Urban Advantage or Urban Penalty?: Under-5 Mortality and Urbanization in Sub-Saharan Africa

Rapid urbanization rates in sub-Saharan Africa (SSA) have been accompanied by worsening urban child health outcomes and a narrowing of the region’s historic under-5 urban survival advantage. I use DHS data from twelve SSA countries to investigate whether there is an aggregate change in this differential between 1995-2000 and 2005-2010. I find that the urban advantage persists, but that it is weakening. I then examine whether the diminishing urban advantage is uniform across urban areas and find it is not. The overall decrease in the mortality differential is due to slower improvements in survival rates in smaller urban areas compared to the largest cities or rural areas. These findings support the growing literature which finds that rapid urbanization in SSA poses the greatest risk to improvements in child survival the smaller cities most likely to see the greatest proportional growth in the coming decades.