Population Health Measures as Indicators of Fertility Change




Metscher, Karen N.

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This dissertation examines the relationships among measures of mortality, fertility, burden of disease, and socioeconomic factors. Regression modeling is used to determine (1) whether population mortality or child mortality better forecasts fertility levels; (2) if a child health model provides a stronger indicator of fertility than child mortality alone; and (3) what impact socioeconomic controls have on the application of these models. A global dataset of 143 countries over a fifteen-year time span (1990-2005) is used. Results indicate that both the child mortality rate and the child health model are strong indicators of fertility change and produce better results than population mortality or socioeconomic factors alone. Use of health measures has an additional advantage over child mortality: health indicators are easily linked to policy and lend themselves to action. The models were then applied at the country level with regional data from India, Mexico, and the Philippines. As with the global analysis, population mortality was found to be a relatively poor indicator of fertility levels. However, the performance of the child health model varied significantly, as did the significance of individual predictor variables within the model. In all country analyses, the model assisted in the identification of the child health factors that are most related to fertility rates within each particular setting. The use of health measures as indicators of fertility change adds value in two ways: (1) by facilitating the linkage of changes in fertility levels to specific contributing factors that can inform good health policy decisions and (2) by associating health status to population growth, health advocates can elevate the importance of health policies among the many competing national priorities.



Population Health, Fertility, Burden of Disease, Child Mortality, Health policy, Population policy