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

During the past two 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 one-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 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 one-half 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. Little is known about the intervening role of health beliefs and domestic practices, but it is hypothesized that they are important in the explanation of the education-mortality relationship. 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.