Kunstadter P, Kunstadter S L, Leepreecha P, Podhisita C, Laoyang M, Thao C S, Thao R S, Yang W S
Institute for Health Policy Studies, School of Medicine, University of California, San Francisco 94109.
Hum Biol. 1992 Dec;64(6):821-41.
The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.
泰国的苗族“山地部落”少数民族比泰国农村的泰族人口面临更多通常与儿童死亡风险相关的因素（高生育率、女性地位低下、教育程度低、分娩时较少使用现代医疗护理、遭受战争、经济和身体受到破坏以及卫生条件差）。尽管如此，在过去30年里，这两个人口群体的婴儿死亡率都从每1000例活产超过120例下降到了每1000例活产不到50例。苗族儿童存活率迅速提高的原因似乎是与道路建设相关的现代治疗和预防医疗护理的可及性提高和使用增加，而不是社会或卫生条件的重大变化。传统观点认为，高生育率既是高婴儿和儿童死亡率的原因，也是其结果，而且父母在看到死亡率下降之前不会降低生育率。大多数苗族父母认识到儿童死亡率的下降，并将其归因于获得现代医疗护理的机会增加。大多数苗族父母还表示，如果他们现在开始生孩子，他们想要的孩子会更少。很少有人提到害怕孩子死亡是生育更多孩子的动机，也很少有人提到意识到儿童死亡率下降是降低生育率的原因。大多数苗族父母根据经济状况而不是感知到的儿童死亡风险来解释他们期望的家庭规模。这项研究的结果表明，生育率和儿童死亡率可能相互独立变化，而且在不等待重大社会变革（如改善教育或女性地位）或大幅降低生育率的情况下，也可以大幅降低儿童死亡率。
