Infant mortality rates in Africa will increase by 30,000-50,000 - Girls will fare worse


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The impact of the global financial crisis on infant mortality is a topic of great policy importance. However, estimates of the likely impacts of the crisis, cited by international institutions and in the popular press, differ wildly.

This blogpost summarizes the main conclusions from some of my own recent research on this topic, jointly with various colleagues.

These conclusions include:

1. The effect of negative growth on child health, including infant mortality, varies a great deal across countries. In developed countries, such as the US, infant mortality decreases when there are negative economic shocks. In low-income countries, including in India and countries in Sub-Saharan Africa, infant mortality increases in those periods (see Ferreira and Schady 2009 for a discussion). The picture for middle income countries is mixed, but on balance, it is closer to that found in the US. Important exceptions are cases in which the economic contraction was very severe--maybe 15 percent or larger. That was the case in two crises in Peru, and in Indonesia in 1998 (see Paxson and Schady 2005 and Schady and Smitz 2009).

2. We estimate that the current downturn will result in somewhere between 30,000 and 50,000 excess deaths in Sub-Saharan Africa in 2009 (Friedman and Schady 2009). This is substantially lower than the numbers on Shanta's blog (700,000 excess deaths) and some of the very large (and I would argue implausible) numbers that are regularly cited in the press. The main reason for the discrepancy is the expected contraction in GDP that is used for the calculations. The numbers we estimate are based on the March 09 IMF projections, while the numbers on Shanta's blog are based on a "growth collapse", which amounts to a 22 percent decline in GDP. Such a collapse now seems unlikely: The June 09 projections from the World Bank's Prospects Group, for example, foresee that per capita consumption in Sub-Saharan Africa will increase by 0.74% in 2009, a modest decline in relation to the 2008 level of 1.87%. (These numbers are simple averages across countries, without population weights.) By next year, the growth rate is projected to be back to 1.95%.

3. Aggregate economic shocks generally have larger impacts on infant mortality among girls than boys -- see Baird, Friedman and Schady 2009, and Friedman and Schady 2009. We find this to be the case in every developing region: Sub-Saharan Africa, Latin America and the Caribbean, East Asia, South Asia, and the Middle East and North Africa. There are not enough countries with data in Eastern Europe and Central Asia to see whether this pattern holds there. This is a novel finding, and a very discouraging one. We also show that these differential mortality patterns by gender are very unlikely to have a "biological" explanation--girls are generally more sturdy than boys, and there are no significant or substantive changes in the boy-girl ratio at birth during crises. Rather, it seems, families make greater efforts to protect boys than girls in dire economic times.  

The upshot of all of this is that there is no reason to think that the sky is falling down, in either poor or middle-income countries (at least in terms of infant mortality).

However, policies that protect girls would seem to be an important priority, especially in countries that are expected to face very deep economic contractions.


Norbert Schady

Economic Advisor, Inter-American Development Bank

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August 11, 2009

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August 11, 2009

Many thanks for sharing a summary of this valuable work. Any chance you could also provide a link to the full paper?

August 11, 2009

Yes the rate of maternal mortality is failing dramatically in for example East Africa (Uganda) but still alot needs and can be done.

Most of pregnant women are frustrated by constant stockouts of medicines in Government health centers. Where medicines are available, money is asked for the service. This is common in rural areas. In most of the health centers, midwives are always overworked because other health providers are constantly is absent from the centers. The midwives work 24 hours with out resting which makes them rude to patients.

So pregnant mothers find it more convenint and cheap for them to go to traditional birth attendants who have local medicines and charge them litttle money but can even give them on credit which governement health centers can not do.

Some incentives in gov’t hospitals encourage women to deliver at health centers. Incentives like “Maama kit” which is an urgent and cost effective measure to ensure that child birth is conducted in a clean environment. Maama consists of basic supplies that are required at birth including sterile gloves, plastic sheets, cord ligature, razor blades, tetracycline, cotton, soap and sanitary pads.

Another pressing issue is PMTCT treatment which is not in most of the health centers. The health centers that give PMTCT treatment are from health center IVs up wards and some few health center IIIs. Consindering the coverage of these health centers, they can not cover the whole population in the regions they are.

Alot needs to be done especially at health centers such that pregnant mothers are not always frustrated

August 17, 2009

Upon hearing the global crisis the first thing that comes to our mind speaking of the afflicted are the export sectors, the financial system likewise investors, but in reality it is the poor ordinary people who do suffer from this. In connection with the economic downturn there was apparent crimes reported, hard life tempted them to commit crime such as theft and abortion. Why so? It is because we are tired of suffering from that kind of life, they can no longer take the burden of getting hungry and availing the service such as the health care need of every individual particularly the pregnant women. The cost of raising a child is very expensive come to think the we have a very low purchasing power with our money. The health care costs that are indicated to be wasteful are behavioral, clinical, and procedural – what that means is that behavioral patterns could be addressed by someone other than a doctor, clinics order unnecessary tests, and health insurance companies might be padding their bills. The biggest cause of people needing an extra cash advance for medical care is overtesting – unnecessary procedures so the physician can cover himself legally, or just gouge patients for cash. Doctors padding bills – no wonder health care costs drive people to needing a personal loan for a simple check up.

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August 26, 2009

i would like to receive update of issues concerning the third world particularly Africa.
It is very important to the course i am studying ...International Development Studies and i may end of working in Africa as the reason of studying IDS. thanks

September 17, 2009

Hey guys. The struggle of OVC in Sub-Sarahan Africa should be one of the top priorities of the International community. To quote Time Magazine, by the end of the decade it would "take 80,000 orphanages, holding 500 orphans each, just to house the children orphaned by AIDS in sub-Sarahan Africa alone."

Here is one small way to help. The Facebook group "100,000 Ways to Help an Orphan" was launched September 16, 209. Once the group gains 100,000 members, not-for-profit company Gene Smart Wellness will sponsor the creation of a house for an orphan family in Masoyi, South Africa.

Search: Gene Smart Wellness (on Facebook)

or click…

to sign up.

Thank you so much.

The Shuga Blog
February 08, 2010

I just bumped into your site. Very informative. I shall become a follower. Keep it up

John Birch
May 03, 2010

Some incentives in govt hospitals encourage women to deliver at health centers. Incentives like Maama kit which is an urgent and cost effective measure to ensure that child birth is conducted in a clean environment. Maama consists of basic supplies that are required at birth including sterile gloves, plastic sheets, cord ligature, razor blades, tetracycline, cotton, soap and sanitary pads.

Gazon Artificial
August 23, 2010

Another well-documented example also illustrates this problem. Historically, until the 1990s Russia and the Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least seven days. Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR. In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.

April 28, 2011

This is just heartbreaking... =(

April 28, 2011

hearing this breaks my heart. especially knowing how us americans pretty much take everything for granted when people in the other side of the world do not even have access to basic necessities...