Urban Mortality Transitions: The Role of Slums

High urban mortality delayed transitions to low mortality in 19th century Europe, but an urban mortality advantage emerged as European transitions progressed into the 20th century. Recent analysis has suggested that high mortality in the rapidly growing urban slums of developing countries might once again delay transitions to low mortality in the 21st century. In this paper we use data from Demographic and Health Surveys across 37 countries to investigate this hypothesis. We document the changes in child mortality over the last twenty years, with a special focus on urban slums and on differences between small and large cities. We show that slum areas fare worse than other urban areas across all child mortality categories and all city categories, but that generally children growing up in urban slums fare at least as well as children in rural areas. Moreover, the improvements in child mortality appear to have affected slum residents at least as much as other urban and rural residents, indicating a neutral role of slum settlements in the mortality transition of developing countries.