Infant mortality in rural areas of the Krasnoyarsk Territory in 1991-2000

Stepanov Leonid Alekseevich Postgraduate student; Faculty of History; Krasnoyarsk State Pedagogical University named after V.P. Astafiev 660049, Russia, Krasnoyarsk Territory, Krasnoyarsk, Central district, Uritskogo str., 33 seregin98@inbox.ru

Introduction

In the 1990s, rural Russia experienced a deep demographic crisis that affected all parameters of population reproduction. Infant mortality occupies a special place among its indicators: it is sensitive to crisis impacts, but at the same time carries the inertia of long-term structural processes, which makes it an indispensable tool for assessing the state of reproduction and the degree of completion of the epidemiological transition.

This indicator is especially important for rural areas. The limited availability of medical care, the deformed age structure of the population and the destruction of social infrastructure in the 1990s created a specific environment in which crisis impacts were superimposed on accumulated structural deformations. At the same time, the dynamics of infant mortality was not limited to a direct reflection of the crisis — it had its own temporal logic, which differed from the trajectory of overall mortality. This is what makes it a valuable analytical tool for detecting the asynchrony of demographic processes.

Despite the general decrease in infant mortality in the RSFSR in the 1980s, this process was unstable and asynchronous in rural areas. In the 1990s, the crisis transformation exacerbated the accumulated structural deformations. The problem of the study is to identify the features of the dynamics and structure of infant mortality in the rural population of the Krasnoyarsk Territory in 1991-2000 in the context of an asynchronous and incomplete epidemiological transition.

The aim of the study is to identify the features of the dynamics, sexual differentiation and structure of the causes of infant mortality in rural areas of the region in 1991-2000 as an indicator of asynchronous and incomplete epidemiological transition.

To achieve it, it is necessary to solve the following tasks::

1) To analyze the dynamics of the total mortality of the rural population of the Krasnoyarsk Territory in the 1990s and determine the place of infant mortality in the system of demographic losses in rural areas.

2) To identify the main trends in infant mortality in rural areas of the region and the features of its sexual differentiation in the context of asynchronous demographic processes.

3) To characterize the structure of causes of death of children under the age of one year and trace its transformation during the 1990s as a reflection of the incompleteness of the epidemiological transition in rural areas of the Krasnoyarsk Territory.

The subject of this study is the dynamics and structure of infant mortality in the rural population of the Krasnoyarsk Territory in the 1990s, considered as a demographic indicator of the state and limitations of population reproduction in the context of post-Soviet transformation and asynchronous epidemiological transition.

The chronological framework of the study covers 1991-2000, which is determined by the logic of demographic processes and institutional changes in the post-Soviet period. The lower limit (1991) is associated with the beginning of stable crisis transformations in the reproduction of the rural population, a sharp deterioration in socio-economic living conditions and a weakening of the social and medical support system, which was directly reflected in the dynamics of mortality, including infant mortality. The upper limit (2000) is determined by the completion of the first stage of the transformational crisis and the fixation of the most unfavorable mortality parameters in the 1990s; after 2000, other trends related to economic stabilization and institutional changes that go beyond the period under review begin to manifest themselves. The selected interval represents an internally integrated stage of demographic development, which makes it possible to analyze infant mortality as a systemic element of the post-Soviet transformation of rural population reproduction. The study used the current mortality statistics of the rural population, published in the collections of Rosstat and Krasnoyarsk Statistics.

This work is based on methods of historical and demographic analysis aimed at studying the dynamics and structure of infant mortality in the rural population of the Krasnoyarsk Territory in the context of reproductive processes and long-term demographic trends. The use of structural and dynamic analysis made it possible to identify steady changes in infant mortality rates, the features of their transformation during the 1990s, as well as the relationship with the dynamics of the total mortality of the rural population. Comparative historical analysis was used to identify regional specifics and correlate the results with national trends. It is necessary to take into account the source limitation: the statistics of infant mortality in rural areas in the 1990s are not free from accounting distortions, primarily in terms of early neonatal mortality. As shown in the work of L. P. Sukhanova and co-authors ^[24], systematic underestimation was most pronounced in rural areas. This fact is taken into account when interpreting the results: the absolute values of the indicators may be underestimated, but this does not change the general orientation and relative ratios on which the main conclusions of the study are based.

The problem of infant mortality has been studied in the works of representatives of various sciences.

At the national level, the dynamics of infant mortality is considered in detail in the works of A. A. Baranov, V. Y. Albitsky, L. S. Namazova-Baranova, R. N. Terletskaya, which revealed crisis increases in indicators in the 1990s, a steady gap between urban and rural areas and the unfavorable situation of Siberia and the Far East, where the infant mortality rate was higher average Russian ^[1-3].

V. I. Starodubov, L. P. Sukhanova, and Yu.G. Sychenkov conceptualized infant mortality as "reproductive losses" - the irretrievable loss of human capital, showing the growth of these losses in the 1990s and the gap between rural and urban areas ^[23]

The article by E. V. Dubrovina records an increase in the proportion of deaths from external causes and "inaccurately identified conditions" ^[11]

The theoretical and methodological foundations of the analysis were laid in the works of A. G. Vishnevsky, who considered infant mortality as one of the key factors of the epidemiological transition taking place asynchronously in Russia, with pronounced regional specifics ^{[8, 9]}. The very concept of the epidemiological transition, on which this research tradition is based, dates back to the work of A. Omran, who linked the long-term reduction of mortality with a change in the structure of causes of death — the displacement of infectious and exogenous pathology by endogenous and chronic conditions ^[26].

The demographic reports "Population of Russia" noted that against the background of a sharp increase in adult mortality in the 1990s, infant mortality rates remained relatively stable, but at the same time significant differences between urban and rural areas were recorded, as well as problems with the reliability of registration of early age-related losses ^[13-16].

In the second book of the third volume, "The population of Russia in the XX century. Historical essays" noted that, despite the general decrease in infant mortality, the rate of this decrease in the RSFSR was among the lowest, while in rural areas the rates remained significantly higher than in urban areas, which indicated the persistence of structural imbalances and the incompleteness of the epidemiological transition by the end of the 1980s ^[17]

The regional demography of Siberia is presented in the works of A. A. Burmatov, V. A. Kyshpanakov, O. L. Rybakovsky, E. E. Tinikova, but infant mortality in them, as a rule, was considered in the context of reproduction of the rural population as a whole, without becoming an independent object of analysis. ^{[4, 12, 18, 25]}.

Social and infrastructural factors were considered by O. M. Verbitskaya, who showed the degradation of the rural healthcare system in the 1990s, the reduction of the FAP network, staff shortages and a decrease in the availability of obstetric and neonatal care ^[5]. These conclusions are complemented by generalizing demographic estimates that record persistently high infant mortality rates in rural areas, even against the background of a sharp decline in the birth rate ^[6]. There was also a pronounced regional differentiation of infant mortality, directly related to the state of medical infrastructure and the level of technical equipment of specialized institutions, with the most unfavorable indicators in Siberia, the Far East and the northern regions of the country ^[7].

The reliability of infant mortality statistics is analyzed in an article by L. P. Sukhanova, N. N. Bushmeleva, Z. H. Sorokina, who revealed systematic distortions in accounting for early neonatal mortality, most pronounced in rural areas ^[24].

Historical and demographic studies of the Krasnoyarsk Territory are most consistently presented in the works of L. N. Slavina. In particular, the general dynamics of mortality of the rural population of the region has been reconstructed and the crisis character of the 1990s has been recorded ^[20-22]. At the same time, infant mortality in these studies is considered as part of the overall indicators.

Certain aspects of early age-related losses in rural areas of the region are discussed in an article by E. I. Semykin, who justified the need for a differentiated analysis of infant mortality with separation of neonatal and post-neonatal periods, and also pointed out the problem of underestimation of infant losses in rural areas of the Krasnoyarsk Territory ^[19]

Despite a significant body of research, the problem of infant mortality among the rural population of the Krasnoyarsk Territory in the 1990s has not yet been the subject of a special historical and demographic analysis focused on identifying its role in the system of reproductive constraints and the asynchrony of demographic processes. The present study is aimed at filling this gap.

The dynamics of the total mortality of the rural population of the Krasnoyarsk Territory and the place of infant mortality in its structure

In the 1990s, the mortality rate of the rural population of the Krasnoyarsk Territory developed in line with the all-Russian crisis trends, but was characterized by a higher intensity and stability of adverse manifestations. The overall mortality rate in rural areas of the region has shown a marked increase over the decade (Table 1), reflecting the deterioration of socio-economic living conditions and accumulated structural deformations of population reproduction.

Table 1. General mortality rates of the rural population of the Krasnoyarsk Territory in 1991-2000

Source: Demographic Yearbook of the Krasnoyarsk Territory. Krasnoyarsk: Krasnoyarsk State Statistical Office, 2023. p. 32.

In the first half of the 1990s, the total mortality rate in rural areas of the region increased sharply: the absolute number of deaths increased from 9.8 thousand in 1991 to 13.7 thousand in 1994, the coefficient increased from 11.9% to 16.8%. In the second half of the decade, the indicators stabilized at a high level and continued to grow slowly, reaching 17.8% by 2000. In rural areas of the Russian Federation, the overall mortality dynamics was similar: the mortality rate increased from 13.4% in 1991 to 17.0% in 2000 ^[10], but by the end of the decade, the indicator in the Krasnoyarsk Territory exceeded the national average.

Against this background, the dynamics of infant mortality was different – and this in itself is analytically significant. The absolute number of deaths of children under one year of age decreased: from 315 cases in 1991 to 205 in 1996 and 227 in 2000 (a decrease of 27.9%). In rural Russia, the decline was deeper, from 10.9 thousand to 6.4 thousand (by 41.9%) ^[10]. However, there was a fundamentally different process behind the reduction of absolute numbers. The infant mortality rate in the region did not decrease – it grew: from 24.7% in 1991 to 32.0% in 1999. We are faced with the classic "scissor effect": the absolute number of deaths fell as the number of births rapidly decreased, but the survival rate of each child born did not improve, but worsened. In other words, fewer children were born, but the risk of dying in the first year of life increased for each of them. It is the coefficient, not the absolute figure, that reflects the real state of reproduction conditions.

At the same time, the role of infant mortality in the demographic loss system was changing. The proportion of children under one year of age among all deaths in the region decreased from 3.2% in 1991 to 1.7% in 1994 and remained below 2% until the end of the decade – a general shift in losses towards older age groups. At the same time, a decrease in the proportion of infant mortality in the loss structure did not mean an improvement in its own parameters: the coefficient remained among the highest in the country.

The regional gap with the all-Russian data was growing. In rural Russia, the infant mortality rate generally decreased: from 19.1% in 1991 to 16.8% in 2000, despite a short-term rise in 1993-1994 ^[10]. In the Krasnoyarsk Territory, this indicator was significantly higher throughout the decade: 24.7% in 1991, 24.4% in the mid-1990s, with a sharp increase in the second half of the decade to 29.8% in 1998 and a maximum value of 32.0% in 1999; in 2000, it decreased to 29.2%, remaining significantly higher than the average Russian level.

Thus, the Krasnoyarsk Territory did not just reproduce the all-Russian trajectory with increased values. Its coefficient grew when the national one decreased, which requires an appeal to regional specifics, and not only to the general patterns of the crisis. Infant mortality in rural areas of the region reflected regionally aggravated reproduction restrictions that did not fit into the framework of the nationwide trajectory of the crisis.

The explanation for this discrepancy lies in the specific historical conditions of rural life in the region in the 1990s. The Krasnoyarsk Territory is one of the most extensive and unevenly developed regions of the country: a significant part of its rural population lived in northern and equivalent areas with a focal type of settlement, low population density and poor transport links. In such conditions, the timeliness of obstetric, neonatal and emergency pediatric care directly depended on the distances and the condition of the road network, which only worsened in the 1990s. The reduction in budget financing of healthcare was accompanied by the curtailment of the network of paramedic and obstetric stations and district hospitals, a shortage of personnel and a decrease in the availability of specialized care in rural areas - processes traced by O. M. Verbitskaya on the all–Russian material ^[5-7] and manifested in the region especially acutely due to its geography. The remoteness of the woman in labor from the maternity hospital, the impossibility of rapid hospitalization of the newborn in critical condition and the shortage of equipment in district institutions created an increased risk of death of the child precisely where the density of medical infrastructure was the lowest.

These structural constraints were compounded by the economic shocks of the second half of the decade. The financial and economic crisis of 1998 sharply reduced the real incomes of the rural population and the possibilities of budgetary financing of the social sphere, which chronologically coincided with the peak values of infant mortality in the region in 1998-1999. The combination of long-term factors (resettlement, northern specifics, degradation of rural medicine) with the short-term shock of 1998 makes it possible to explain why it was in the Krasnoyarsk Territory that the infant mortality rate reached its maximum when the all-Russian rural indicator was already declining. This combination makes the regional case a meaningful object of independent analysis, rather than a particular manifestation of the average trend.

Dynamics and gender differentiation of infant mortality

One of the stable patterns of infant mortality is its sexual differentiation, expressed in the excess mortality of boys over the mortality of girls, which is considered in demography as a manifestation of the biologically determined vulnerability of the male infant population.

In rural areas of the Krasnoyarsk Territory in the 1990s, this pattern persisted throughout the study period, but had a number of features (Table 2). In all the years of observation, the number of boys who died exceeded the number of girls who died.

Table 2. The number of deaths of children under the age of 1 by gender in rural areas of the Krasnoyarsk Territory in 1991-2000, people.

Source: Demographic Yearbook of the Krasnoyarsk Territory. Krasnoyarsk: Krasnoyarsk State Statistical Office, 2023. p. 35.

On average, the proportion of boys among deceased infants in the region ranged from 56.8-63.4%, while the proportion of girls was 36.4-43.2%, which generally corresponds to generally accepted demographic ideas about the sex structure of infant mortality.

In the first half of the 1990s, the reduction in the absolute number of deaths of children under one year of age occurred synchronously in both sexes - from 315 cases in 1991 to 205 in 1996 (206 in 1997). This dynamics reflected the inertial decrease in infant mortality typical for this period. At the same time, the gender gap persisted: for example, in 1996, out of 205 babies who died, 128 were boys and 77 were girls.

At the end of the decade, the dynamics of infant mortality changed. In 1998-1999, against the background of a general increase in infant mortality rates, the number of children who died increased again to 247 and 248, respectively. At the same time, the increase in mortality was more pronounced among boys: in 1998, 157 boys died compared to 90 girls (63.6% and 36.4%, respectively), which indicated a widening gender gap in the context of the demographic crisis.

In the early 2000s, a renewed decrease in infant mortality was recorded: by the 2002 census, the total number of dead children had decreased to 181 people. Sexual asymmetry persisted, but was less pronounced: 99 boys (54.7%), 82 girls (45.3%). Of course, these changes go beyond the chronological interval, but they allow us to capture the general direction of subsequent processes.

At the national level, in the 1990s, there was also a steady excess of boys' mortality over girls' mortality. During the entire decade, the proportion of boys among those who died before the age of one averaged about 59-60%, while the proportion of girls was 40-41%. Thus, in 1991, out of 10,943 deceased infants, 6,475 were boys (59.2%) and 4,468 were girls (40.8%), and in 2000 the corresponding figures were 3,691 (58.1%) and 2,661 (41.9%) people ^[10].

In the dynamics of rural Russia as a whole, the sexual differentiation of infant mortality was relatively stable and did not show sharp fluctuations even during periods of general growth in indicators. The decrease in the absolute number of deceased infants in the 1990s occurred synchronously for both sexes: the total number of deceased boys decreased from 6,475 in 1991 to 3,691 in 2000. (by 43.0%), and girls – from 4,468 to 2,661 (by 40.4%) ^[10].

Against this background, the rural area of the Krasnoyarsk Territory was characterized by a more pronounced instability of the sexual structure of infant mortality. In some years, the proportion of boys among deceased infants in the region exceeded 63%, and the widening of the gender gap was most clearly manifested during periods of rising infant mortality in the second half of the 1990s. Consequently, while in Russian villages as a whole, the gender differentiation of infant mortality remained relatively stable, in the Krasnoyarsk Territory it turned out to be more sensitive to crisis fluctuations in the demographic situation.

A comparison with the all-Russian data reveals a noticeable difference. In rural Russia, sexual differentiation was stable for about 59-60% of boys and did not show sharp fluctuations even during periods of general mortality growth. In the villages of the Krasnoyarsk Territory, the gap widened precisely during the crisis years, to 63.6% in 1998. The biologically determined lower resistance of boys to adverse external influences – malnutrition, hypothermia, delayed medical care — explains the basic excess of their mortality and suggests that in the conditions of exacerbation of these factors in 1998-1999, the male infant contingent reacted more acutely. Thus, the dynamics of the gender gap can be considered as an indirect indicator of the intensity of social stress.: A stable gap is the norm, and a widening gap is a signal of deterioration in living and medical conditions beyond the average level.

The structure of causes of death of children under the age of 1 year

The structure of the causes of infant mortality is an important indicator of the stage of epidemiological transition and allows us to assess the nature and direction of changes in the conditions of population reproduction (Table 3). In contrast to the dynamics of the overall infant mortality rate, the analysis of the causes of death made it possible to identify the ratio of endogenous and exogenous factors of early age losses, as well as to trace the degree and direction of their transformation over time.

Table 3. Infant mortality rates by main cause classes in rural areas of the Krasnoyarsk Territory in 1991-2000 (deaths under the age of 1 year per 10,000 births)

Sources: Demographic Yearbook of the Krasnoyarsk Territory, 1997. Krasnoyarsk: Krasnoyarsk Statistical Office, 1998. p. 122; Demographic Yearbook of the Krasnoyarsk Territory, 2001. Krasnoyarsk: Krasnoyarsk State Statistical Office, 2002. p. 114.

Note: ICD-10 classes of causes of death: I – infectious and parasitic diseases; VI – diseases of the nervous system; X – respiratory diseases; XVI – certain conditions that occur in the perinatal period; XVII – congenital anomalies (malformations), deformities and chromosomal abnormalities; XX – external influences (poisoning, injuries, accidents)

In rural areas of the Krasnoyarsk Territory in the 1990s, the structure of the causes of infant mortality was characterized by a steady predominance of causes related to the perinatal period and congenital anomalies, while maintaining a significant role of exogenous factors.

Throughout the decade, the leading causes of death in children under the age of one year remained certain conditions that occur in the perinatal period. Their contribution to the overall infant mortality rate was the highest and ranged from 75.4 to 96.6 cases per 10,000 live births, reaching maximum values in 1998 (96.6) and 2000 (91.2). In absolute terms, the number of deaths from certain conditions occurring in the perinatal period remained high throughout the decade: 99 infants in 1991, 78 in 1994, 69 in 1996-1997, and 71 in 2000. Even against the background of a general reduction in infant mortality, this group of causes formed the largest contribution to the structure of early age losses. Within this group, a significant proportion consisted of birth injuries and intrauterine hypoxia and asphyxia during childbirth, the cumulative number of which in the early 1990s exceeded 40-50 cases per year, and by the end of the decade decreased only partially, remaining a structurally significant component of infant mortality. The steady dominance of this group of reasons testified to the continuing problems of obstetric and neonatal care and the state of maternal health in rural areas of the region.

In Russian villages, perinatal conditions also occupied a leading place in the structure of causes of infant mortality. Their coefficients in the 1990s ranged from 61.6 cases per 10,000 live births in 1990 to 74.0 in 1994, gradually decreasing to 63.0 in 2000 by the end of the decade ^[10]. Unlike the villages of the region, the national level did not show such high values and sharp fluctuations.

Further in the structure of the causes of infant mortality were congenital anomalies, deformities and chromosomal abnormalities. During the 1990s, mortality rates for this group remained high and unstable, ranging from 44.0 in 1991 to 66.4 in 1998 and 60.4 in 2000. The number of deaths due to congenital anomalies, deformities and chromosomal abnormalities ranged from 38 to 58 cases per year during the 1990s.: 56 cases in 1991, 54 in 1994, 49 in 1996, 55 in 1998 and 47 in 2000. The absence of a pronounced downward trend indicates the persistence of structural limitations in the field of prevention and early diagnosis of congenital pathology in rural areas of the region. The most significant subgroup remained congenital anomalies of the circulatory system, the number of deaths from which ranged from 16 to 26 cases per year.

At the national level, infant mortality rates from congenital anomalies in the 1990s showed a moderate increase in the first half of the decade, from 33.3 in 1990 to 42.4 in 1997, with subsequent stabilization and decrease to 34.0 in 2000 ^[10], which highlighted the great instability and lack of downward trend of this group of causes in villages edges.

Exogenous causes continued to play a significant role – those that are characteristic of the pre-transition stages of epidemiological development. Respiratory diseases remained at a high and unstable level throughout the decade: 50.9 in 1997, 62.0 in 1999, 51.4 in 2000. Absolute numbers confirm: 49 cases in 1991, 57 in 1992, 40-48 at the end of the decade. The main share was acute pneumonia – more than 30 cases in some years. In rural Russia as a whole, the coefficient steadily decreased from 41.2 in 1990 to 26.7 in 2000 ^[10]. The Krasnoyarsk Territory was breaking out of this trajectory.

Mortality from infectious and parasitic diseases demonstrated a similar, but even more fluctuating dynamics. The coefficients remained unstable and increased sharply in some years: 35.2 in 1993 and 24.5 in 1999. The absolute number of deaths in this group did not decrease steadily: 36 cases in 1993, 15 in 1998 and 19 in 1999. The continued significant role of this group of causes indicates an incomplete displacement of infectious pathology from the structure infant mortality and the sustainability of factors contributing to its reproduction in rural areas of the region. Special attention should be paid to 1993, which saw the peak of infectious mortality (35.2 per 10,000), with a decrease in the absolute number of dead infants (283 versus 298 in 1992) and an increase in the overall rate to 27.7%. This combination may indicate both a local increase in morbidity and the specifics of registering causes of death in a particular year; it is out of the general trajectory and needs additional source verification, which is why it is not used in the work as a basis for independent conclusions.

In rural areas of the Russian Federation, mortality rates from infectious and parasitic diseases in the 1990s showed a steady downward trend, from 19.7 in 1990 to 13.1 in 2000 ^[10]. In the Krasnoyarsk Territory, on the contrary, the dynamics of this group of causes was more fluctuating, reflecting the persistence of factors preventing the displacement of infectious pathology from the structure of infant mortality.

Accidents, poisoning, and injuries deserve special attention. During the crisis years, their ratio increased sharply: 41.1 in 1998 and 40.1 in 1999, against 22.8 in 1991. Absolute numbers: 29 cases in 1991, 34 in 1998, 31 in 1999. In rural Russia, this indicator was kept twice as low – 10.9–14.3 during the decade ^[10]. The steady and almost threefold excess is difficult to attribute only to random fluctuations and allows us to consider this group of causes as one of the most sensitive indicators of social disadvantage in the structure of infant mortality. It can be assumed that it is based on factors characteristic of post—Soviet villages - a decrease in the availability of medical care, a weakening of social control and household disorder, which O. M. Verbitskaya pointed out in relation to rural healthcare in the 1990s ^[5-7].

In Russian villages, mortality from accidents, poisoning and injuries remained relatively stable in the 1990s: the coefficients ranged from 10.9 in 1990 to 14.3 in 1999 and amounted to 12.9 in 2000 ^[10], when higher values and sharp rises in indicators were recorded in the Krasnoyarsk Territory during the crisis years, which demonstrated increased sensitivity of the regional infant mortality structure to socio-economic shocks.

Diseases of the nervous system and sensory organs made the least contribution to the structure of the causes of infant mortality in rural areas of the Krasnoyarsk Territory. Their indicators remained relatively low throughout the decade and decreased to minimum values in the mid-1990s (1.2 in 1996-1997), however, at the end of the decade, the coefficients increased again to 5.1-5.2 in 1999-2000.

Thus, the structure of the causes of infant mortality in rural areas of the Krasnoyarsk Territory in the 1990s combined signs of various stages of epidemiological transition: with the dominance of perinatal conditions and congenital anomalies, a significant proportion of exogenous causes remained and increased during the crisis years - respiratory diseases, infectious diseases and external influences. Compared to rural Russia as a whole, these features were more pronounced in the region.

Conclusion

The conducted research made it possible to reconstruct the dynamics, structure and features of infant mortality in the rural population of the Krasnoyarsk Territory in the 1990s as one of the most sensitive indicators of the state of population reproduction in the conditions of post-Soviet transformation. The results obtained are generally consistent with the conclusions of the Russian demographic and historical-demographic literature, while clarifying them in relation to the rural periphery of the large Siberian region.

It was found that the dynamics of infant mortality in rural areas of the Krasnoyarsk Territory developed in line with national trends, but was characterized by higher levels and pronounced instability. While the absolute number of deaths of children under one year of age decreased from 315 cases in 1991 to 227 cases in 2000, infant mortality rates remained high throughout the decade and ranged from 24-25% in the early 1990s to a maximum of 29.8–32.0% in 1998-1999. These fluctuations coincided with periods of socio-economic aggravation and indicated a high sensitivity of infant mortality in rural areas to crisis impacts, in contrast to the more sluggish nature of the overall mortality dynamics.

The analysis of sexual differentiation showed a steady excess of boys' mortality over girls' mortality throughout the decade: the proportion of boys among deceased infants averaged 56.8–63.6%. At the same time, during periods of rising infant mortality, primarily in the late 1990s, the gender gap widened, reaching more than 63% of deaths among boys, reflecting the asynchronous reaction of various demographic groups to deteriorating reproductive conditions and a combination of biological and socio-economic factors.

The study of the structure of the causes of infant mortality revealed a stable dominance of perinatal conditions and congenital anomalies, while maintaining a significant role of exogenous causes — respiratory diseases, infectious diseases and external influences. Mortality from the latter increased during the crisis years to values that had no analogues in rural areas of Russia as a whole, indicating the incompleteness of the epidemiological transition and the increased sensitivity of the regional structure of causes of death to socio-economic shocks.

Taken together, the results obtained made it possible to consider infant mortality in the rural population of the Krasnoyarsk Territory in the 1990s not as a peripheral element of demographic processes, but as a structurally significant indicator of the quality of population reproduction conditions. The analysis of early age-related losses reflected a combination of long-term structural deformations and short-term crisis impacts, and also confirmed the asynchronous and incomplete nature of the epidemiological transition in rural areas of the region in the post-Soviet period.

The scientific novelty of the study lies in the fact that the infant mortality rate of the rural population of the Krasnoyarsk Territory in the 1990s for the first time became an independent subject of historical and demographic analysis: based on current statistics, its dynamics, sexual differentiation and the structure of causes of death were reconstructed, and the data obtained were systematically compared with all-Russian rural indicators. This allowed us to show that the region did not reproduce the average nationwide trajectory with increased values, but demonstrated the opposite direction of the coefficient and a more pronounced incompleteness of the epidemiological transition. It is advisable to conduct further study of the problem in several directions: the transition to the regional (microterritorial) level, which can reveal intraregional differentiation of early age losses; the involvement of materials from health authorities and socio-demographic sources to verify the role of individual mortality factors; as well as the expansion of the chronological framework to 2010-2020, which would make it possible to strictly assess the degree of completion of epidemiological the transition is based on a long-term retrospect.

The article is published in the version approved by the reviewers (after receiving a positive review recommending the manuscript for publication) with corrections made by the author (after receiving the editor’s comments, if any).
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