Differentials in child mortality and health care in Pakistan.

Differentials in child mortality are analyzed by parent's education, health care, and rural-urban residence with data on 7405 currently married women, obtained from the Pakistan Contraceptive Prevalence Survey, 1984-85. The assumption is that educated parents and fathers working in the formal sector have less risks of child mortality than illiterates and those working in the traditional sector; the findings support this assumption. Educated mothers have a greater impact on child mortality risk than educated fathers. Child mortality is highest in families where both parents are illiterates. Mothers, who are housewives or who are working in a family business, have higher child mortality risk than working mothers. Child mortality risk was reduced with a hospital delivery. Father's education and a hospital delivery only reduced risk when women were aged 35 years or less. Urban educated mothers with a hospital delivery had a lower risk of child mortality than mothers with no education. Residence was not a significant factor, when hospital delivery was controlled for younger mothers. Older mothers with a hospital delivery had lower child mortality. Educated mothers with an immunized child had lower child mortality than mothers aged over 25 years. Father's education and immunization showed even lower mortality. Younger educated urban mothers, who immunized their child or infant, had lower child mortality than educated mothers. Rural educated mothers had lower child mortality than rural uneducated mothers, but including immunization as a factor, did not improve child survival. The use of oral rehydration therapy among urban educated mothers also reduced child mortality risk compared with other drug use. The majority of the population was rural (70%) and had the highest child mortality. Not only is child survival reflected in the maldistribution of health facilities, but in lack of access to these facilities, and low levels of literacy, poor sanitation, and low income. Improvement in living conditions in rural areas is recommended; development programs should emphasize access to health and education.