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  • DHS ANALYTICAL STUDIES 37

    The effecTs of ferTiliTy Behavior on child

    survival and child nuTriTional sTaTus:

    evidence from The demographic and

    healTh surveys, 2006 To 2012

    feBruary 2014

    This publication was produced for review by the United States Agency for International Development. It was prepared by Shea Rutstein and Rebecca Winter of ICF International.

  • DHS Analytical Studies No. 37

    The Effects of Fertility Behavior on Child Survival and Child Nutritional Status: Evidence from the Demographic

    and Health Surveys, 2006 to 2012

    Shea Rutstein

    Rebecca Winter

    ICF International

    Rockville, Maryland, USA

    February 2014

    Corresponding author: Shea Rutstein, International Health and Development, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1 3015720950; fax: +1 3015720999; email: Shea.Rutstein@icfi.com

  • Acknowledgment: The authors thank Jessica Yi for help with the literature review and Iqbal Shah for serving as the external reviewer. Editors: Richard Mason and Nancy Klein Document Production: Yuan Cheng This study was carried out with support provided by the United States Agency for International Development (USAID) through The DHS Program (#GPOC00080000800). The views expressed are those of the authors and do not necessarily reflect the views of USAID or the United States Government. Recommended citation: Rutstein, Shea, and Rebecca Winter. 2014. The Effects of Fertility Behavior on Child Survival and Child Nutritional Status: Evidence from the Demographic and Health Surveys, 2006 to 2012. DHS Analytical Studies No. 37. Rockville, Maryland, USA: ICF International.

  • iii

    Contents

    List of Tables ............................................................................................................................................... v

    List of Figures ............................................................................................................................................. vi

    Preface ........................................................................................................................................................ vii

    Executive Summary ................................................................................................................................... ix

    Glossary of Terms ....................................................................................................................................... x

    Introduction and Rationale ........................................................................................................................ 1

    Literature Review .................................................................................................................................. 1

    Methods and Data ....................................................................................................................................... 7

    Methods ................................................................................................................................................. 7

    DHS Data Used in the Study ............................................................................................................... 11

    Creation of the Pooled Data Set ......................................................................................................... 13

    Results ........................................................................................................................................................ 15

    Univariate Results .............................................................................................................................. 15

    Bivariate Results ................................................................................................................................. 27

    Multivariate Results ............................................................................................................................ 37

    Discussion .................................................................................................................................................. 53

    References .................................................................................................................................................. 59

    Appendix .................................................................................................................................................... 63

  • v

    List of Tables

    Table 1. List of surveys, by year ............................................................................................................... 13

    Table 2. Distribution of births 0 to 179 months prior to survey by duration of preceding birthtoconception interval, 45 DHS surveys, 20062012 ..................................................................... 17

    Table 3. Distribution of births 0 to 179 months prior to survey by the mothers age at childs birth, 45 DHS surveys, 20062012 ...................................................................................................... 19

    Table 4. Distribution of births 0 to 179 months prior to survey by the childs birth order, 45 DHS surveys, 20062012 .................................................................................................................... 21

    Table 5. Distribution of births 0 to 179 months prior to survey by maternal fertilityrelated risk factors, 45 DHS surveys, 20062012 ......................................................................................... 23

    Table 6. Distribution of births 0 to 179 months prior to survey by maternal fertilityrelated risk factors, 45 DHS surveys, 20062012 ......................................................................................... 26

    Table 7. Unadjusted relative risk of mortality by duration of preceding birthtoconception interval, mothers age at childs birth, and the birth order, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 ....................................................................... 29

    Table 8. Unadjusted relative risk of mortality by the mothers fertilityrelated risk, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 ............................................... 31

    Table 9. Unadjusted relative risk of mortality by the mothers fertility-related risk, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 ............................................... 32

    Table 10. Unadjusted odds ratios for stunting, underweight, and wasting by duration of preceding birthtoconception interval, mothers age at childs birth, and birth order, living children age 0 to 59 months at survey, 42 DHS surveys, 20062012 ...................................................... 33

    Table 11. Unadjusted odds ratios for stunting, underweight, and wasting by the mothers fertilityrelated risk, living children age 0 to 59 months at survey, 45 DHS surveys, 20062012 .......... 35

    Table 12. Unadjusted odds ratios for stunting, underweight, and wasting by the mothers fertilityrelated risk, living children age 0 to 59 months at survey, 45 DHS surveys, 20062012 .......... 36

    Table 13. Adjusted relative risk of mortality by duration of preceding birthtoconception interval, mothers age at childs birth, and the birth order, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 .................................................................................... 38

    Table 14. Adjusted relative risk of mortality by the mothers fertilityrelated risk, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 ................................................... 45

    Table 15. Adjusted relative risk of mortality by the mothers fertilityrelated risk, children born 0 to 179 months prior to the survey, 45 DHS surveys, 20062012 ................................................... 47

    Table 16. Adjusted odds ratios for stunting, underweight, and wasting by duration of preceding birthtoconception interval, mothers age at childs birth, and birth order, living children age 0 to 59 months at survey, 45 DHS surveys, 20062012 ...................................................... 48

  • vi

    Table 17. Adjusted odds ratios for stunting, underweight, and wasting, by the mothers fertilityrelated risk, living children age 0 to 59 months at survey, 45 DHS surveys, 20062012 .......... 50

    Table 18. Adjusted odds ratios for stunting, underweight, and wasting by the mothers fertilityrelated risk, living children age 0 to 59 months at survey, 45 DHS surveys, 20062012 .......... 52

    Table 19. Calculation of populationattributable risks for infant and underfive mortality by duration of preceding birthtoconception interval, mothers age at childs birth, and the birth order, 45 DHS surveys, 20062012 ............................................................................................ 55

    Appendix Table A1. Distribution of births 0 to 179 months and 0 to 59 months prior to survey by control variables used in multivariate analyses, 45 DHS surveys, 2006-2012 ........................... 63

    List of Figures

    Figure 1. Adjusted relative risks of underfive and child (one to four years) mortality by length of birthtoconception interval, 45 DHS surveys between 2006 and 2012 .................................... 39

    Figure 2. Adjusted relative risks of infant and postneonatal mortality by length of birthtoconception interval, 45 DHS surveys between 2006 and 2012 ......................................

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