Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

Birth order is correlated with mother's age so it is not surprising that mortality risks are elevatedamong first births (which are predominantly to younger mothers) and births of order seven or higher(which are generally to older mothers). The most consistent findings can be seen in the relationship betweenmortality rates and the length of the interval between births. The data show that short birthintervals significantly reduce a child's chances of survival. Children born less than two years after aprevious birth are three times more likely to die in infancy than those born after an interval of four yearsor more (155 vs. 49 per 1,1300). This relationship persists in all the age groups examined. This findingsupports the importance of child spacing practices as a means of reducing mortality of young children.7.5 High-Risk Fertility BehaviorPrevious research has shown strong relationships between fertility patterns and children's survivalchances. Typically, infants and children have a greater probability of dying early if they are born tomothers who are especially young or old, if they are born after a short birth interval, or if they are of highbirth order. Data to examine these relationships are presented in Table 7.5, which shows the distributionof births in the five years preceding the survey and of currently married women according to thesecategories of increased risk. In this analysis, a mother is classified as "too young if she is less than 18years of age and "too old" if she is over 34 years of age. A "short birth interval" is defined by a birthoccurring less than 24 months after a previous birth, and a child is of "high birth order" if the mother hadpreviously given birth to three or more children (i.e., if the child is of birth order 4 or higher). Firstbirths, although often at increased risk, are classified in the "not in any high-risk category," because theyare not considered an avoidable risk.Table 7.5 is further divided into two categories, with births falling into either single high-riskcategories (such as those bom to mothers below the age of 18 or over the age of 34, those bom after aninterval of less than 24 months and those of binh order higher than three) or multiple high-risk categories(such as those born after an interval of less than 24 months to mothers below the age of 18, children ofbirth order 4 or higher who are bom to mothers over 34 years, etc.).The results indicate that well over half (58 percent) of children bom in the five years before thesurvey fall into at least one high-risk category; one in seven births is characterized by two or more highriskfactors. The most common high-risk category is high birth order.Table 7.5 also indicates the relative risk of dying for children born in the five years before thesurvey by comparing the proportion dead in each high-risk category with the proportion dead amongchildren not in any high-risk category. These risk ratios are presented in column 2. One risk categorystands out--the multiple high-risk category of children of high birth order born to older women after ashort interval, which has a relative risk ratio of over three. Also high is the category of children born aftera short interval to young mothers (relative risk of 2.55). Fortunately, however, only a small proportionof recent births falls into either of these two categories, so that, even though the fertility behavior resultsin much higher risk of death for the child, few children are subject to that higher risk. Of greater practicalimportance are the categories of births that occur after an interval that is too short. Such births accountfor 15 percent of all births and suffer mortality risks that are almost twice that for children who fall in the"not in any high-risk category." Moreover, 15 percent of children born in Bangladesh are exposed togreater risk of dying because they are born to mothers under 18 years.97