The effect of birth intention status on infant mortality: a fixed effects analysis of 60 countries

Most studies on the impact of birth intentions on children’s wellbeing do not separate the effect of pregnancy intention status from the socio-demographic characteristics associated with it. There is a lack of studies taking a multi-country comparative perspective. We analysed 60 Demographic and Health Surveys in Asia, Americas and Africa to examine the effect of birth intentions on infant mortality using sibling fixed-effects linear probability models accounting for confounding due to unobserved time-invariant family-level characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 44 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept and reporting of birth intentions. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large-scale, cross-country comparative study to analyse the effect of birth intentions on infant mortality using a fixed-effects approach.