Maternal education and child survival in developing countries: The search for pathways of influence

Citation: Cleland, John G., van Ginneken, Jerome K. (1988) Maternal education and child survival in developing countries: The search for pathways of influence. Social Science and Medicine (Volume 27) (RSS)
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Tagged: uw-madison (RSS), wisconsin (RSS), sociology (RSS), demography (RSS), prelim (RSS), qual (RSS), WisconsinDemographyPrelimAugust2009 (RSS)

Summary

Discussion of the mechanisms by which female education impacts child health and survival in developing populations. Background associations: The Cochran World Bank study (1980) and UN (1985) study both found linear negative relationships between maternal edu and child mortality worldwide (studies did not include India and China). Childhood mortality improvements are greater than infant mortality improvements. Studies of India and China are consistent with these other findings. Even small increases in education can reduce the risk of mortality for children. Important Mechanisms: 1. Economic (material) advantage accounts for 50% of the relationship between edu and child mortality (U.N. 1985). With few exceptions, we can assume an additive (rather than interaction) model for the relationship between mortality, maternal edu, and economic (income, sanitation, water, etc) advantage. 2. Educated mothers are much more likely to access modern medical assistance for their children (Fernandez 1984). In many cases, greater overall access to modern healthcare can narrow the advantage that edu brings (Palloni 1985; Rosensweig and Schultz 1982), but the independent educational advantage still persists. 3. In the domestic sphere, more educated mothers tend to invest more in their children's welfare, have greater autonomy in healthcare decisions, be less fatalistic about disease, more knowledgeable about disease, more innovative w/remedies, and have a more sanitary lifestyle. While these findings suggest that domestic attitudes/care behaviors are extremely important intervening mechanisms, there is little direct evidence to support the link. Unimportant mechanism: 1. The shifts in maternal ages and birth spacing seen with more education have no independent effect on the edu-mortality association 2. Nutrition status is not an intervening factor b/c it would only affect a small pre/post-natal window, while the brunt of the improvement from edu is felt much later 3. Selection bias on education (women with healthy children are exceptional status-wise, psychologically, etc) is not important b/c of persistence of the edu-mortality relationship across populations that vary widely in edu access Miguel's summary: During the past 2 decades a considerable amount of information has become available from developing countries showing that maternal education has a strong impact on infant and child mortality. On average, each 1-year increment in mother's education corresponds with a 7-9% decline in under-5s mortality. Education exercises a stronger influence in early and later childhood than in infancy. The inverse education-mortality relationship is found in all major regions of the developing world; the association is very pronounced, but appreciably closer in childhood that in infancy; and even a modest exposure of the mother to formal schooling is associated with reduced risks of death in most contexts. The central theme of this paper is to assess the various mechanisms or intervening factors which could explain how mother's education influences the health and survivorship of her children. Two of the possible intervening variables, namely reproductive health patterns and more equitable treatment of sons and daughters, play a relatively minor role in the explanation of the relationship. Economic advantages associated with education (i.e. income, water and latrine facilities, housing quality, etc.) account for about ? of the overall education-mortality relationship. The influence of use of preventive and curative health services as a group of intervening variables is complex and variable. There are countries whose primary health services are so weak that they have no effect on the health of mothers and children; there are also other countries whose health services may tend to accentuate educational disparities because of differential access. Moreover, the ability of superior service provision to erode the advantage conferred by education should not be exaggerated. Large differences in relative risks of infant death across social classes and educational categories still persist in developed countries. The persistence of a strong influence of maternal education on child survivorship, regardless of the proximity or effectiveness of government health care provision, suggests that domestic child care practices may be the major intervening mechanism. Little is know about the intervening role of health beliefs and domestic practices (improved domestic health care is perhaps the pathway for which the evidence is most positive as compared to knowledge about disease and nutrition), but it is hypothesized that they are important in the explanation of the education-mortality. Finally, suggestions for specific studies on mechanisms or intervening factors are made and the relevance of such studies for formulation of health and educational policies is stressed.