California Center for Population Research

The fundamental cause argument represents a distinctively sociological approach to explaining persistent social disparities in health across a range of sociohistorical contexts. We elaborate and test this U.S.-based argument using nationally representative survey data from China covering births from 1970 to 2001, and focusing on social disparities in infant mortality over a period of dramatic social, political, and macroeconomic change. Our results show that despite the massive changes during the last several decades, the increasing use of medical pregnancy care, and the steady decline in the overall risk of infant mortality, disparities in infant mortality by mother’s education and urban/rural place of residence remained largely unchanged. During this period, more educated women were increasingly likely to take advantage of the newly-available prenatal care and delivery assistance facilities, while urban women maintained a stable advantage over rural women in use of these facilities. This differential utilization of highly-effective maternal care technology has maintained social disparities in infant mortality over a period of major social and technological change in China, providing support for the fundamental cause argument.