria: An analysis of microdata from Bendel State. Research in Population Economics 7:93-112. Olsen, R.J. 1980 Estimating the effect of child mortality on the number of births. Demography 17(4):429- 443. Olsen, R.J., and K.I. Wolpin 1983 The impact of exogenous child mortality on fertility: A waiting time regression with dynamic regressors. Econometrica 51(3):731-749. Omran, A.R., and F. Roudi 1993 The middle east population puzzle. Population Bulletin 48(1). Palloni, A. 1981 Mortality in Latin America: Emerging patterns. Population and Development Review 7(4):623-649. 1990 Fertility and mortality decline in Latin America. Annals of the American Academy of Political and Social Science 510:126-144. Panis, C.W.A., and L.A. Lillard 1993 Timing of Child Replacement Effects on Fertility in Malaysia. RAND Labor and Popula- tion Program Working Paper Series 93-13. Santa Monica, Calif.: RAND. Park, C.B., S.H. Han, and M.K. Choe 1979 The effect of infant death on subsequent fertility in Korea and the role of family planning. American Journal of Public Health 69(6):557-565. Pebley, A.R., H. Delgado, and E. Brinemann 1979 Fertility desires and child mortality experience among Guatemalan women. Studies in Family Planning 10(4): 129-136. Phai, N.V., J. Knodel, M.V. Cam, and H. Xuyen 1996 Fertility and family planning in Vietnam: Evidence from the 1994 Inter-censal Demo- graphic Survey. Studies in Family Planning 27(1): 1-17. Pison, G., K.H. Hill, B. Cohen, and K.A. Foote, eds. 1995 Population Dynamics of Senegal. Committee on Population, National Research Council. Washington, D.C.: National Academy Press. Pitt, M.M. 1994 Women's Schooling, Selective Fertility and Child Mortality in Sub-Saharan Africa. Un published manuscript, Department of Economics, Brown University, Providence, R.I.
36 INTRODUCTION Preston, S.H. 1975 Health programs and population growth. Population and Development Review 1(2): 189- 199. 1978a The Effects of Infant and Child Mortality on Fertility. New York: Academic Press. 1978b Introduction. Pp. 1-18 in S.H. Preston, ea., The Effects of Infant and Child Mortality on Fertility. New York: Academic Press. Preston, S.H., and M. Haines 1991 Fatal Years: Child Mortalityin Late Nineteenth-Century America. Princeton,N.J.: Princeton University Press. Pritchett, L.H. 1994a Desired fertility and the impact of population policies. Population and Development Review 20(1):1-55. 1994b The impact of population policies: Reply. Population and Development Review 20(3):621-630. Rao, K.V., and R. Beaujot 1986 Effect of infant mortality on subsequent fertility in Pakistan and Sri Lanka. Journal of Biosocial Science 18(3):297-303. Rashad, H., M. E1 Bahy, and S. Attia 1993 Linking Fertility Changes to Community Level Changes in Mortality: The Egyptian Case. Amman, Jordan: The Jordanian Printing Press for UNICEF. Rele, J.R., and I. Alam 1993 Fertility transition in Asia: The statistical evidence. Pp. 15-37 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, England: Clarendon Press. Ross, J.A., and E. Frankenberg 1993 Findings From Two Decades of Family Planning Research. New York: The Population Council. Sah, R.K. 1991 The effects of child mortality changes on fertility choice and parental welfare. Journal of Political Economy 99(3):582-606. Sanderson, W.C., and J-P. Tan 1995 Population in Asia. World Bank regional and sectoral studies series. Washington D.C.: The World Bank. Santow, G., and M.D. Bracher 1984 Child death and time to the next birth in Central Java. Population Studies 38(2):241-253. Schultz, T.P. 1976 Interrelationships between mortality and fertility. Pp. 239-289 in R.G. Ridker, ea., Popu lation and Development. Baltimore, Md.: Johns Hopkins University Press. 1988 Economic demography and development: New directions in an old field. Pp. 416-458 in G. Ranis and T.P. Schultz, eds., The State of Development Economics: Progress and Perspectives. Oxford, England: Basil Blackwell. 1994a Human capital, family planning, and their effects on population growth. American Eco- nomic Review 84(2):255-260. 1994b Sources of Fertility Decline in Modern Economic Growth: Is Aggregate Evidence on the Demographic Transition Credible? New Haven, Conn.: Yale University. Setel, P. 1995 The effects of HIV and AIDS on fertility in East and Central Africa. Health Transition Review 5(Suppl.):179-189. Shah, I.H., and J.G. Cleland 1993 High fertility in Bangladesh, Nepal, and Pakistan: Motives and means. Pp. 175-207 in R. Leete and I. Alam, eds., The Revolution in Asian Fertility: Dimensions, Causes, and Implications. Oxford, England: Clarendon Press.
BARNEY COHEN AND MARK R. MONTGOMERY Taylor, C.E. 1991 Letter to the editor. Lancet 337:51. Taylor, C.E., J.S. Newman, and N.U. Kelly 1976 The child survival hypothesis. Population Studies 30(2):263-278. Teitelbaum, M.S. 1984 The British Fertility Decline: Demographic Transition in the Crucible of the Industrial Revolution. Princeton, N.J.: Princeton University Press. 37 Tien, H.Y. 1984 Induced fertility transition: Impact of population policies and socioeconomic change in the People's Republic of China. Population Studies 38(3):385-400. Trussell, J. 1988 Does family planning reduce infant mortality? An exchange. Population and Develop- mentReview 14(1):171-178. Trussell, J., and R. Olsen 1983 Evaluation of the Olsen technique for estimating the fertility response to child mortality. Demography 20(3):391-405. Trussell, J., and A.R. Pebley 1984 The potential impact of changes in fertility on infant, child, and maternal mortality. Stud ies in Family Planning 15(6) :267-280. UNICEF 1991 The State of the World's Children, 1991. New York: Oxford University Press for UNICEF. United Nations Secretariat 1988 Interrelationships between child survival and fertility. Population Bulletin of the United Nations 25:27-50. van de Walle, E. 1992 Fertility transition, conscious choice, and numeracy. Demography 29(4):487-502. van de Walle, F. 1986 Infant mortality and the European demographic transition. Pp. 201-233 in A.J. Coale and S.C. Watkins, eds., The Decline of Fertility in Europe. Revised Proceedings of a Confer- ence on the Princeton European Fertility Project. Princeton, N.J.: Princeton University Press. Vinovskis, M. 1991 Angels' heads and weeping willows: Death in early America. Pp. 209-231 in G. Moran and M. Vinovskis, eds., Religion, Family and the Life Course: Explorations in the Social History of Early America. Ann Arbor: University of Michigan Press. Warwick, D.P. 1986 The Indonesian Family Planning Program: Government influence and client choice. Population and Development Review 12(3):453-490. Weeks, J.R. 1988 The demography of Islamic Nations. Population Bulletin 43(4). Williams, A.D. 1977 Measuring the impact of child mortality on fertility: A methodological note. Demogra- phy 14(4):581-590. Wolf, A.P. 1986 The preeminent role of government intervention in China's family revolution. Popula- tion and Development Review 12(1):101-116. Wolpin, K.I. 1984 An estimable dynamic stochastic model of fertility and child mortality. Journal of Politi- cal Economy 92(5):852-874.
38 INTRODUCTION World Bank 1995 World Development Report, 1995: Workers in an Integrating World. New York: Oxford University Press for the World Bank. Yamada, T. 1985 Casual relationships between infant mortality and fertility in developed and less devel- oped countries. Southern Economic Journal 52(2):364-370. Zeng Yi, Tu Ping, Gu Baochang, Xu Yi, Li Bohua, and Li Yongping 1993 Causes and implications of the recent increase in the reported sex ratio at birth in China. Population and Development Review 19(2):283-302.
