Fertility and child mortality in Cote d'Ivoire and Ghana.

Abstract

This article summarizes a 1994 World Bank working paper on methodological issues and a study of the determinants of child mortality and fertility in Ghana and the Cote d'Ivoire. Data were obtained from the 1985, 1986, and 1987 Cote d'Ivoire Living Standards Survey and the 1987-88 and 1988-89 Ghana Living Standards Survey. Both surveys entailed two-stage, self-weighted stratified samples. The study sample included women who had at least one birth 5 or more years before the survey. The conceptual framework distinguishes between endogenous and exogenous variables affecting fertility. The statistical approach relies on parallel reduced-form techniques. Model I assumes that all explanatory variables are exogenous. Model II excludes husbands' characteristics and household composition. Model III assumes that excluded model II factors are exogenous and likely to affect child mortality and fertility. Findings indicate that economic resources of households, maternal education, access to markets, and food prices were associated with child mortality in Ghana. Sanitation in both countries affected child survival only for less educated mothers. Urban residence in Ghana particularly benefitted uneducated mothers. In Cote d'Ivoire, household assets were not a significant predictor of child mortality. When child mortality is treated as exogenous in fertility model I, only 4-15 fewer child deaths were associated with a reduction of only one birth. Local health programs and environment explained little of the variation in child mortality in both countries. Women's education was strongly related to fertility declines in both countries. Assets and maternal health were positively related to fertility in Cote d'Ivoire and negatively related in Ghana. Findings suggest that the negative effects of household assets on fertility apply in urban subsamples among older women in each country. The authors conclude that economic growth must occur simultaneously with increased levels of female education and urbanization.