A study on child survival in rural Bangladesh has shown that the death of a child's mother massively reduces that child's chances of survival to age 10 years, whereas the father's death has a negligible effect. The findings are reported in an Article in the Women Deliver Special Issue of The Lancet, written by Professor Corine Ronsmans, London School of Hygiene and Tropical Medicine, UK, and colleagues.
The authors used data from population surveillance during 1982� in Matlab, Bangladesh, and the cumulative probabilities of survival and rates of age-specific death up to age 10 years, according to the survival status of the mother or father during that period.
The authors found there were 144,861 livebirths, and 14,868 children died by 10 years of age. The cumulative probability of survival to age 10 years was 24% in children whose mothers died (n=1385) before their tenth birthday, compared with 89% in those whose mothers remained alive (n=143 473). The greatest effect was noted in children aged 2 months whose mothers had died, who were 25 times more likely to die than children whose mothers were alive when the children were in this age range. The effect of the father's death (n=2691) on cumulative probability of survival of the child up to 10 years of age was negligible, a finding that did not change as the age of the child varied.
The authors say the increased risk of death in neonates and infants after the death of the mothers is largely attributable to the interruption of breastfeeding, which is a major determinant of infant survival. In rural Bangladesh, breastfeeding is generally prolonged, and 92% of infants in Matlab were still breastfed at 12 months of age. The authors say: "The inadequacy of alternative feeding options when breastfeeding is stopped also accounts for the short time between the death of a mother and her infant."
Many Bangladeshi men remarry soon after the loss of their wives, and the authors highlight a Bengali saying which says that when the mother dies the father behaves like someone else's father and becomes a distant relative. The authors say "This proverb aptly sums up the neglect of a motherless child."
When the father dies, households and extended family tend to step in to help the widowed mother. The authors believe this financial support from the extended family might compensate for the loss of the father. Widows also remarry, and young children accompany their mother to her new husband's house, ensuring a social safety net.
Another important finding was that the effect of a mother's death on child mortality did not vary with the child's sex. The authors say: "The higher mortality rate in girls than in boys during infancy and childhood in rural Bangladesh is well known. Mortality rate in girls has declined at a much faster pace than in boys in Bangladesh, and differences in the mortality rates between girls and boys in Matlab and elsewhere in Bangladesh have now disappeared."
The authors call for more research into the causes of death of Bangladeshi mothers, saying: "Although the death of a mother is a rare event, it does not go unnoticed and the consequences are devastating for the child. Little is known about the rates and causes of mortality in women of reproductive age in Bangladesh, most of whom are mothers. In Matlab, infectious diseases were identified as the main cause of death in women of reproductive age, and most women did not seek professional care before death. Much more work is needed to understand what happens to a young mother when she is ill, and to the child when the mother is ill or dies".
They conclude: "The death of a mother not only affects the survival of her child in the immediate maternal period, as embodied in the Millennium Development Goal 5, but also throughout the life cycle of the child and into the next generation. The future for children will not be safe without sustained investments to ensure that a mother is healthy throughout the life of her child."
In an accompanying Comment, Dr Hussain R Yusuf and Dr Hani K Atrash, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA, say: "An important implication of this study is the role that reduction of maternal mortality could play in improving child survival. Further, this study highlights the need for establishing formal structures for supporting and ensuring the health and wellbeing of children in the absence of their mothers. In places such as Bangladesh, much of the existent care for children who have lost parents is probably delivered by informal support networks."
Professor Corine Ronsmans, London School of Hygiene and Tropical Medicine, UK. T) +44 (0) 207 9272190 E) carine.ronsmans@lshtm.ac.uk
Dr Hussain R Yusuf, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA. T) +1 404-498-3937 E) hyusuf@cdc.gov
For full Article and Comment see: http://press.thelancet.com/parentdeath.pdf
Journal
The Lancet