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The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.Fertility and child mortality decline may vary independent of one another. This study among the Hmong in Thailand sets out to compare the ethnic minority, the Hmong hill people, with rural Thai people in terms of child survival. The causes of the decline in infant mortality and the parents' perceptions of explanations for the increase in child survival are examined. The relationship between child survival and desired family size is also discussed. Community survey data are provided. Survey questionnaires were collected among all 1014 households (2037 ever-married women) in 26 Hmong communities in 5 provinces in northern Thailand in 1988 and 1989. Households were randomly selected in communities with more than 100 households. Case study interviews were conducted among 200 households in 1990 and 1991. Background information is given for Thailand and Hmong society. All-season roads link Hmong villages with markets and health facilities in towns. Each Hmong village in 1989 had at least 1 pickup truck. Cash crops have diversified and replaced the former opium fields; the economy is moving away from a subsistence and cash economy to a mostly cash economy. 50% of Hmong communities maintain a health station, but 95% of births occur at home. Household hygiene has remained poor; there have been shortages in household rice supplies. Fertility declined from over 7 in 1983 to over 5 in 1991. Women's status is low, and modern family planning methods are used by less than 25% of eligible couples. Polygyny is common and men control most of the resources. Less than 10% of women have some education. Demographic and social conditions vary between rural ethnic Thai populations and the Hmong, yet both experienced a parallel increase in child survival. Among the Hmong, risk factors persisted in spite of child survival increases. The low status of women did not affect female child mortality, nor did low educational status affect child mortality. There is support for the argument that reduction in child mortality does not require reduction in fertility and increases in family planning. Child mortality decreases are likely to be due to road building and access to modern and curative health care and immunization. Parents report greater concern about economic and social conditions in relation to desired childbearing than about child death. |
