The social component of mortality decline: An investigation in south India employing alternative methodologies

Abstract

It has previously been reported that mother's education exerts an influence on infant and child mortality that is independent both of the level of medical technology found in the society and of the family's access to it.1 This finding suggests that social change may have played an important role in the mortality transition and that social factors may explain the failure of health services to be more effective. Clearly an adequate investigation of this proposition means a study not only of mortality but of pre-existing morbidity, an area in which there has been only a limited development of research methodology. Since 1979 we have been testing the limits of the survey approach in a rural area of south India, and experimenting with the development of supplementary or alternative methods for collecting demographic information. These alternative approaches draw heavily on the methods of anthropology. The continuing work is a joint project of the Population Centre, Bangalore, and the Department of Demography, Australian National University. The original focus of the research had been on changes in marriage and control of marital fertility,2 but, given long periods of village residence, we had inevitably learnt much about the conditions of health, and by 1981 were in a position to concentrate our interest upon these matters. The work reported here was carried out in a rural area of southern Karnataka (once Mysore) 125 kilometres west of the city of Bangalore. The study population consisted of one large village with 2,557 inhabitants and eight smaller villages, ranging in size from 62 to 543 persons and totalling another 2,216 inhabitants. The area is traversed by a moderately important sealed road, but only the large village is right on it and most of the others are approached easily only by ox cart. The most distant of the small villages * This research constitutes part of a joint project of the Population Centre, Bangalore, India, and the Department of Demography, Australian National University. Most of the funding has come from the two institutions, but other support, especially for the analysis, has been provided by the Ford Foundation and by a Population Council International Research Award. The project has benefited from the research assistance of Pat Quiggin in Canberra, and also in Karnataka and/or Canberra from Wendy Cosford, Jennie Widdowson,