Today there is widespread consensus that the rapid decline in mortality achieved by China after 1949 was due to large investments in public health and nutrition and, to a lesser extent, education. While not challenging the crucial role of public health investments, this paper argues that little-explored social factors may also be important. Its most basic proposition is that the Communist revolution of 1949 reduced mortality in part by fundamentally altering family structure and organization. The corollary is that patterns of preliberation family organization were implicated in the exceedingly high levels of child mortality in the early 20th century. Drawing on field data gathered from three villages in the northwestern province of Shaanxi, the paper develops and tests a series of hypotheses about the links between changes in family organization and the decline in infant and child mortality during the decades 1940–79. The data reveal clear connections between pre-1949 family organization—characterized by complex domestic structures, sharp generational hierarchies, and relatively high fertility—and the high levels of child mortality that prevailed before the Communist takeover, and between post-1949 family life—marked by rapidly simplifying structures, weakening internal hierarchies, and birth planning—and the large declines in mortality in the first three decades after the socialist revolution.

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This page updated 28 April 2005

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