Evidence for causal links between education and maternal and child health: systematic review

Abstract

Objective Numerous studies have documented an inverse association between years of schooling attained, particularly by women, and reduced maternal, infant and child mortality. However, if factors affecting educational attainment — many of which are unobservable, e.g. motivation and genetic endowment — also affect the likelihood of engaging in behaviours that enhance health, then assumed effects of schooling will be inflated in analyses that do not address this endogeneity. This systematic review assesses evidence for a causal link between education and maternal and child health in low and middle‐income countries. Methods Eligible studies controlled for observable and unobservable factors affecting both education and health. Reported effects were converted into partial correlations. When possible, we also conducted meta‐analyses to estimate mean effects by outcome. Results Of 4952 papers identified, 16 met the inclusion criteria. The 15 child health papers examined neonatal, infant and child mortality, stunting and wasting. Significant effects of education on infant and child health were observed for 30 of 33 models that did not account for endogeneity. In contrast, only 18 of 46 effects were significant in models that addressed endogeneity. Notably, for only one outcome —child mortality measured dichotomously —was the effect of maternal educational attainment significant in a meta‐analysis. The one maternal morbidity paper found significant effects for the two preventable outcomes considered. Conclusion While we find evidence for a causal link between education and health, effects are weaker in models that address endogeneity compared to naïve models that do not account for unobservable factors affecting both education and health. Advances in women's educational outcomes have undoubtedly played a role in improving health in many settings; however, the effect is not as strong as some researchers and advocates have claimed.

Children’s education and parental old-age health: Evidence from a population-based, nationally representative study in India

“…India's older population is particularly economically and socially vulnerable due to high rates of illiteracy and economic dependency (Bloom et al 2010). In this context, investments in children's education may be advantageous not only for the health of those individuals themselves (Grossman 1975;Link and Phelan 1995;Lleras-Muney 2005;Baker et al 2011;Berkman et al 2014;De Neve et al 2015) and for their own children (Gakidou et al 2010;Karlsson et al 2019;Mensch et al 2019), but also for the older generations (Zimmer et al 2007;Torssander 2013).…”

Nationally and regionally representative analysis of 1.65 million children aged under 5 years using a child-based human development index: A multi-country cross-sectional study

“…Although this finding appears counterintuitive, a growing literature suggests mixed child health returns to additional years of maternal schooling [35][36][37][38]. A recent systematic review examined evidence for a causal link between maternal education and child health and found that parental schooling may play a more muted role in parents' decisions about whether and how much to invest in their children's health than previously suggested [39]. Moreover, even well-educated parents seeking to correct common health risks in their children may lack access to high quality primary healthcare services or face high out-of-pocket expenditures [40].…”

The influence of the Municipal Human Development Index compared to maternal education on infant mortality: a retrospective cohort study in the extreme south of Brazil

“…The higher educational level of mothers, together with their better intellectual capacities, help in health choices, increase the understanding and use of information and improve the perception of health problems [45]. They also invest in more health-beneficial behaviors, both at the individual and child levels, showing better adherence to health recommendations in terms of nutrition, exercise and reduction of harmful habits [46][47][48][49].…”