The Differential Mortality of Undesired Infants in Sub-Saharan Africa


With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1–3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.

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  1. 1.

    I use the term “gender” in this article to refer to socially constructed aspects of male–female differences, and expectations of such differences, rather than biologically determined aspects (Haig 2004). Specifically, maternal preferences concern the gender of children whereas the sex of each child is registered in DHS surveys.

  2. 2.

    A model with all women is included in Online Resource 1, section F.

  3. 3.

    Section B of Online Resource 1 shows that similar patterns can be obtained when mothers who have experienced the death of a child are studied separately.

  4. 4.

    Section C of Online Resource 1 also includes interactions between maternal age and sibling composition.

  5. 5.

    Infant mortality is here defined as deaths occurring to live born children until and including the 12th month of life, to include the many children who are reported to die at exactly 12 months due to heaping.

  6. 6.

    Alternative models are shown in Online Resource 1, section C.


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The article has benefited from comments by seminar participants at the Wittgenstein Centre for Demography and Global Human Capital, Statistics Norway, and the University of Oslo. I would like to particularly thank Prashant Bharadwaj, Christophe Guilmoto, Nico Keilman, Andreas Kotsadam, Øystein Kravdal, Raya Muttarak, Martina Björkman Nyqvist, and three anonymous reviewers for helpful comments. While carrying out part of this research, I have been associated with the Centre for the Study of Equality, Social Organization, and Performance (ESOP) at the Department of Economics at the University of Oslo. ESOP is supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 179552. It has also partly been completed under the Systems Analysis Scholarship from the International Institute of Applied Systems Analysis and the South African National Research Foundation.

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Flatø, M. The Differential Mortality of Undesired Infants in Sub-Saharan Africa. Demography 55, 271–294 (2018).

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  • Fertility desires
  • Gender preference
  • Infant mortality
  • Unwanted childbearing
  • Sub-Saharan Africa