Does Family Planning Reduce Infant Mortality?: Reply

Recent reviews of relevant evidence have confirmed that an increase in the practice of family planning can theoretically reduce infant and child mortality rates. Although it is widely accepted that family planning can theoretically reduce infant and child mortality it is not clear whether the changes in family-formation patterns that typically accompany the adoption of contraception do in fact have a significant favorable effect on infant mortality rates. This note compares the proportions of high-risk pregnancies in groups of developing countries at different stages of the family planning transition. Countries with relatively high levels of contraceptive use have fewer teenage births as well as fewer births of orders over 6 when compared with countries in which family planning is minimal. These differentials would by themselves result in lower infant mortality rates in the later phases of the fertility transition. This effect is offset however by the fact that countries with higher levels of contraceptive prevalence also tend to have higher proportions of births of order 1 and higher proportions of births after short birth intervals both of which are associated with higher than average mortality risks. The net effect of these 2 compensating sets of factors on infant mortality rates is very small. Thus changes in the age/order/interval distributions of births do not necessarily improve the chances for survival of infants as a society moves through a fertility transition.