Child mortality and the fertility transition: aggregated and multilevel evidence from Costa Rica

Abstract

Is decreasing child mortality a prerequisite—a necessary condition—for decreasing fertility? Can decreasing child mortality alone trigger the fertility transition? These questions have important policy implications. If improving child survival is a precondition for birth control, family planning programs in the least developed regions are unlikely to succeed, especially if these programs have a vertical organization independent of child health interventions. In turn, if reducing child mortality is a sufficient condition, family planning programs may be somewhat superfluous: “Development is the best contraceptive.” In this chapter I address the issue of whether reduced child mortality is crucial for the fertility transition by examining the empirical evidence from Costa Rica, a developing country that managed to decrease both child mortality and birth rates. Here I examine Costa Rica’s record at the aggregate and the individual level. A strong association between child mortality and fertility is well documented in the literature. Countries with low infant mortality almost always have low birth rates (Heer, 1966; Mauldin et al., 1978). Couples that have lost a child are, in turn, less likely to use contraception, tend to have more children, and have shorter birth intervals (Taylor et al., 1976). However, this association is neither proof of causation nor indicates the direction of causation.