The Impact of Women's Literacy on Child Health and its Interaction with Access to Health Services

Research has consistently demonstrated a strong correlation between women's education and child health, but the absence of data from intervention studies has left open the possibility that this may be due to the confounding effects of wealth or social privilege. Moreover, it is not known what mechanisms mediate the education-health link, nor how it is affected by access to health services. In Nicaragua during the 1980s, thousands of adults became literate through a mass education campaign. This provided a rare opportunity to measure the impact of women's literacy on child health for women who otherwise would have almost certainly remained illiterate for the rest of their lives, and to assess whether access to health services increases or decreases the advantage conferred by education. Results from this retrospective cohort study of 4434 women show that among the children of women who became literate exclusively by adult education, mortality and risk of malnutrition are significantly lower than among those women who remained illiterate. Furthermore, when the infant mortality rates are given approximate time locations, a sharp reduction is found following the adult education campaign for the adult-education group, but not for the illiterate or formal-schooling groups. The survival advantage conferred by education was significantly greater among those with poor access to health services. The results also suggest that the effect of education in reducing the risk of malnutrition operates independently of its effect on mortality, and that both are independent of wealth and their parents' decision to educate their daughters.