Abstract
BACKGROUND: One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). OBJECTIVE: We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0-11 months) and child (12-59 months) mortality in Nigeria? (2) How does father's occupation, type of residence, and geopolitical region modify the relationship? METHODS: We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0-11 months) and child (12-59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father's occupation. Other confounding variables were also controlled. FINDINGS: Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father's occupation, type of residence, and geopolitical region. CONCLUSION: The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.