Kunstadter P, Kunstadter S L, Podhisita C, Leepreecha P
Institute for Health Policy Studies, University of California, San Francisco 94143.
Soc Sci Med. 1993 May;36(9):1109-20. doi: 10.1016/0277-9536(93)90231-r.
Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex-specific mortality rates calculated from reproductive histories show no surplus of female deaths in the past, but females have benefitted more from recent mortality declines than males. Ethnographic evidence suggests that Hmong have customs which act to protect the health of mother and child ('chicken soup theory'), and that they are predisposed to accept innovations (including use of modern medicine) which they see as beneficial. This may allow them to respond especially quickly to small opportunities for improving their children's survival, as compared with other ethnic groups.
传统理论无法解释泰国苗族人口中婴儿死亡率出现的60%的下降情况，即从20世纪60年代中期的每1000人中有123例死亡降至80年代中期的48例。泰国北部的苗族人口一直保持着高生育率，且对现代医疗服务的利用率较低。大多数苗族居住在相对偏远的乡村，以个体农耕为生。他们的教育水平较低，尤其是女性。他们生活在多代同堂的父系父居大家庭中。女性地位低下。这些特征与泰国多数民族形成了强烈对比，泰国多数民族在死亡率出现类似下降的同时，广泛使用计划生育，生育率迅速下降，广泛使用现代医疗设施，男女教育水平迅速提高，经济快速发展，且以核心家庭为主。苗族按出生顺序和母亲年龄分布的怀孕情况相对保持稳定，而在最近几批人群中，每个胎次和所有母亲年龄组的胎儿和幼儿死亡率都有所下降。正如传统理论所预测的，婴儿死亡率在高胎次出生以及母亲年龄最大的情况下最高，然而，初胎怀孕或母亲年龄非常小（10 - 14岁）的女性生育的婴儿，其死亡风险受到的影响相对较小。在最近几批人群中，每个胎次水平和所有母亲年龄组的胎儿和婴儿死亡率都在稳步下降。现代医疗护理以及与女性低地位相关的女性死亡过剩情况的减少，可能解释了无论胎次或母亲年龄如何，胎儿和儿童死亡率的下降。现代分娩医疗护理的使用是最近才出现的，在最近所有苗族分娩中所占比例不到10%，但由现代接生人员接生的孩子的存活率并非始终显著更高。根据生育史计算的特定性别死亡率显示，过去不存在女性死亡过剩的情况，但与男性相比，女性从最近的死亡率下降中受益更多。人种志证据表明，苗族有保护母婴健康的习俗（“鸡汤理论”），并且他们倾向于接受他们认为有益的创新（包括使用现代医学）。与其他民族相比，这可能使他们能够特别迅速地抓住改善子女存活率的小机会。
