INFANT AND CHILD MORTALITY 8 This chapter presents estimates of childhood mortality, measured by perinatal, infant, and child mortality rates. The chapter includes a description of the indicators, the current levels and trends, differen- tials by selected background characteristics, and factors that contribute to elevating children’s mortality risks. Analyzing the levels and trends of childhood mortality is important in gauging the impact of ma- ternal and child health programs improving the health of infants and children. The data can also be used as input in population projections. Differentials in childhood mortality by selected characteristics are use- ful in identifying groups in need for priority attention and in planning meaningful strategies to address them. 8.1 DEFINITIONS AND ASSESSMENT OF DATA QUALITY Six indicators are analyzed in this chapter: Infant mortality rate, neonatal mortality rate, postneo- natal mortality rate, child mortality rate, under-five mortality rate, and perinatal mortality rate. The infant mortality rate (IMR) is defined as the number of infant deaths per 1,000 live births during the first 12 months of life. It is described as the probability of dying between birth and age one year. Because the level of mortality is higher at the early ages of infancy than at the later ages of infancy, it is useful to break up the rate into neonatal mortality (NN), the probability of dying within the first month of life, and postneonatal mortality (PNN), the probability of dying after the first month of life but before age one year. The child mortality rate is the probability of dying between exact age one and age five, defined as the number of deaths of children age 1-4 years per 1,000 children surviving to age 12 months. Another useful summary indicator of infant and child mortality is the under-five mortality rate or the probability of dying between birth and exact age five, defined as the number of deaths below age five per 1,000 live births during the given period. In this report, the five childhood mortality estimates pertain to periods of 0 to 4, 5 to 9, and 10 to 14 years preceding the survey. Perinatal mortality is also presented in this chapter. It is defined as the number of stillbirths and early neonatal deaths that occurred zero to four years preceding the survey per 1,000 pregnancies of seven or more months’ duration. The above mortality rates are estimated directly from the information derived from the questions asked in the reproductive history section of the Women’s Questionnaire. There are two types of data col- lected in this section. The first refers to a woman’s total number of pregnancies, classified as live births and non-live births. To elicit complete reporting of all live births, interviewers asked the respondents to report the number of children still living and those who died, each classified by sex. The second type of data relates to detailed information on each of the woman’s pregnancies from the first to the last. The fol- lowing information was collected: whether the pregnancy resulted in single or multiple births and the out- come of the pregnancy (born alive, born dead, or lost before full term). Infant and Child Mortality | 107 For all live births, the name, sex, date of birth, and survival status of the child were recorded. For surviving children, their age in completed years at last birthday was recorded. For dead children, the age at death was noted. If the child was born dead (stillbirth) or the pregnancy was lost before term (miscar- riage), the date of pregnancy termination and duration of pregnancy at the time of loss were also recorded. For these pregnancies, the women were asked whether the pregnancy loss was induced. The accuracy of these estimates depends on the respondent’s full recall about all of her births, particularly those who have died, and her ability to accurately report the children’s date of birth and age at death. Table C.4 in Appendix C shows that there are no substantial differentials in the distributions of reported birth dates between living and dead children. The percentage of births in 1997 to 2002 with complete birth dates for living and dead children is equal to 100 percent and close to 100 percent for the earlier period. Moreover, a close examination of the pattern of reporting of age at death (Table C.6 in Appendix C) reveals that for deaths reported to have occurred zero to four years preceding the survey, there is no evidence of substantial heaping of age at death at any age. For deaths 5 to 9 and 10 to 14 years before the survey, there is a heaping at age 12 months. However, it is too small to have an impact on the estimated IMR. The reporting of date of birth and of age at death zero to four years before the survey is reasonable. However, deaths reported in the earlier periods before the survey should be accepted with some reservation. 8.2 LEVELS AND TRENDS IN INFANT, CHILD, AND UNDER-FIVE MORTALITY Table 8.1 shows early childhood mortality rates based on the 2003 National Demographic and Health Survey (NDHS). The IMR during the five-year period before the survey, which centers in year 2000, is 29 deaths per 1,000 live births. The neonatal mortality rate for the same period is 17 deaths per 1,000 live births, and the postneonatal mortality rate is 12 deaths per 1,000 live births. Child mortality is 12 deaths per 1,000 and the under-five mortality rate is 40 deaths per 1,000 live births. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Philippines 2003 Years Neonatal Postneonatal Infant Child Under-five preceding Approximate mortality mortality mortality mortality mortality 1 the survey calendar years (NN) (PNN) (1q0) (4q1) (5q0) 0-4 1998-2003 17 12 29 12 40 5-9 1993-1997 17 14 31 12 43 10-14 1988-1992 18 16 34 19 52 1 Computed as the difference between the infant and neonatal mortality rates These estimates are associated with sampling errors. For example, at 95 percent confidence lim- its, for the zero to four years preceding the survey, the actual IMR lies between 24 and 33 deaths per 1,000 live births (Appendix B). The 2003 NDHS data confirm the pattern of decline in childhood mortality in the past 15 years. Under-five mortality has declined from 54 to 48 to 40 per 1,000 as reported in the 1993 NDS, the 1998 NDHS, and the 2003 NDHS, respectively. Infant mortality rates from the three surveys also show a de- cline, from 34 to 35 to 29. 108 | Infant and Child Mortality 8.3 SOCIOECONOMIC DIFFERENTIALS IN CHILDHOOD MORTALITY Childhood mortality varies according to residence, education, and socioeconomic status. Data in Table 8.2 show that mortality rates in urban areas are much lower than those in rural areas. For example, the IMR in urban areas is 24 deaths per 1,000 live births, compared with 36 deaths per 1,000 live births in rural areas. Childhood mortality is inversely related to the mother’s education level and wealth status. The IMR for children whose mothers have no education is 65 deaths per 1,000 live births, compared with 15 deaths per 1,000 live births for children whose mothers have college or higher education. The IMR is higher than the national average in seven regions: MIMAROPA, Western Visayas, Eastern Visayas, Northern Mindanao, Davao, Caraga, and Autonomous Region in Muslim Mindanao (ARMM). While there seems to be substantial differentials in childhood mortality by region, the large sampling errors (ex- ceeding 20 points per 1,000 in some regions) suggest that the observed differences should be used with caution. Table 8.2 Early childhood mortality rates by socioeconomic characteristics and region Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preced- ing the survey, by background characteristic, Philippines 2003 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortality mortality 1 characteristic (NN) (PNN) (1q0) (4q1) (5q0) Residence Urban 14 10 24 7 30 Rural 21 15 36 17 52 Region National Capital Region 15 9 24 8 31 Cordillera Admin Region 6 8 14 20 34 I - Ilocos 19 10 29 11 39 II - Cagayan Valley 17 10 28 8 35 III - Central Luzon 15 10 25 6 31 IVA - CALABARZON 17 9 25 6 31 IVB - MIMAROPA 18 26 44 25 68 V - Bicol 19 9 28 15 43 VI - Western Visayas 22 18 39 11 50 VII - Central Visayas 18 10 28 11 39 VIII - Eastern Visayas 24 12 36 22 57 IX - Zamboanga Peninsula 6 21 27 17 43 X - Northern Mindanao 24 15 38 11 49 XI - Davao 18 20 38 10 47 XII - SOCCSKSARGEN 15 13 27 10 37 XIII -Caraga 21 14 35 14 49 ARMM 18 23 41 33 72 Education No education (33) 32 65 42 105 Elementary 22 21 43 20 62 High school 18 9 26 9 35 College or higher 9 7 15 3 18 Wealth index quintile Lowest 21 21 42 25 66 Second 19 13 32 15 47 Middle 15 10 26 6 32 Fourth 15 7 22 4 26 Highest 13 6 19 1 21 Total 17 13 30 12 42 Note: Figures in parentheses are based on 250-499 unweighted exposed persons. 1 Computed as the difference between the infant and neonatal mortality rates Infant and Child Mortality | 109 8.4 BIODEMOGRAPHIC DIFFERENTIALS IN CHILDHOOD MORTALITY Table 8.3 presents early childhood mortality by demographic characteristics.