Presentation for EPC

1. New insights from the Egyptian Demographic and Health Survey
Niccolò Certi
Curzio Checcucci
Guglielmo Maggi
Infant and Child Mortality
Differentials by
Women’s Empowerment

2. Women’s empowerment
2
Egyptian mortality background
Source: 2014 CIA World Fact-Book .
▪ Egyptian infant mortality rate: 22.41 per one thousand births (CIA);
▪ Higher mortality rate for infants than children: 6,2% vs 1,9% in 1995, 3,3% vs
0,8% in 2005 and 2,2% vs 0,5% in 2014 (DHS);
▪ Negative trend of under five mortality through years: it is 9 times lower in
2014 respect to 1960 (DHS);
▪ Residence area, education, age of the mother at child birth, sex and weight of
the child are important differential factors (DHS).

3. Definitions background:
“The chance that an individual have in a social relationship to achieve his or her
own will, even when faced with the resistance of others.” (Weber M., 1978)
“The process that leads people to perceive themselves as able to and entitled to
make decisions.” (Csazar F., 2005)
Our approach:
Variables are measured at the time of interview, not at the moment of event, we
anyway believe that they still measure an undergoing process, started earlier.
3
Women’s empowerment

4. 1. Does women’s empowerment affect children mortality?
2. Are there differences or similarities between the
determinants of infant and child mortality?
4
Research questions

5. ▪ Data collected in 2014 by Demographic and Health Survey Program for Egypt.
▪ 19.757 Egyptian women interviewed: mothers of 59.266 children.
▪ Almost one thousand questions on different topics (for 1.082 variables in the
data-set) :
• basic information on the respondent and their partner;
• fertility preferences, contraceptive methods;
• attitudes towards domestic violence;
• methods of making decision inside the household.
5
2014 DHS Data

6. 6
Empowerment variables
Key variables:
• Decision index autonomy
Number of decisions took alone or jointly with husband:
- ‘’no autonomy’’: 0 decisions;
- ‘’intermediate’’: 1 or 2 decisions;
- ‘’medium-high’’: decisions on all issues.
• Beating justification:
- ‘’0’’: no justifications for domestic violence;
- ‘’1’’: at least one reason.
• Max education level:
- ‘’no education’’
- ‘’primary’’
- ‘’secondary’’
- ‘’higher’’
Issues
Woman’s own wealth care
Relatives visits
Husband purchases
Issues
Burning food
Arguing with husband
Neglecting children
Refusing sex

7. 7
Control variables
Demographic features:
• Residence:
0 for urban ; 1 for rural areas;
• Sex child:
0 for male ; 1 for female;
• Order of birth: 1, 2, 3, 4, 5, 6, 7
7 accounts for seventh or younger children;
• Mother’s age at child birth: continuous
Age of the mother at the birth of his child;
Temporal variables:
• Mother’s cohort: 1964-71, 1972-78; 1979-84; 1985-99
• DUR: different from infant to child mortality
Exposure periods in which we assumed the risk constant.

8. 8
Descriptive findings
5.06%
1.17%
4.47%
0.86%
2.63%
0.43%
1.65%
0.19%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
Infant Child
Highest Educational Level
No Educ Primary Secondary Higher
2.77%
0.47%
4.55%
1.01%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
5.00%
Infant Child
Beating Justification
0 1
4.93%
1.13%
3.31%
0.62%
2.18%
0.40%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
Infant Child
Decision Index
no autonomy intermediate medium-high

9. 9
EHA approach and model
EVENT HISTORY ANALYSIS
Life course perspective
EVENT OF
ORIGIN
Birth
EXPOSURE
TIME
Calculated in
days
EXIT FROM
POPULATION
AT RISK
Death;
First birthday;
Right censoring
EVENT OF
ORIGIN
First
birthday
EXPOSURE
TIME
Calculated in
months
EXIT FROM
POPULATION
AT RISK
Death;
Forth birthday;
Right censoring
Infant mortality Child mortality
PIECEWISE CONSTANT EXPONENTIAL MODEL
ℎ 𝑡 𝑿) = ℎ0 ∙ 𝑒𝑥𝑝(𝑿𝜷)
Where ℎ0 is constant in a specific time interval

10. 10
Model results
INFANT (0-1 years old) CHILD (1-4 years old)
RELATIVE RISK P-VALUE RELATIVE RISK P-VALUE
DECISON
MAKING INDEX
intermediate 0.830 0.001 0.858 0.320
medium-high 0.726 0.003 0.900 0.728
VIOLENCE
JUSTIFICATION
1 1.228 0.000 1.568 0.001
EDUCATIONAL
LEVEL
primary 0.998 0.977 0.907 0.595
secondary 0.832 0.001 0.576 0.001
higher 0.765 0.019 0.321 0.006
Controlling for residence, mother’s cohort, mother’s age at child birth, birth
order, child’s gender and exposure time.

11. 11
Supplementary infant’s results
▪ The child’s gender does not affect the risk of mortality;
▪ Non-significance of the interaction between child’s gender and mother’s cohort;
▪ Risk decreases in the most recent cohorts;
▪ Mild decrease in risk as mother’s age at birth child increases;
▪ Positive significant correlation for order of birth, if we control for mother’s age at
child birth.

12. 12
Supplementary child’s results
▪ Child's gender remains not significant, even though the p-value becomes much
lower than infant’s results;
▪ Interactions between child's gender and mother's cohort remain non-significant and
the same happens for interactions with other covariates.
▪ The only variable that actually has no effect on mortality from one model to another
is child’s birth order;

13. 13
Decision autonomy in child mortality
RELATIVE RISK P-VALUE
DECISON
INDEX
intermediate 0.751 0.061
medium-high 0.543 0.037
RELATIVE RISK P-VALUE
DECISON
INDEX
intermediate 0.825 0.210
medium-high 0.798 0.451
EDUCATION
LEVEL
primary 0.879 0.483
secondary 0.487 0.000
higher 0.242 0.000
Controlling for residence, mother’s cohort,
mother’s age at child birth, child’s gender
and exposure time.
Controlling for residence, mother’s cohort,
mother’s age at child birth, child’s gender and
exposure time.
Strong dependence between number of decisions and education.

14. 14
Decision autonomy in child mortality
▪ In child mortality, unlike infant, the decision-making autonomy do not show relevant
explanation power comparing to education level.
• We can therefore assume education as an antecedent variable: mothers who
make more decisions are those who are better educated and higher education
lowers the risk of child mortality.
• Decision making autonomy affects mortality only through the level of education
(spurious effect).

15. 15
Violence justification in child mortality
RELATIVE RISK P-VALUE
VIOLENCE
JUSTIFICATION
1 1.625 0.000
EDUCATION
LEVEL
primary 0.894 0.541
secondary 0.529 0.000
higher 0.278 0.001
RELATIVE RISK P-VALUE
VIOLENCE
JUSTIFICATION
1 1.896 0.000
Controlling for residence, mother’s cohort,
mother’s age at child birth, child’s gender and
exposure time.
Controlling for residence, mother’s cohort,
mother’s age at child birth, child’s gender and
exposure time.
Justification of domestic violence, in contrast to number of decisions inside the
household, remains a strong empowerment component with crucial role in
decreasing the risk of mortality, with or without higher education levels.

16. 16
Conclusions
1) Women’s empowerment clearly decreases both risks of infant and child mortality.
This effect is more pronounced for the child mortality where socio-economic factors
and, especially women’s emancipation, show greater risk ratios, while biological
factors lose their importance;
2) Higher education moderates the effects of women’s decision making autonomy.
3) Justifications to domestic violence is a strong empowerment component with high
negative correlation with mortality.
4) Empowerment variables are not losing importance among more recent mothers’
cohorts.
In all, the positive relationship between women’s empowerment and child health care
represents an indication for politics towards the need of strengthening gender and social
equality.

17. 17
Main limitations and perspectives
▪ Time-constant empowerment variables: need for more complete data, so to
account for their time variability;
▪ Regarding for a time-varying variable for job employment;
▪ More controls on partner/ husband information.

18. 18
THANK YOU
FOR YOUR ATTENTION
Niccolò Certi: niccolo.certi@stud.unifi.it
Curzio Checcucci : curzio.checcucci@stud.unifi.it
Guglielmo Maggi: guglielmo.maggi@stud.unifi.it

19. 19
References
Bernardi, F. (2006), ‘’Análisis de la historia de acontecimientos’’ Madrid, Centro de
Investigaciones Sociológicas, Colección de Cuadernos Metodológicos del CIS, 38
Csazar, F. (2005), ‘’Understanding the Concept of Power ‘’ in (ed) R. Alsop Power,
Rights and Poverty: Concepts and Connections Washington DC: World Bank: 137-146
DHS (2014), ‘’Egypt, Demographic and Health Survey’’
DHS (2005), ‘’Egypt, Demographic and Health Survey’’
DHS (1995), ‘’Egypt, Demographic and Health Survey’’
Griffis, H. M. (2012), ‘’ Women's Empowerment and Infant and Child Mortality:
Incorporating Social Institutions and Context’’ Florida State University Libraries
Weber, M. (1978), ‘’Economy and Society: an Outline of Interpretative Sociology’’
Berkeley/Los Angeles/London: University of California Press

20. 21
Residence effect
INFANT (0-1 years old) CHILD (1-4 years old)
RELATIVE RISK P-VALUE RELATIVE RISK P-VALUE
RESIDENCE
rural 1.239 0.000 1.079 0.600
▪ In contrast to infant mortality, effect of mother’s residence area is not direct:
mother’s residence area seems to have an effect through the mother’s
education. Living in urban areas is more likely to have a medium/high level of
education for mothers and therefore a lower risk of mortality related to their
children.
• We supposed mother’s education level as an intervenient variable:
Note: controlling for all other previously presented variables.