Data from the Dominican Republic's 1991 Demographic and Health Survey (DHS) and other surveys of recent decades were the basis for this assessment of maternal and child health, morbidity, and mortality. The first of three major sections describes changes in infant mortality over the past three decades and estimates maternal mortality rates using the sister survival method. The major causes of infant death are also identified. The second section provides data on the incidence and treatment of diarrhea and acute respiratory infections in young children. The third section uses information from the Household Questionnaire of the 1991 DHS to assess maternal morbidity and to analyze the coverage of prenatal care. Infant mortality in the Dominican Republic is known to have declined, but there is no consensus on the current level. Analysis of trends and internal consistency of estimates from different sources suggests that infant mortality declined from around 100/1000 live births in the early 1960s to 43/1000 in the late 1980s. Despite the progress, the Dominican Republic still has the second highest level of infant mortality among the Caribbean islands. The neonatal mortality rate exceeds the postneonatal rate, and marked geographic and socioeconomic differentials persist. A high proportion of infant deaths are caused by respiratory and diarrheal disorders and preventable infections. Application of the sister survival method to 1991 DHS data indicated that the maternal mortality rate declined from 25/10,000 live births in 1971 to around 18/10,000 in 1980, with the decline due in large part to improved health services. The 1991 DHS data indicated that 16.6% of children under five had at least one diarrheal episode and one-fifth had signs of respiratory infection in the two weeks preceding the survey. Both diarrhea and respiratory infections had their greatest incidence in children 6-11 months old. 30% of the children with diarrhea and 40% with respiratory infections were taken to a health facility. 31.6% of children with diarrhea received oral rehydration therapy. The 1991 DHS data showed that 37% of children 12-23 months old were completely vaccinated and only 1% had no vaccinations. Prenatal care was obtained from a physician for 97% of births in the five years preceding the 1991 DHS. Over 90% of deliveries occurred in health facilities and nearly 90% were professionally attended.
Results of the Dominican Republic's four most important fertility surveys were used to analyze how relations between selected sociodemographic factors and infant mortality have changed in recent decades, and to evaluate the contribution of changes in the distribution of these factors to mortality decline. The empirical analysis was carried out in four parts, the first of which analyzed trends in infant mortality in the Dominican Republic between 1960 and 1990. The second part established the importance of each determinant in each period studied and used logistic regression to analyze changes in the structure of the relationship between the variables and infant mortality. The third section analyzed changes in the relative weight of the categories of determinants during the study period. The final section standardized the risk of death in 1964-69 using the composition of births in 1985-90 and vice versa to evaluate the influence of each determinant in the infant mortality decline. The number of study variables was limited to six by lack of comparability in the four fertility surveys. The six variables were region and zone of residence, education and age of the mother, and birth order and interval. The results of this research did not indicate any clear pattern of change in the structure of relations between determinants and infant mortality. It appears plausible that there are various routes toward the transition leading to low mortality. In the Dominican Republic, maternal education was most important from 1964 to 1969, when infant mortality was high, and became relatively less important as a determinant in subsequent years. The changing relationship between maternal education and infant mortality suggests that there are no generalized patterns but rather the weight of each variable differs from one context to another and depends on the influence of other socioeconomic, medical, and demographic determinants.
This work argues that intraurban mobility resulting from urban renewal in Santo Domingo is one of the city's major problems. Santo Domingo's growth from 30,000 in 1920 to 1,800,000 in the late 1980s was unplanned, and the expansion of urban infrastructure generally followed demographic expansion. The Dominican government has regularly provoked massive dislocations in the course of urban renewal, especially at the end of the Trujillo era and under the governments of Balaguer. More than 50,000 families have been forced to move in the past 30 years, representing 20% of the population. Among the consequences of this policy are a form of rootlessness of the population resulting from lack of title to the land and the constant threat of having to move again. The feeling of impermanence has psychological and cultural effects and also discourages residents from making significant improvements to their housing. The disorder of the city is increased because most of the families forced to move from areas undergoing renewal establish themselves in other marginal zones, which then undergo chaotic growth. From the fall of Trujillo to the disturbances of 1965-66, rural migration to the periphery of the city was massive, and it resumed again with the return of political stability. The massive construction projects beginning in 1967 were intended to beautify areas of high visibility, improve traffic flow, develop aesthetic elements, and remove low income populations from the center for the city. Around one-third of the national budget was devoted to construction in these years. Thousands of families were relocated in new areas belonging to the government at great distances from the city center and with few or no public services. The urban policy encouraged speculation and deterioration of urban management due to confusion between government institutions and private interests. Between 1978-86, government construction policy changed, with the amount of investment reduced and low cost housing emphasized. But massive construction began again with Balaguer's return to power. Some 20,000 families have been displaced and another 14,000 have been told to move. The forced removals have involved around 10% of the population. Their effects have included rapid expansion of the marginal urban periphery, artificially high rents, aggravation of problems in providing public services, loss of identity of neighborhoods, reinforcement of individual strategies at the expense of communal welfare, and weakening of survival resources of the most impoverished sectors.
The effects of the massive entry of Haitian agricultural workers into rice, coffee, and other agricultural production in the Dominican Republic over the past 15 years are analyzed using data from surveys conducted in 1985 and 1987. Unlike the classic Latin American cases of labor migration, the movement of Haitian workers to the Dominican Republic crosses national borders and involves a landless proletariat rather than peasant farmers seeking to supplement their subsistence. Most of the Haitians finding work in coffee and rice cultivation were former sugar cane workers with several years of residence in the Dominican Republic who were forced out of sugar cane cutting by the collapse of the industry in the 1980s. Although Haitians have been employed in Dominican agriculture since the early 1900s, their massive movement to crops of great labor demand other than sugar began in the 1980s. Most of the Haitian workers in rice and coffee are illiterate men with no more than 3 years of primary education. Their average age is 28.4 years for coffee and 29.1 for rice workers. 40% of coffee workers and 53% of rice workers had children. The survey found a greater proportion of migrants from the North zone of Haiti than have previous studies, probably because of the accelerating crisis in the peasant economy in the North and the curtailment of movement to the Bahamas. The technical and social organization of agricultural work goes far in explaining migratory flows. Rice cultivation has heavy labor demands year round, while demand for labor in coffee cultivation is concentrated between August-December. The more complex and better paying jobs in rice cultivation are performed primarily by Dominican workers, who have formed a landless agricultural proletariat in place for at least 2 generations. Dominican workers thus meet the condition of staying in place all year that is not completely possible for Haitian workers. No such ethnic separation occurs in the coffee harvest, and Haitian and Dominican workers are at the same hierarchical level. For various reasons, including the fact that the majority of coffee workers on large plantations are not Haitian, the field bosses tend to be Haitian as well. Assimilation of Haitian workers into coffee production has been easier than into rice cultivation, where social factors in addition to division of labor have hindered their progress. 3 different labor migration microsystems were detected among the workers studied: a circular system including sugar and coffee, a circular system in which peasants from the North of Haiti worked in rice cultivation, and noncircular settlement of former sugar cane cutters in coffee and rice. Haitian workers use their kin and friends as sources of information on labor demands and relative wages at different places in the Dominican Republic.
Data on 30,000 persons in 8000 households interviewed in the Expanded Household Questionnaire for the 1991 Demographic and Health Survey in the Dominican Republic provide a representative national sample for study of migration in rural and urban areas and in the eight health regions of the country. The data indicate that the number of persons living in a province other than that of birth increased from 381,000 in 1950 to 1,216,000 in 1981, but the proportion migrating remained constant at about one-fifth of the population. By 1991, an estimated 32% were living outside their province of birth. The 1981 census provided no information on the zone of origin of the migrants. The 1991 Demographic and Health Survey revealed that most migratory flows have an urban zone as the origin and destination. 52% of migrants were born in an urban zone and 65% went to an urban zone. Demographic and Health Survey data show that all types of migration currently coexist in the Dominican Republic, with urban-urban moves predominating at 37.3% of the total. 28% were rural-urban moves, 20% were rural-rural, and 15% were from urban to rural areas. 57% of migrants moved to a zone similar to that of their birth. 60% of the most recent migrations originated in an urban zone. Half of recent migrants were employed before moving. 55.4% were wage earners and 35.0% were self-employed. 53.0% of the nonemployed migrants did housework and 35.5% were students. 44.0% stated they migrated for family reasons, 22.0% to search for work or improve their income, and 12.0% to achieve greater comfort or better services at the place of destination.
