issue 164 - October 1986
Why reading keeps
What makes a child live or die? Peter Adamson reports
on a startling discovery: that maternal literacy may be the
most powerful single factor in promoting children's survival.
In the mid-1970s, Professor Iram Orubuloye and Professor John CaIdwell completed a remarkable piece of research in two villages of Eastern Nigeria. The object of their study was to see if public health services reduced infant deaths.
In one of the villages, clinics were conveniently located and frequently used. In the other, there were no public health services within a manageable distance.
Apart from this one significant difference, the two villages were broadly similar in levels of food supply and access to water and sanitation. The results showed that the use of public health clinics did indeed reduce the rate of infant deaths. But it also showed something less obvious.
In the 'healthy' village, a baby born to an illiterate woman was found to be two-and-a-half times more likely to die in childhood than a baby born to a mother who had been to school When the data from the village without health services was examined, the effect of the mother's education was seen to be even more pronounced. There, the child of an educated woman was found to be four times more likely to survive.
Surveys in at least 25 different nations over the last quarter of a century have all come to the conclusion that child health improves with the level of maternal education. But it had previously been assumed that the mother's educational level was simply an indicator of her social and economic position and that it was this, rather than the provision of education itself, that determined her child's well-being. What this research in Nigeria showed is that a mother's level of education is in fact a powerful lever in its own right for raising the level of child health.
More evidence comes from China, Sri Lanka, and the Indian state of Kerala. With per capita GNPs of considerably less than $750 per year, they are among the poorest regions of the developing world. Yet in each case, infant mortality rates are also among the lowest in the poor world. And of all the factors which might explain this apparent anomaly, none is more prominent than the fact that each has invested heavily in the education of its girls. Almost all girls attend secondary school and female literacy has been promoted to nearly European and North American levels.
In a further Nigerian study, this time in Ibadan, Professor Caldwell compared infant mortality rates in two contrasting areas of the city. He found that the death rate among children born to women with elementary education was 30 per cent lower than among children born to women with no schooling at all.
He concluded the Ibadan study with this unequivocal statement: 'Maternal education is the single most significant determinant of these marked differences in child mortality. Such differences are also affected by a large range of other socioeconomic factors, but no other factor has the impact of maternal education."
Similar conclusions have been reached by studies in Kenya. As a result of a very high level of investment in education (currently claiming approximately 20 per cent of the national budget) Kenya has managed to push primary school enrolment ratios to well over 80 per cent for both boys and girls. Over the same period (1962-79) Kenya has also managed to lower its infant mortality rate dramatically. A study by Henry Mosely2showed that more than three-quarters of the fall in infant mortality rates was due to the rise in the number of women who had been to school. Why does maternal education exert such a powerful influence? Common sense suggests several explanations. An educated mother is clearly more likely to be better informed about such issues as the importance of immunisation, ante-natal care, breast-feeding, hand-washing, weaning, home hygiene and the treatment of basic illnesses and injuries. Studies in São Paulo, for example, have shown that children of educated mothers were better fed - for any level of income.
But perhaps even more important than this increased knowledge is the psychological shift in the mother. Education tends to undermine fatalism and resignation, substituting a degree of confidence, a different perception of the possible, an awareness of choice, an attitude of questioning, a belief that decisions can be made, circumstances changed, lives improved.
In practice, such changes may mean that a mother is not only more likely to know more about the world outside the home but to demand more from it. She is, for example, more likely to visit doctors and nurses and more likely to demand their respect and attention. All of this adds up to an enhanced ability to cope with the day-today difficulties of protecting the lives and health of children in difficult physical and economic circumstances.
After many years of research Professor Caldwell's own conclusion is this: 'The education of women greatly changes the traditional balance of familial relationships with profound effects on child care ... A woman with schooling is more likely to challenge her mother-in-law and the mother-in-law is much less likely to fight the challenge. The younger woman will assert the wisdom of the school against the wisdom of the old. She is more likely to attempt to communicate with her husband, and her husband is less likely to reject the attempt.'
Educating women also has the effect of shrinking family size, by making mothers more aware of family planning methods, by tending to increase the average age of marriage and by opening up work-opportunities for women. Crucially, too, an educated woman is more likely to be able to persuade her husband to use - or allow her to use - contraception. And before she can persuade her husband, she must be able to persuade herself that she has the ability and the right to choose to limit her family; that she need not accept, fatalistically, every baby that is 'sent' to her to mother. Education helps her believe she has this right to choose the pattern of her life.
What has family size to do with infant survival? Smaller families, with longer spaces between pregnancies, mean that both mothers and children are healthier - for healthier mothers produce healthier babies, more likely to survive, A space of less than two years between births doubles the risk of maternal and child death.
If the education of girls is indeed, as the World Bank has said, one of the best investments which any nation can make in its own future, then most countries of the developing world have made a very considerable investment over the last twenty years. In 1960, the average rate of female enrolment in primary schools in the poorest half of the world was only just over 30 per cent. Today, it is more than 80 per cent.
Apart from the great gains made in China, where almost 100 per cent of girls now attend primary schools, the rate of female enrolment has also doubled or almost doubled in Bangladesh, Ethiopia, Nepal, Somalia, Zaire, Mozambique, Tanzania, Sudan, Ghana, Kenya, Zambia, Papua New Guinea, Morocco, Tunisia, Syria, Algeria, Iran, Iraq and Libya.
Too many girls are still left out of school. But by any standards this is a remarkable record which should not go unacknowledged. In the cause of justice for the world's women, as well as in the cause of better health for the world's children, this change has a fair claim to being regarded as one of the great achievements of the last quarter of a century.
And it is one of the most hopeful signs for the next. For the steep rise in the numbers of girls enrolled in schools is beginning to translate itself now into a rise in the numbers of mothers who are literate - and whose new-born confidence will not only help improve their own lives but also keep their new-born babies alive.
Peter Adamson was the first editor of the NI and currently produces UNICEF's State of the World's Children' report.
1 J C Caldwell, Maternal education as a factor in child mortality,world Health Forum, vol.2, No. 1
2 W Henry Mosely, Will primary health care reduce infant and child mortality?