What is the role of the mother's education in family health?

Responsible researcher: Adriano Valladão Pires Ribeiro

Article title: HOW DOES MOTHER'S SCHOOLING AFFECT FAMILY HEALTH, NUTRITION, MEDICAL CARE USAGE, AND HOUSEHOLD SANITATION?

Article authors: Jere R. Behrman and Barbara L. Wolfe

Location of intervention: Nicaragua

Sample size: 1699 families

Big topic: Health

Type of Intervention: Role of mother's education in family health

Variable of main interest: Mother's education

Evaluation method: LISREL function

Policy Problem

The mother's education in a family would play a prominent role in increasing the demand for health items for the entire family, such as food, the use of medical care and sanitation conditions. One problem, however, is that several factors regarding health status are not observable, making it difficult to draw a direct relationship between these factors and the level of education. Therefore, exploring the effects of the mother's education on family health demands an adequate treatment of this problem.

Assessment Context

Starting from the idea that the mother's level of education would be linked to important factors such as health and nutrition, led, for example, the World Bank to suggest increasing women's education as a means of improving the health conditions of the population in developing countries. development. Next, we present a study carried out in Nicaragua on the impact of mother's education and other unobserved factors on health conditions. The data come from a national socioeconomic survey of women between 15 and 45 years old conducted in 1977 and 1978. Information from mothers in 1699 families in which there are health indicators for children under 5 years old was used.

Intervention Details​

Thinking about a model, parents, given their family income, would choose the consumption of health items for themselves and their children, as well as the consumption of goods and services not related to health. The health of each member of a family would be determined by nutrient intake, water and sanitation conditions, use of medical care, income, education and age of the mother, in addition to other characteristics of the mother and the district where they live. The characteristics of where they live include, among others, the availability and information about health services, while those of the mother include knowledge and health habits and past health status.

With the exception of the consumption of goods and services not related to health, income and the mother's age and education, all other variables above are not directly observed. In the process of determining the relationship between the mother's education level and the consumption of health items for the family, the lack of or error in measuring an important variable may end up placing more importance on education than it would have if the other factors were present. Thus, results obtained without this problem having been resolved or alleviated may end up providing a distorted view of reality. idp.edu.br

Methodology

The first step is to overcome the problem of unobserved health variables. Various related information available through the research was then used to infer about them, thus being able to say that they were imperfectly observed. The relationship between the information used and the variables is described below.

Children's Health: Standardized measurements of children's weight, height and biceps circumference.

Mother's Health: Four indices of health conditions based on information from mothers, such as the number of days too sick to work or perform similar activities in the last 6 months and having had, at some point in their lives, parasitic diseases, preventable diseases (examples : diphtheria and tetanus) or diseases with therapeutic treatment (example: typhoid and high blood pressure).

Nutrition: Two normalized measures of the family's nutrient intake (calories and proteins) in the week before the survey and qualitative information on whether or not they had a refrigerator (an important indicator given Nicaragua's tropical climate).

Use of Medical Assistance: Deviation in relation to the standard of the number of injections for children, in which trimester of the last pregnancy the mother had the first medical pregnancy examination and a qualitative variable of social security participation, since such participation covers subsidized medical assistance.

Water and Sanitation Conditions: Three indicators related to the absence and conditions of the bathroom in the house.

Location Characteristics: Index based on the total population of the district, the population density of the district, hospital beds per 1000 inhabitants and the proportion of the literate population.

Mother's Characteristics: Index based on the mother's education, whether she was brought to an urban area, whether her mother was present during adolescence, whether her father was present during adolescence and the number of siblings.

After constructing the measurements of the latent variables using this information, it is possible to examine both the effects of the mother's education, district characteristics and other mother characteristics on the first 5 (child's health, mother's health, nutrition, use of health care health care and water and sanitation conditions). First, the effect is estimated using only the mother's level of education without considering her other characteristics and the characteristics of the district. Second, the characteristics of the location are added to the system. Finally, it estimates the effect by also adding the mother's other characteristics.

Results

The first procedure only indicates the impact of the mother's education on health items. The effect is positive and significant for the child's health, nutrition, use of medical assistance and water and sanitation conditions, that is, only their own health is not so impacted by their education. Furthermore, there is a positive indirect effect on children's health via nutrition and sanitation. The second procedure also considers the characteristics of the location. Even though these characteristics have a positive effect on all health conditions, the impact of the mother's education remains very similar. In other words, the inclusion of these characteristics increases the explanatory power of health items, but without affecting the impact of education. Finally, the mother's other characteristics in the system, when added to the system, have a positive impact on all health items. Unlike the second procedure, here the mother's education loses all relevance and it would not be possible to say that this is a factor that has a positive impact on health and nutrition.

Politics Lessons

When dealing with relationships that involve imperfectly observed factors, great caution must be exercised when drawing conclusions and recommendations. The study presented reveals that the apparent importance of the mother's education in the family's health and nutrition may be overestimated. When adding other characteristics of the mother into the analysis, her education loses its positive effect on health in Nicaragua. If such a result is true for other developing countries, recommendations like the World Bank's may be misleading.

Reference

Behrman, Jere R.; Wolfe, Barbara L.. “How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation?”, Journal of Econometrics, Volume 36, Issues 1–2. 1987.