Cleland J G, Van Ginneken J K
International Statistical Institute Research Centre, Voorburg, The Netherlands.
Soc Sci Med. 1988;27(12):1357-68. doi: 10.1016/0277-9536(88)90201-8.
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.
在过去二十年中，发展中国家已提供了大量信息，表明母亲受教育程度对婴幼儿死亡率有重大影响。平均而言，母亲受教育年限每增加一年，五岁以下儿童死亡率就下降7%至9%。教育在儿童早期和后期比在婴儿期的影响更大。本文的核心主题是评估各种机制或干预因素，这些因素可以解释母亲的教育程度如何影响其子女的健康和生存。两个可能的干预变量，即生殖健康模式以及对子女更公平的对待，在解释这种关系时作用相对较小。与教育相关的经济优势（即收入、水和卫生设施、住房质量等）约占教育与死亡率总体关系的一半。作为一组干预变量的预防和治疗性卫生服务的使用影响复杂且多变。有些国家的初级卫生服务非常薄弱，对母亲和儿童的健康没有影响；还有其他一些国家，由于获得服务的差异，其卫生服务可能会加剧教育差距。关于健康观念和家庭做法的干预作用知之甚少，但据推测，它们在解释教育与死亡率的关系中很重要。最后，针对机制或干预因素的具体研究提出了建议，并强调了此类研究对制定卫生和教育政策的相关性。
