Exploring the Missing Link between Maternal Health & Education

“Education is the most powerful weapon which you can use to change the world.” -Nelson Mandela

True, education has transformative powers and is one of the greatest resources humanity has got to offer. Unfortunately, women -not just in India, but all over the globe- are rarely given the opportunity to embrace this power. Globally, two-thirds of the illiterate population are women. A sad state, for education really does save lives: In fact, if every woman has access to a primary and secondary education, maternal (and childhood) deaths can be cut nearly by half.

Maternal mortality is one of the starkest indicators of global inequality and is one of the dominant development agenda for every nation across the globe today. Every new day sees approximately 800 female deaths. Unfortunately, 99% of these deaths are from preventable causes related to pregnancy and childbirth. However, the good news is that maternal mortality is on a decline. Thanks to “continuum care” for pregnant women and children involving the complete gamut of nutrition, skilled birth attendants, antenatal, intrapartum and postpartum care, HIV/AIDS counselling and reproductive health support that tops the policy implementation agenda, things are improving.

However, while policy documents as well as academic literature on maternal mortality gives credit to these improvements, they blatantly miss on another key contributor to the reduced maternal deaths – Education. It is a well-research and established fact that there exists a positive correlation between maternal education and maternal health. Maternal education not only improves the access of information for women but empowers them with the autonomy of choice and decision as well as the means to purchase health inputs. Undoubtedly, the demand of the time is not either health or education for young girls and women, but both.

Establishing the Correlation

Maternal mortality serves as a crucial determinant of life expectancy for women, however not much is known about the causal effect of education on maternal health and mortality. But studies have time and again suggested the significant contribution of education to maternal health by way of not just altering the traditional balance of power in the patriarchal fabric of our family structure, but also changing the knowledge and perception among women about disease causation and the role of modern medicine in both female and childcare practices, thus, taking advantage of the modern healthcare services.

In fact, studies indicate the significant correlation of lower levels of maternal education and higher maternal and childhood mortality. Research reveals that education has an established link with improved mother and child health, and lower fertility. Women, as the primary promoters of health education and healthy practices in the family, with even little formal education are more likely than the uneducated group to encourage late marriages, fewer children with adequate birth planning and use of contraception, and exhibit better awareness of nutritional and health needs of children. In turn, they can extend the benefits of their education to their family.

In fact, statistical studies indicate an almost 29% reduction in the probability of maternal health complications such as short birth intervals, unwanted pregnancies and unsafe abortions, by extending a woman’s years of schooling. Increasing women’s education enhances their cognitive skills, autonomy and economic resources, showing a positive influence on antenatal healthcare use. Indeed, just increasing the years of education by a year can reduce maternal morbidity by 174 deaths per 100,000 births! These data clearly accentuate the influential role of education in reducing maternal deaths and highlight the contributions of maternal education to health transitions.

Education: A Road to Safe Motherhood

Maternal health improvement in developing countries, like India, is a direct function of factors such as:

Provision of complementary nutrition for pregnant women
Availability and access to improved maternal healthcare facilities such as early prenatal care, emergency obstetric units, postnatal care, improvements in sanitation (clean water, covered toilet spaces, etc.).
Utilization of maternal healthcare facilities such as antenatal and delivery care services to encourage institutional delivery by skilled birth-attendants
Modification in the female reproductive behavior and fertility.
Utilization of child immunization services,
Treatment and management of childhood diseases such as acute respiratory infection (ARI) or diarrhoea

Furthermore, increase in the educational level of women, too is an evidence-based modulating factor that affects all the above variables. It is a known fact that a major challenge to achieving this better maternal health also comes by way of the lack the proper information and awareness about maternal health, pregnancy and delivery-related processes among women and their families. Most women, especially in India, do not even attend clinics till 6 or 7 months of pregnancy, losing track of expected delivery date and the chance for an institutional delivery. This is where the unsung role of education in maternal health comes to the fore. In addition to this, the prevalence of teenage fertility is another challenge to maternal mortality reduction. This trend is more visible in case of women dropping out of school early.

Educated women tend to show more awareness towards pregnancy complications, especially during adolescent years, such as pre-eclampsia, infections, bleeding, high blood pressure and unsafe abortion that are the proximate causes of maternal mortality. To the extent that these women show an increased likelihood of assessing information, adopting simple and cost-effective practices to maintain sanitation and hygiene, using family planning methods, and a willingness towards accepting treatment and qualified birth-attendance. Such mothers also tend to be more inclined to seek medical care, such as immunization, for their children, thus help to protect and promote their own as well as their families’ health and well-being.

The all-round impact of women education on maternal health can be witnessed in the following key areas:

Fertility: Education shows a strong positive correlation to reduced fertility. It enables women to control the number of children they want to have and the timing of childbearing.

Child Survival: Increasing women education opportunities has positive effects on infant and child health. A child born to an educated mother has 50% more likelihood of survival than one born to an illiterate mother because of the awareness and acceptance towards modern pediatric and childcare practices.

HIV/AIDS Awareness: Education also decreases a female’s risk of contracting HIV. Education empowers women with the basic facts about STIs and HIV/AIDS and the helps them reduce transmission risks to their baby through drugs during pregnancy.

Income Potential: Education boosts women’s income potential. In fact, a single year of primary schooling can increase their wage potential by 10-20%.

In view of these, it is not wrong to say that education can be the road to a safer motherhood.

Maternal Mortality & Health: The Indian Scene

Education emerges as the single most important determinant of maternal health-care utilization in India. While other socioeconomic factors, play a significant role, too, education by itself is a strong determinant of the maternal healthcare utilization in the country.

A study of the Indian scenario exhibits a positive association between maternal education and use of maternal-care services. In addition, in India, the striking north-south dichotomy due to distinctly diverse socioeconomic and cultural representation serves as an important and perplexing factor. While women in the south enjoy greater freedom and higher levels of education; northern women are bound by traditional conservatism and are largely illiterate or less educated. Accordingly, there is a marked difference in the maternal-care utilization and status of education in these two disparate regions of the country. Undoubtedly, the difference in the maternal care services utilization in the southern part of India is nor as pronounced as in the northern parts.

The last two decades have witnessed a steady decline in maternal mortality and a concomitant increase in the education and health levels despite cultural differences, establishing the dominating influence of education in improving female health.

Conclusion

Thus, improving universal access to basic education for the girl child emerges as an essential foundation for increasing the count of trained health workers at the community level, reducing poverty and contributing to the overall economic growth of the country through increased productivity. Females with basic education eventually pave way to educated mothers, more able in managing the size of their family per existing capacities and of providing quality care to their family, particularly children.

Extensive research shows maternal schooling to be a very strong and consistent predictor of reduced child mortality and morbidity. The relationship between maternal schooling and above factors that are known to reduce the risks of maternal and child mortality are quite different from those of their uneducated counterparts. Education and health, thus, have a close relationship where they complement and support each other, and this marked impact is visible in the most powerful way in the maternal and child health benefits that accrue among families that have literate women opposed to those that have illiterate mothers.

Education is thus the best way to empower women to make healthier choices, laying the true foundations for a successful socioeconomic development.

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References:

https://unchronicle.un.org/article/education-key-reducing-child-mortality-link-between-maternal-health-and-education

https://unchronicle.un.org/article/improving-maternal-health-through-education-safe-motherhood-necessity

https://www.unicef.org/mdg/maternal.html

http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-606

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036613

http://www.uniteforsight.org/women-children-course/health-promotion-women-children

http://www.prb.org/Publications/Media-Guides/2011/girls-education-fact-sheet.aspx