Birth Order and Demand for Immunization for Children under the Age of Five in Cameroon

"...cultural factors are at the root of prejudices leading to the abandonment of children."

Evidence shows that, as the number of children increases, the resources allocated to each one diminishes, such that children of higher birth order end up with fewer resources than their older siblings at that age. In Cameroon, every woman has an average of 5 children at the end of her fertile life. This study from the African Economic Research Consortium (AERC) analyses the effect of birth order on the immunisation status of children in Cameroon, considering the contribution of cultural, economic, and community factors.

To do this, it uses data from the Expanded Programme on Immunization (EPI) module of the Demographic and Health Surveys, which was administered to 3,350, 2,317, 8,125, and 25,524 children under 5 in 1991, 1998, 2004, and 2011, respectively. The modelling of the effect of birth order on the child's immunisation status is based on the hypothesis of heterogeneity between children in relation to their demo-biological characteristics, the socio-cultural characteristics of the mother, the socio-cultural characteristics of the child, and family and community characteristics.

In short, the researchers find that birth order has a negative and highly significant effect on the full and timely immunisation of children under 5 and that the impact increases with birth order. Moreover, the impact of birth order increases after adjusting for cultural factors. The probability of being fully immunised increases when the child is born in poor health and when he or she is a twin. (Twins have a particular consideration in the Cameroonian society; as a result, they receive special attention.) There is no gender difference in the immunisation of children. The mother is the one who is most willing to immunise the child, and this is more significant when she is educated. (Education promotes knowledge of the immunisation schedule and an understanding of the importance of immunisation for child survival.) Exposure to the media increases the chances of a child being immunised on time: The effect is 8% for those whose mothers have little exposure and 13.2% for those whose mothers have high media exposure.

Considering children under 2 years of age, and vaccines taken during the first 4 months, the corresponding birth order effect points to the benefits of routine immunisation and response campaigns in promoting immunisation of children under 5. (At the age of 2, the complementary vaccination strategies of the EPI still give the mother the possibility to make up for the absence of child immunisation until the age of 5. The proliferation of kindergartens and the desire to empower women through work means that by the age of 3, most children are already in school and can be immunised during campaigns. This explains the importance of the dilution phenomenon on children under the age of 2 compared with those under the age of 5.)

In terms of policy implications, the researchers suggest that the "negative effect of birth order which increases with birth order presupposes a certain fatigue of parents and limited resources allocated to each child as births increase, which highlights the need for birth control through spacing. The modal birth interval is currently 24 months, and therefore its increase to 48 months could reduce the burden on the mother since the youngest child would already be able to self-manage for certain tasks. To this end, the state should encourage women to space births by promoting modern contraceptive methods. The increase in the negative impact of birth order due to cultural factors requires increased awareness on the importance of immunization. This sensitization should be done not only through the media, but also in public spaces to reach out to population segments with no media exposure..."