Women’s empowerment and infant mortality in Latin America: evidence from 286 cities

Levels of women’s empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014–2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women’s labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women’s rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women’s educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women’s rights was associated with higher IMRs in all countries. Women’s empowerment could have positive implications for population health. Fostering women’s socioeconomic development and girls’ education should be part of strategies to reduce IMRs in cities of Global South. ARTICLE HISTORY Received 14 July 2020 Accepted 18 March 2021

[1]  A. D. Diez Roux,et al.  Characterising variability and predictors of infant mortality in urban settings: findings from 286 Latin American cities , 2020, Journal of Epidemiology & Community Health.

[2]  D. Rasella,et al.  Increases In Women's Political Representation Associated With Reductions In Child Mortality In Brazil , 2020, Health affairs.

[3]  A. Diez-Roux,et al.  Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis , 2019, The Lancet. Planetary health.

[4]  G. Ferrant,et al.  Measuring women’s economic empowerment , 2019, OECD Development Policy Papers.

[5]  Waleska Teixeira Caiaffa,et al.  Building a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study , 2018, Journal of Urban Health.

[6]  M. Ezzati,et al.  Cities for global health , 2018, British Medical Journal.

[7]  Ross Macmillan,et al.  Gender and the Politics of Death: Female Representation, Political and Developmental Context, and Population Health in a Cross-National Panel , 2018, Demography.

[8]  B. Ribotta Estimaciones sub-nacionales de la cobertura de las estadísticas vitales. Experiencias recientes en América Latina , 2017 .

[9]  Matthew Lange,et al.  Female political representation and child health: Evidence from a multilevel analysis. , 2016, Social science & medicine.

[10]  Pierre Pratley Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world. , 2016, Social science & medicine.

[11]  M. Székely,et al.  Out-of-School and Out-of-Work Youth in Latin America: A Persistent Problem in a Decade of Prosperity , 2015, Economía.

[12]  T. Heaton Are Improvements in Child Health Due to Increasing Status of Women in Developing Nations? , 2015, Biodemography and social biology.

[13]  Leonardo Gasparini,et al.  Bridging Gender Gaps? The Rise and Deceleration of Female Labor Force Participation in Latin America: An overview , 2015 .

[14]  N. Madise,et al.  Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out , 2014, Health & place.

[15]  Andrea Cornwall Women.s empowerment: what works and why? , 2014 .

[16]  Paula Soto Villagrán Patriarcado y orden urbano. Nuevas y viejas formas de dominación de género en la ciudad , 2014 .

[17]  R. Feenstra,et al.  The Next Generation of the Penn World Table , 2013 .

[18]  A. Barros,et al.  Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions , 2013, PLoS medicine.

[19]  Sylvia Chant,et al.  Cities through a “gender lens”: a golden “urban age” for women in the global South? , 2013 .

[20]  Cesar G Victora,et al.  Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries , 2012, The Lancet.

[21]  Debbie A Lawlor,et al.  Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper , 2012, International journal of epidemiology.

[22]  David S. Abrams,et al.  Estimating the Deterrent Effect of Incarceration Using Sentencing Enhancements , 2011 .

[23]  Rafael Lozano,et al.  Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis , 2010, The Lancet.

[24]  Andrea Cornwall,et al.  Introduction: Women's Empowerment: Contentions and contestations , 2010 .

[25]  T. Lesnick,et al.  Empowerment of women and its association with the health of the community. , 2010, Journal of women's health.

[26]  Irma Clots Figueras,et al.  Are female leaders good for education? evidence from India , 2007 .

[27]  K. Koenen,et al.  Women's status and child well-being: a state-level analysis. , 2006, Social science & medicine.

[28]  H. Bodenhorn Urban Poverty, School Attendance, and Adolescent Labor Force Attachment: Some Historical Evidence , 2006 .

[29]  R. Martorell,et al.  The Importance of Women's Status for Child Nutrition in Developing Countries , 2003 .

[30]  J. Beall Participation in the city: where do women fit in? , 1996, Gender and development.

[31]  D. Hojman Evolution of infant and child mortality in Chile: a model. , 1992, Applied economics.

[32]  C. Wood,et al.  Mortality, income distribution and rural-urban residence in Brazil , 1978 .