Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean

Inter-country differences in infant and child mortality are explained by looking at demographic, economic, health and educational factors. A model is presented in which the infant mortality rate, the child mortality rate, and the birth rate are endogenous. The model is tested using cross-national multiple regression analysis and simulations. The presence of simultaneity is confirmed. Introducing non-economic factors transforms the character of the relationship between exogenous and endogenous variables, from a 'diminishing returns' to an 'increasing returns' one. The role played by public expenditure in education, vaccination coverage, low birth weight, female schooling, number of nurses, access to safe water, or malnutrition can be assessed, as well as that played by 'structural adjustment' variables such as the inflation rate or the external debt to GNP ratio. Infant and child mortality can be diminished everywhere in the region with relatively small amounts of expenditure. Disappointing outcomes in some countries obey political rather than economic problems. It would be a mistake to blame the debt crisis.