Causal pathways to infant mortality: linking social variables to infant mortality through intermediate variables.

Using a conceptual model that integrates social and biomedical models of causation, this paper delineates the pathways through which social factors ultimately influence infant mortality in the African-American community. Two social factors, maternal education and marital status, are shown to influence the risk of infant death through the following intermediate variables: bio-demographic (maternal age, birth order, birth interval and outcome of last pregnancy), health care (prenatal care utilization) and proximate infant health status at birth (preterm delivery and low birth weight). While the impact of maternal education is largely explained by the intermediate variables, marital status remains a significant, albeit a weak, predictor net of all other variables.