Fertility and infant mortality trends in Nicaragua 1964-1993. The role of women's education

Objectives-To assess trends in fertility and infant mortality rates (IMR) i n Leon, Nicaragua, and to examine the effect of women's education on these trends during 1964-1993, a period of rapid social change. Design-Cross sectional survey, based on random cluster sampling. A retrospe ctive questionnaire on reproductive events was used. Setting-The municipali ty of Leon, which is the second largest city in Nicaragua, with a total pop ulation of 195 000 inhabitants. Subjects-10 867 women aged 15-49 years, corresponding to 176 281 person yea rs of reproductive life. Their children contributed 22 899 person years und er 12 months of age to the IMR analysis. Main outcome measures-Fertility rate (number of pregnancies per 1000 person years) for specific age groups and calendar periods, total fertility rate, and IMR. Results-Fertility rates and LMR declined in parallel, especially during the 1980s. However, education specific fertility rates did not decline, but th e proportion of educated young women increased from 20% to 46 %. This had a lso an impact on the overall IMR decline, although LMR reduction mainly too k place among infants of women without formal education, decreasing from 11 8 to 69 per 1000 during the observation period. Conclusions-In this demographic transition over three decades, fertility an d IIR declined simultaneously. The decreasing trend in fertility was mainly explained by an increase in women's education, while the IMR decline seeme d to be the result of health interventions, specially targeted to poorer gr oups of women and their infants. Thus, social differences in fertility rate s remained unchanged, while equity in chances of child survival increased.