The Crucial Role of Mothers and Siblings in Child Survival: Evidence from 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

There is a considerable body of research on the effects of siblings on child mortality through birth intervals. This research commonly focuses on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother’s pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are co-resident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering over 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a minimum 24-month birth interval is advantageous between both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced and is present in addition to that of an older sibling. Moreover, child mortality is further found to be particularly low during a mother’s subsequent pregnancy, contrasting the shock resulting from a younger sibling’s birth. Further, we find that when a mother or sibling is absent from the household there is a higher risk of mortality, and the death of either reduces child survival up to six months before the death