A central proposition of demographic transition theory is that declines in infant and child mortality can encourage subsequent declines in fertility. Even the earliest formulations of the theory recognized that fertility decline would occur only with a lag, but neither theory nor empirical work has explored the length of such lags. This paper urges that individual perceptions and beliefs about mortality risks, conspicuously absent from the demographic research agenda, be studied directly. It proceeds to link mortality perceptions to health care decisionmaking and investments in children. The paper concludes by calling for a new agenda on mortality decline. This agenda would focus on three main themes: individual perceptions of health levels and trends, including mortality risks, with the concept of social learning being prominent; the overlap of modern and traditional health care systems and the associated beliefs, with an emphasis on the perceived efficacy of modern modes of prevention and treatment; and the role played by perceived mortality risks and health in affecting parental investments in schooling, with attention to adult as well as to child mortality and health. These issues can be studied profitably in high-mortality settings as well as in settings of moderate mortality risk.
Montgomery, Mark R. 1999. "Mortality decline and the demographic response: Toward a new agenda," Policy Research Division Working Paper no. 122. New York: Population Council.