What explains rural-urban differentials in child mortality in Brazil?

Abstract

This paper presents an analysis of differentials in child survival by rural-urban place of residence in Brazil and examines the hypothesis that observed mortality differentials by place of residence are merely manifestations of underlying differences in socioeconomic status and demographic and reproductive behavior. The child mortality data come from the 1986 Demographic and Health Survey of Brazil and supplementary community-level variables are obtained from a database assembled by the Brazilian federal statistical agency. Child mortality rates are substantially and significantly lower in urban areas of Brazil. Our results suggest, however, that the urban advantage does not simply reflect underlying differences in socioeconomic and behavioral characteristics at the individual and household levels; rather, community variables appear to play an independent and important role. We also find that the effects of community characteristics on child survival are moderated by household socioeconomic factors, especially maternal education. Differences in socioeconomic characteristics are therefore important in explaining rural-urban child mortality differentials, but not in the way hypothesized by previous researchers.