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0.480
0.290
0.409
0.373
0.464
0.427
0.197
0.132
(0.042) (0.043)
Household wealth 0.203
0.170
(0.050) (0.052)
Husband education 0.022 0.014
(0.012) (0.013)
Husband occupation
White collar
Service 0.235 0.241
(0.170) (0.173)
Agriculture 0.221 0.155
(0.165) (0.166)
Blue collar 0.234 0.223
(0.145) (0.146)
Knowledge 0.100
0.033
(0.025) (0.030)
Attitudes
Health care utilization 0.115
0.051
(0.024) (0.026)
Ethnicity 0.392
0.392
(0.094) (0.100)
Autonomy 0.045 0.026
(0.031) (0.036)
Reproductive behaviors
Maternal age at birth
1519 0.092 0.012
(0.177) (0.179)
2034
35+ 0.038 0.010
(0.085) (0.090)
Parity
First 0.748
0.741
(0.114) (0.117)
Second or third 0.203
0.183
(0.079) (0.082)
Fourth or higher
Birth interval
Less than 2 years
24 years 0.210
0.223
(0.076) (0.078)
4+ years 0.657
0.602
(0.102) (0.107)
Geographic controls
Area of residence
Capital
Small city 0.085 0.239
0.176 0.351
0.185
0.414
0.340
0.269
0.459
0.436
0.398
0.448
0.466
0.430
0.741
0.563
0.480
0.627
0.699
0.640
po0:05;
po0:01;
po0:001:
Table 4
Proportion of education effect
a
on child stunting explained by
mechanism, demographic and health survey
Education
coefcient
Proportion of
effect explained
by mechanism
Bivariate model 0.578
Geographic controls 0.480 0.170
Socioeconomic model 0.290 0.396
Knowledge model 0.409 0.148
Attitudes model 0.373 0.223
Autonomy model 0.464 0.033
Reproductive model 0.427 0.110
Full model 0.197 0.590
Source:1998. Bolivia DHS.
a
Compared to education coefcient in model with geo-
graphic controls.
M.B. Frost et al. / Social Science & Medicine 60 (2005) 395407 404
maternal education effect. Thus, the results show that
among the mechanisms considered, socioeconomic
status and utilization of modern health facilities are
the most important pathways of inuence between
maternal education and child nutritional status. How-
ever, the education coefcient in the full model retains
its statistical signicance. Thus, the mechanisms as
they are currently measured do not account for all
of the maternal education effect on child nutritional
status.
Discussion
In contrast to the ndings of Caldwell (1979) and
Martin et al. (1983), we nd that part of the effect of
maternal education on child health outcomes is ex-
plained by socioeconomic status. This nding is
supported by Desai and Alva (1998). However, in
contrast to their work, we nd that only about half of
the maternal education effect is explained by socio-
economic status and geographic residence. In addition,
we account for about 65 percent of the maternal
education effect on child nutritional status via geo-
graphic residence, socioeconomic status, modern atti-
tudes towards health care, health knowledge, and
reproductive behaviors. Socioeconomic status remains
the primary pathway linking maternal education and
child nutritional status, but modern health care utiliza-
tion and health knowledge also account for portions of
the maternal education effect. Reproductive behaviors
explain some of the maternal education effect, but parity
and birth spacing also exhibit a strong independent
inuence on child nutritional status.
More specically, Desai and Alva (1998) argue that
individual-level and community-level factors greatly
attenuate the inuence of maternal education on
stunting and infant mortality, but that maternal educa-
tion remains strongly associated with child immuniza-
tions. They conclude that maternal education may
inuence health-seeking behaviors such as immuniza-
tions, whereas environmental conditions are more likely
to inuence nutritional status and child survival out-
comes than are parenting behaviors and characteristics.
Our ndings are similar, except that we nd modern
health care utilization accounts for some of the maternal
education effect on stunting. In our model, maternal
education inuences health-seeking behaviors, which in
turn inuences stunting. Thus, in our Bolivian sample,
environmental conditions are important in determining
child nutritional status, but so too are health-seeking
behaviors such as modern health care utilization and
reproductive behaviors, as well as maternal education.
In concurrence with the model estimated by Castro
Mart!n and Jua rez (1995) examining pathways linking
maternal education and fertility in Latin America, we
nd similar links between maternal education and child
nutritional status. We also conclude that maternal
education is a vehicle for socioeconomic improvement,
and a transformer of attitudes from traditional, fatalistic
views of health care to acceptance and utilization of
modern health care. In addition, we nd some evidence
of maternal education as a source of knowledge related
to health.
Still, even in our nal model, maternal education
continues to have a signicant, independent inuence on
child nutritional status. There may yet be other path-
ways through which maternal education operates to
inuence child nutritional status. Past studies have also
suggested parental values and cognitive skills such as
literacy and numeracy, as well as parental interpersonal
behaviors as potential mechanisms (LeVine et al., 1994;
Glewwe, 1999). In addition, studies suggest that
educated mothers are better able to comply with
doctors treatment and care regimens for their children
(Ware, 1984), and that they can better understand,
question, and communicate with health care profes-
sionals (Joshi, 1994). Maternal education may also
operate through community level variables in addition
to individual level factors (Alderman et al., 2003). Our
data do not allow us to consider these pathways. Future
research is needed to broaden and test additional
pathways linking maternal education and child health
outcomes.
Our inability to explain all of the maternal education
effect may also be the result of measurement error. In
particular, we found female autonomy to be a very weak
pathway linking maternal education and child nutri-
tional status. Because we do not have direct measures of
autonomy, our results may be due to poor measurement.
Perhaps, with better measures, autonomy would be a
more important pathway or autonomy may operate
independent of maternal education. Das Gupta (1990)
argues that the basic abilities and personality character-
istics of the mother inuence child health outcomes
independent of education or economic wealth. She
concludes that women with greater decision-making
power in the household have children with better health
outcomes. Additionally, Simon, Adams and Madhavan
(2002) nd that mothers indicating they feel power to
inuence outcomes are better able to mobilize resources
to meet the nutritional needs of their children. Thus,
with more direct indicators of autonomy, the conclu-
sions found in our data regarding autonomy might be
quite different.
Our ndings overall suggest that, given an environ-
ment with sufcient resources, maternal education can
inuence child nutritional status by promoting the
utilization of modern health care, as well as improving
health care knowledge and reproductive behaviors. Our
ndings, however, are limited to one contextBolivia.
Improved measures in different contexts are needed in
ARTICLE IN PRESS
M.B. Frost et al. / Social Science & Medicine 60 (2005) 395407 405
order to clarify further the mechanisms through which
maternal education inuences child health outcomes.
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