Under-five mortality exposure in low- and middle-income countries: A multi-generation and cohort perspective of sibling and offspring loss

Demographic research tends to track child mortality conditions with annualized death rates, paying little mind to how these annualized rates reflect in the lives of the surviving population. Yet, demography’s age-old interest in how exposure to child mortality affects individuals’ perceptions, decisions, and behaviors, and ultimately macro-level population processes, raises questions about how pervasive intimate experiences of child death remain across the globe—particularly in low- and middle-income countries where declines in mortality are recent. In this paper, we document women’s experiences of under-five mortality in 50 low- and middle-income countries, focusing comprehensively on experiences in their immediate natal or conjugal family in the form of sibling or offspring death. Specifically, we analyze Demographic and Health Survey Program data on 1.05 million women spanning three decadal birth cohorts to document women’s life-course exposure to under-five sibling or offspring death, the intergenerational clustering of these experiences, and how they are (not) changing across cohorts. The results show an exceedingly high, and often stable, percentage of women have experienced under-five sibling and offspring deaths. Moreover, women’s risk of offspring death is often strongly associated with their history of sibling death; this strong intergenerational clustering has remained stable, or has grown larger, across cohorts in most countries.