Children of well-educated mothers and fathers have higher survival rates

We’ve known for a long time that there is a correlation between the educational level of mothers and surviving as a child. But this new review study published in The Lancet shows also the importance of fathers’ education even in rich countries!

From the press release:

Every day, around 15 000 children under the age of five die from causes that could have been prevented.

But the children of highly educated parents survive more often than others. This statistic applies worldwide, according to a newly published sweeping systematic review in The Lancet.

The mother’s level of education is particularly important for her children’s survival.

“One year of extra education for the mother is associated with an approximately three per cent reduction in mortality on average,” says Professor Terje Andreas Eikemo at the Norwegian University of Science and Technology’s (NTNU) Department of Sociology and Political Science. Eikemo heads a research group called CHAIN — The Centre for Global Health Inequalities Research at NTNU.

This finding points to the great importance of education for girls. An estimated 750 million adults cannot read or write, and two-thirds of these are women.

“The findings provide a strong argument for continuing the effort to ensure that girls complete primary and secondary education, especially now that the pandemic risks setting back progress,” says Kam Sripada, a neuroscientist and one of the first authors of the study.

The study is also one of the largest ever to show that the father’s education also plays a major role. Here, a child’s risk of dying before their fifth birthday was 1.6 per cent lower per year of schooling that the father has.

The group has reviewed previous research in the field, a total of 300 study articles including data at the individual level, from just over three million births.

“We collected all the data and all the articles in all languages that look at parents’ education and the importance of child mortality. Our study reviewed the mortality rates at one month, one year and five years,” says Professor Eikemo.

The importance of the parents’ education becomes more critical as the children get older. The higher the parents’ education level, the better their children do on average.

“Good health in children’s first five years is important for more than just survival. The brain also develops the fastest in that phase. That’s why it’s crucial to invest in the school system – from the earliest years all the way through higher education. Good conditions can be transferred from one generation to the next, and the opposite is also true,” says Sripada.

Mortality among children under the age of five has halved worldwide since 1990, as a result of international, national and local efforts.

But infant mortality rates vary greatly from country to country. In developing countries, just over ten per cent of children die before the age of five. In Norway, the percentage is 0.3 per cent. The global average is now just under 5 per cent.

The main reasons for children dying before the age of five are premature birth, pneumonia, various infections, diarrhoea, malnutrition and malaria, in addition to various complications during and immediately after birth.

The causal relationships are complicated. Level of education, for example, is related to both income and social status, which in turn is related to factors such as lifestyle and access to health services.

“There may be various factors that explain the findings in our study. Parents’ health literacy, health-seeking behaviours and consanguanity are among the potential links between parents’ education and child mortality,” says Sripada.

The researchers found no limit to where the benefit of more schooling flattened out. The more education, the better.

“We didn’t find any flattening where more education means less. Every year of extra education gives an increased chance of survival,” Eikemo says.

Researchers also were able to see the benefits of education when they adjusted for socio-economic status, which more or less overlaps with the more politically charged concept of social class.

“Rich countries have less infant mortality, but also in these countries it’s linked to parents’ education,” says Eikemo.

The study focuses attention on the connection between social inequalities and health.

“This is a scientific breakthrough. It is the result of fantastic team work from multiple intersecting disciplines,” says Eikemo.

Abstract of the review study:

Background
The educational attainment of parents, particularly mothers, has been associated with lower levels of child mortality, yet there is no consensus on the magnitude of this relationship globally. We aimed to estimate the total reductions in under-5 mortality that are associated with increased maternal and paternal education, during distinct age intervals.
Methods
This study is a comprehensive global systematic review and meta-analysis of all existing studies of the effects of parental education on neonatal, infant, and under-5 child mortality, combined with primary analyses of Demographic and Health Survey (DHS) data. The literature search of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) was done between Jan 23 and Feb 8, 2019, and updated on Jan 7, 2021, with no language or publication date restrictions. Teams of independent reviewers assessed each record for its inclusion of individual-level data on parental education and child mortality and excluded articles on the basis of study design and availability of relevant statistics. Full-text screening was done in 15 languages. Data extracted from these studies were combined with primary microdata from the DHS for meta-analyses relating maternal or paternal education with mortality at six age intervals: 0–27 days, 1–11 months, 1–4 years, 0–4 years, 0–11 months, and 1 month to 4 years. Novel mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among the studies and to adjust for study-level covariates (wealth or income, partner’s years of schooling, and sex of the child). This study was registered with PROSPERO (CRD42020141731).
Findings
The systematic review returned 5339 unique records, yielding 186 included studies after exclusions. DHS data were compiled from 114 unique surveys, capturing 3 112 474 livebirths. Data extracted from the systematic review were synthesized together with primary DHS data, for meta-analysis on a total of 300 studies from 92 countries. Both increased maternal and paternal education showed a dose–response relationship linked to reduced under-5 mortality, with maternal education emerging as a stronger predictor. We observed a reduction in under-5 mortality of 31·0% (95% CI 29·0–32·6) for children born to mothers with 12 years of education (ie, completed secondary education) and 17·3% (15·0–18·8) for children born to fathers with 12 years of education, compared with those born to a parent with no education. We also showed that a single additional year of schooling was, on average, associated with a reduction in under-5 mortality of 3·04% (2·82–3·23) for maternal education and 1·57% (1·35–1·72) for paternal education. The association between higher parental education and lower child mortality was significant for both parents at all ages studied and was largest after the first month of life. The meta-analysis framework incorporated uncertainty associated with each individual effect size into the model fitting process, in an effort to decrease the risk of bias introduced by study design and quality.
Interpretation
To our knowledge, this study is the first effort to systematically quantify the transgenerational importance of education for child survival at the global level. The results showed that lower maternal and paternal education are both risk factors for child mortality, even after controlling for other markers of family socioeconomic status. This study provides robust evidence for universal quality education as a mechanism to achieve the Sustainable Development Goal target 3.2 of reducing neonatal and child mortality.

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