'Parental incompetence' and 'selective neglect': blaming the victim in child survival.

The Child Survival Revolution has produced inconsistent results in reducing global infant and child morbidity and mortality rates. Several recent studies employ concepts of 'parental incompetence' and 'selective neglect' as catch-phrases to account for variations in the outcome of family health programs. This concept shifts liability for illness from health agencies and providers to beneficiaries. It associates program failure with noncompliance resulting from parental ignorance or indifference to the welfare of offspring. This paper presents data which support a view of parents as concerned and pro-active health seekers whose parenting standards sometimes conflict with those of external health agents, and whose caretaking decisions sometimes force them to weigh concerns for individual children against demands of the family as a whole. Implications of parental accountability for child survival are discussed as they shape research and health policy.