Inequality of child mortality among ethnic groups in sub-Saharan Africa

Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping reli gious and racial affiliations may widen the inequalities in health and surv ival among ethnic groups throughout the region, particularly among children . Paradoxically, there has been no systematic examination of ethnic inequal ity in child survival chances across countries in the region. This paper us es survey data collected in the 1990s in 11 countries (Central African Repu blic, Cote d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, U ganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The f ocus was on one or two groups in each country which may have experienced di stinct child health and survival chances, compared to the rest of the natio nal population, as a result of their geographical location. The factors exa mined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educ ational attainment and nutritional status of the mothers, use of modern mat ernal and child health services including immunization, and patterns of fer tility and migration. The results show remarkable consistency. In all 11 co untries there were significant differentials between ethnic groups in the o dds of dying during infancy or before the age of 5 years. Multivariate anal ysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consist ent results in this study support placing the notion of ethnicity at the fo refront of theories and analyses of child mortality in Africa which incorpo rate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly defined ethnic groups, as co mpared to the majority in the national population, according to fundamental indicators of wellbeing child survival, education, housing, and so forth - suggests that many countries in sub-Saharan Africa, despite their widespre ad poverty, are as marked by social inequality as are countries in other re gions in the world.