Department of Sociology and Nuffield College, University of Oxford, Oxford, UK.
Demography. 2019 Oct;56(5):1765-1790. doi: 10.1007/s13524-019-00812-3.
Since the 1980s, the demographic literature has suggested that maternal schooling plays a key role in determining children's chances of survival in low- and middle-income countries; however, few studies have successfully identified a causal relationship between maternal education and under-5 mortality. To identify such a causal effect, we exploited exogenous variation in maternal education induced by schooling reforms introducing universal primary education in the second half of the 1990s in Malawi and Uganda. Using a two-stage residual inclusion approach and combining individual-level data from Demographic and Health Surveys with district-level data on the intensity of the reform, we tested whether increased maternal schooling reduced children's probability of dying before age 5. In Malawi, for each additional year of maternal education, children have a 10 % lower probability of dying; in Uganda, the odds of dying for children of women with one additional year of education are 16.6 % lower. We also explored which pathways might explain this effect of maternal education. The estimates suggest that financial barriers to medical care, attitudes toward modern health services, and rejection of domestic violence may play a role. Moreover, being more educated seems to confer enhanced proximity to a health facility and knowledge about the transmission of AIDS in Malawi, and wealth and improved personal illness control in Uganda.
自 20 世纪 80 年代以来，人口统计学文献表明，母亲的受教育程度在决定中低收入国家儿童的生存机会方面起着关键作用；然而，很少有研究成功地确定了母亲教育与 5 岁以下儿童死亡率之间的因果关系。为了确定这种因果效应，我们利用了 20 世纪 90 年代后半期在马拉维和乌干达实施的普及小学教育的学校改革所带来的母亲教育的外生变化。我们采用两阶段残差纳入方法，将个人层面的人口与健康调查数据与改革强度的地区层面数据相结合，检验了母亲教育程度的提高是否降低了儿童在 5 岁前死亡的概率。在马拉维，母亲每多接受一年教育，儿童死亡的概率就会降低 10%；在乌干达，母亲多接受一年教育，其子女死亡的几率就会降低 16.6%。我们还探讨了哪些途径可能解释这种母亲教育的影响。这些估计表明，医疗保健方面的经济障碍、对现代卫生服务的态度以及对家庭暴力的抵制可能发挥了作用。此外，在马拉维，受教育程度更高似乎更接近医疗机构，并且更了解艾滋病的传播；在乌干达，受教育程度更高还意味着更富有和个人疾病控制的改善。
