Patterns and determinants of infant mortality in developed nations, 1950–1975

The results show strong support for standard explanations of infant mortality and show that the United States position is associated with high teenage fertility unemployment ethnic diversity and few hospital beds.

Abstract

Despite a level of per capita income among the highest in the world, the United States ranks 15th (Hartford 1984) or 19th (Haub 1983) on infant mortality.This ranking represents more than minor fluctuations or measurement error among nations that have already reached nearly identically low levels.Substantial variation in infant mortality exists among developed nations, and the position of the U.S. has been declining relative to other nations over the last several decades.Not surprisingly this has concerned many.Critics blame the high rate in the U.S. on failures of the medical care system, inequitable income distribution, and inadequate federal welfare and health policies (Sidel and SideI1983).Of current debate among policymakers are whether federal goals for improvement in infant mortality by 1990 will be reached and what role budget cutbacks have had on recent trends in infant mortality (Miller 1985).In addition to these policy issues, the anomalous position of the U.S. raises questions concerning the adequacy of standard economic and demographic explanations of mortality.The historic decline in infant mortality in developed nations is usually seen as the result of a higher standard of living, urbanization, and better medical care that accompanies economic development (McKeown and Record 1962; Preston 1977).Changes in fertility and the role of women may also have contributed to the decline in infant mortality: fewer children, older ages at childbirth, and higher education of women lower the probability of infant death (Knodel and Hermalin 1984).Yet as illustrated by the V.S.-where the decline in infant mortality lags behind economic and demographic change-these explanations may not account for current patterns of infant mortality in developed nations.Indeed, there may be thresholds in the relationship of economic and demographic variables to infant mortality above which changes in the determinants have little influence (Preston 1975).Perhaps developed nations have passed the thresholds, and standard explanations no longer apply to high-income low-fertility nations.This reasoning raises a number of issues that go well beyond the need to explain the particular position of the U.S. on infant mortality.It suggests the more general need to study infant mortality (or mortality at other ages) in developed nations separately from developing nations and to address several questions.To what extent do developmental, fertility, and medical care variables account for variation in infant mortality among developed nations over the last several decades?What other factors may contribute to the observed patterns and to the relatively high rates in the V .S.? And more generally, what role do the characteristics of a nation's social, demographic, and medical systems play in infant mortality at the tail end of the demographic transition?These questions become more important when infant mortality is seen as a crucial characteristic of stratification systems as well as a demographic phenomenon.The