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Maternal education is associated with reduced female disadvantages in under-five mortality in sub-Saharan Africa and southern Asia
Authors: Christiaan WS Monden, and Jeroen Smits
Source: International Journal of Epidemiology, 42: 211–218; DOI: 10.1093/ije/dys201
Topic(s): Childhood mortality
Children under five
Gender
Infant mortality
Maternal health
Neonatal mortality
Country: More than one region
  Multiple Regions
Published: DEC 2012
Abstract: Background The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia. Methods We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0–59), neonatal (month 0), post-neonatal (month 1–11) and child mortality (month 12–59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more ‘gender neutral’ thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database. Results In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06–1.13] among non-educated mothers, 1.14 (95% CI 1.09–1.19) among mothers with some primary education and 1.25 (95% CI 1.16–1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82–0.95), 1.10 (95% CI 0.97–1.25) and 1.13 (95% CI 1.02–1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio¼0.54 (95% CI 0.41–0.72). Conclusions Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a ‘gender neutral’ situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother. Keywords Under-five mortality, neonatal mortality, post-neonatal mortality, child mortality, gender bias, maternal educational status, southern Asia, sub-Saharan Africa