Infant mortality decline in Malaysia, 1946-1975: the roles of changes in variables and changes in the structure of relationships.

This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)