Gateway Health Behaviors
11
General Gateway Factors
Maternal Education: In many ways, maternal education could be considered the classic
“gateway factor” though it has never been described as such. Data has shown that with each year
of maternal education, there is an average of 7-9% decrease in infant and child mortality rates,
however the pathways and mechanisms are still unclear. Caldwell’s (1979) paper on Nigeria
argued that maternal education plays a role in improved child health even after accounting for
socioeconomic status. Since then, studies have shown that increased levels of mother’s education
were associated with improved child survival (Hobcraft et al, 1984; Mensch et al, 1985). Other
studies attempted to identify the pathways of the relationship between maternal education and
child survival. Hobcraft (1993) provided a thorough review of the literature on women’s
education and child survival. Four pathways were investigated as shown in Table 3.
Table 3: Pathways between maternal education and child survival
Pathway Results
Education leads to greater cleanliness
Does not translate into reduced diarrheal disease incidence
Education leads to greater health service utilization
due to a “closer identification with the modern world,
greater confidence at handling bureaucracies or a
more innovative attitude to life” (Cleland 1990:412)
Education leads to a greater emphasis on child quality
Scant evidence for this
Education leads to empowerment
Evidence for this is indirect: educated women use more
health services, therefore they are empowered
Some other associations with education are:
ƒ Educated women marry later and have their first births later
ƒ Educated women have lower rates of maternal mortality
ƒ Large differences in prenatal care according to women’s level of education
ƒ Educated women were more likely to be attended by a trained person at delivery
ƒ Educated women were more likely to be vaccinated with tetanus-toxoid.
ƒ Neonatal mortality is less sensitive to maternal education than 1-23 months of age.
ƒ More educated women have fewer stunted children
ƒ More educated women are more likely to have initiated vaccination and get their children
fully vaccinated.
ƒ More educated women seek treatment for childhood diseases more
Another study done by Desai and Alva (1998) concludes that
Educated mothers are more likely to engage in health-promoting behavior. However, in
many instances external factors supersede the abilities of families to enhance the health of
their members. Thus, individual-level improvement in health-enhancing behavior may fail to
translate into actual improvements in health.
In their review of the pathways between maternal education and child survival, Cleland and van
Ginneken conclude that “the importance of education – particularly that of the mother – has been
well established …yet our understanding of the mechanisms of influence remain no better today
than 10 years ago” (1988:1365).
Convention