Mortality Transition and Family Formation in Two Quarters of Gaza City

This thesis is the first in-depth investigation of demographic trends in the Gaza Strip. The Palestinian populations of ash-Shati refugee camp and the ash-Shaja’iyya quarter of Gaza city were surveyed in 1985 to obtain estimates of fertility and mortality. These estimates are examined and the findings are interpreted in the context of historical data on demographic change in other Palestinian communities. Variations in marriage and fertility patterns are described. As in other Arab populations, the rise in the female age at first marriage is a major contributor to changes and differentials in fertility. But a unique finding is that in these two Muslim communities the norm of universal marriage for women was disrupted, primarily due to a shortage of spouses through sex-selective emigration. After loss of exposure to union, lactational amenorrhoea plays the most important role in suppressing fertility. However, even the refugees, who have had access to family planning services for twenty years, make limited use of contraception. Reasons for these findings are discussed. The mortality analysis establishes the secular trend in the age pattern of child deaths, but focuses largely on mortality differentials. Log-linear rates models are used to estimate the effect of demographic and socio-economic variables on the risk of death in childhood. When all births are included in the model and other influences simultaneously controlled, the most important co-variates of mortality are the length of the preceding birth interval and mother’s age together with mother’s education, household wealth and period of birth. Other factors such as public health measures and therapeutic medicine, which cannot be quantified but which may have contributed to the mortality transition, are also considered. A separate analysis reveals that, by the 1980s, when the majority of child deaths occurred in the first half of infancy, it was the daughters of poorly educated older women who did not use ante-natal care who were most likely to die. Possible explanations for this finding emerge from a brief examination of childcare practices.