Female Literacy & Its Relevance With Maternal and Infant Mortality Rates

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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN

0976 6510(Online), Volume 3, Issue 2, May-August (2012)

65

FEMALE LITERACY & ITS RELEVANCE WITH MATERNAL

AND INFANT MORTALITY RATES

Garima Jain

Ph.D. Scholar IET-Lucknow

Email : [email protected]

Dr. Vikram Bisen

Associate Professor IET-Lucknow

ABSTRACT

When a female is educated the next generation is bound to be educated henceeducation has many folds impact on the social and economical development of any nation.

Education as such, results in positive externalities. Not only does it have an intrinsic value inthe sense of the joy of learning, reading etc, but it also has instrumental, social and process

roles. Moreover education may spread through interpersonal motivation. When one family

sends their child to school, their neighbor is likely to do so as well. Womens education too,often spreads this way, more specifically, through same sex effects. i.e. an educated woman is

far more likely to send her daughter to school than an uneducated woman. Also, she is likelyto maintain better conditions of nutrition and hygiene in her household and thereby improve

her familys health (Sen 1997).Literacy is directly related to the status of a woman, her age at marriage, her decision powerand to mention especially capability to access health care services. Literacy not only increases

womens self-confidence but also makes them more exposed to information and thereby

altering the way others respond to them. Female literacy improves the chances that womenwill obtain meaningful employment, reduces their demand for children and improves health-

seeking behavior, makes them aware of Nutritional requirements - all these combinedimprove the chances of survival of both - the mother and the baby.

The present paper focuses on the relationship between the female literacy and mortality rates

(IMR and MMR) and establishes an inverse relationship between them.

INTRODUCTION

Not only might women residing in countries with higher female literacyenjoy greater personal safety and physical integrity, they may also have greater inheritance

rights, ownership rights in land and loans, and labour market rights (Jtting et al., 2008;Magadi, Madise, & Rodrigues, 2000). Countries with higher female literacy may also devote

more resources to the provisioning of maternal health care services along a range of maternalhealth care delivery models, including physicians, nurses, and traditional birth attendants. In

terms of the inverse equity hypothesis, the greater range of services available to women in

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countries with higher female literacy may contribute to lower inequalities in use compared to

those found in countries with lower female literacy.The United Nations Millennium Development Goals have identified improving womens

access to maternal health care as a key target in reducing maternal mortality in the world.Individual socio-demographic and national-level environmental factors may affect womens

use of maternal health care. At the individual level, age, income, education, and urban or rural

residence may all play a role in womens use of maternal health care services (Gyimah,Baffour, & Addai, 2006; Magadi, Agwanda, & Obare, 2007; Magadi, Zulu, & Brockenhoff,

2003; Obermeyer & Potter, 1991). Differences between countries along such dimensions asfemale literacy rates or levels of economic development may play a pivotal role in womens

reproductive health, and maternal and infant mortality (Frey & Field, 2000; Obermeyer,1993;

Shen & Williamson, 1997; Shiffman, 2000; Wang, 2007). National female literacy rates arean important indicator of womens status and autonomy in society (Frey & Field, 2000;

Magadi, Agwanda & Obare, 2007).

Mortality, which is one of the major structural variables of demography, has continuouslybeen affecting the population structure, particularly in developing countries like India. Most

of the countries in the world, developed as well as developing, have experienced drasticimprovement in life expectancy. Among various factors responsible for decline in mortality,

economic factors: increase in per capita income, social factors: improvement in nutrition,housing and clothing, sanitation, water supply, cleanliness, individual hygienic practices and

developments of medical science have played an important role. However, women andchildren do not equally enjoy fruits of these developments. Women and children are still thedeprived sector of the society and maternal and infant mortality remain high in spite of a

striking fall in general mortality rate.

CONCEPTS OF MATERNAL AND INFANT MORTALITY

Maternal mortality is a sensitive indicator of health and general socioeconomic developmentof a community or of a nation. It is one of the leading causes of death among women in their

reproductive age. In India like most developing countries, women of reproductive ages

constitute a little more than one-fifth of the total population and are exposed repeatedly to the

risk of pregnancy. More maternal deaths occur in India in one week than in all of Europe inone year. In a single day in India, the total number of casualties due to pregnancy and child

birth-related complications is more than recorded in one month in the entire developedworld.Maternal mortality is difficult to measure (Campbell and Graham 1990). The tenth

revision of the International Classification of Diseases (ICD- 10) defines a maternal death as

the death of a woman while pregnant or within 42 days of termination of pregnancy,irrespective of the duration and site of the pregnancy, from any cause related to or aggravated

by the pregnancy or its management but not from accidental or incidental causes.While many health indicators are required to arrive at a comprehensive assessment of the

health status of a population, a particularly sensitive and widely used summary indicator is theInfant Mortality Rate (Visaria 1985). Infant Mortality refers to death of children in age group

0-1. Infant Mortality Rate (IMR) is the number of infant deaths that occur per thousand livebirths in a population in one calendar year. It is one of the universally accepted indicators of

health status of not only infants but also of the whole population and of socio-economicconditions under which they live.

EDUCATION AS AN INTERVENING VARIABLE IN MATERNAL AND INFANT

MORTALITY DECLINE

It is universally accepted that the higher the female literacy rate, the lower the MMR.

Studying at school /college for a longer period will prevent early marriage and earlymotherhood. Educated women will seek proper antenatal and intra-natal supervision. The

female literacy rates in Sri-Lanka and Thailand are over 80 percent and the MMR in these


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two countries is 60 per 100,000 only. Although economically, there is not much of difference

between the MMR of these two countries 340 as compared to 60. Kerala, having the highestfemale literacy rate in India, has the lowest MMR, compared to Bihar < U.P. and M.P.

Mothers residing in countries with higher literacy rates were more likely to use maternal

health care, after adjusting for national economic development and individual socio-

demographic factors. socio-economic status has been linked to more frequent use of maternalhealth clinics (Rabe-Hesketh & Skrondal, 2005).

Although Magadi et al. (2007)found women in high female literacy countries less likely tomake an inadequate number of visits to maternal health care clinics than women in low

female literacy countries.

The reduction of maternal and infant deaths is high priority for the international community,

especially in view of the increased attention on the Millennium Development Goals. Maternal

deaths arise from the risks attributable to pregnancy and childbirth as well as from the poor

quality care from health services.

Ecological analyses have found direct associations between female literacy and nationaleconomic development for outcomes such as maternal and infant mortality in positive

direction (Jtting, Morrisson, Dayton-Johnson & Drechsler, 2008; Wang, 2007).

A number of studies have examined empirical evidences concerning the influence ofdemographic and socio-economic factors of child survival (Gandotra et al. 1980; Clealand

and Ginneken et al. 1988; Miller 1983; Das Gupta 1990; Caldwell 1979; Griffith et al. 2001).All these studies reinforce the existing argument for a greater emphasis on the schooling of

girls to give women themselves and the next generation a greater chance of survival. Severalauthors have discussed the mechanism of literacy influence on infant survival (Caldwell 1979,1986; Cohrane 1980; Hobecraft et al. 1984; United Nations 1985; Ware 1984; Gokhale et al.

2002; Govindasamy and Ramesh 1997). Ruzika and Kanitkar (1 972) found mothers literacy

to be the most effective single factor determining the level of infant mortality in an urban

setting.

Pooled data from the Demographic and Health Surveys (DHS) of South-Asian countries fromthe late 1990s to examine the association between female literacy and antenatal care visits and

found that women in countries with higher female literacy were more likely to start antenatal

care late in their pregnancy, but less likely to make an inadequate number of visits.

Womens literacy and their use of health facilities go hand in hand. Krishnan (1985)

examined overall death rates in terms of literacy, doctor, hospital and bed population ratio,per capita income expenditure on medical and health services. He observed that literacy was

the most important factor while health services also had some explanatory power.

A number of cross-section studies for India have explored the impact of female literacy onmaternal and child death. Sharma and Retherford (1999) have used 1991 Census data,aggregated to district level, for 326 districts. They show that female literacy would have a

significant negative impact on maternal and child deaths.High maternal and infant deaths can be attributed to low status and low capability of women.

These deaths are preventable if more and more women are literate thereby exposing them tonew ideas. Literacy can make them aware of a range of services from antenatal to nutrition,personal hygiene, immunisation, birth spacing, maternal skills, breast-feeding and overall

health.

In order to reduce the high maternal mortality in the developing countries, government

should work on the causes which are multiple, inter-related and tiered. The most superficial of


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International Journal of

0976 6510(Online), Volu

themselves of antenatal care, te

delivery and complete immunizReviews suggest that birth int

mortality than does maternal aassociation is not always foun

complete their family in a short

Afew studies (Jejeebhoy and

that interspouse consultation isregard to family size and the ad

the role of schooling in crea

extensive use and approval ofenhancing female autonomy, i

result in decline in the number

and maternal deaths. More receducation (at least 5-6 years) th

in female autonomy, particularand Basu 1996; Jejeebhoy 1995

The influence of female literexamined using data from the s

as well as microlevel data on ru

3 years. After consideringcomprehensive models were de

underweight, anaemia, and unmodels were low maternal bo

hospitalized deliveries, treatmvaccinations.

Addition of female illiteracy

variables significantly. Mean psignificantly higher (p


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International Journal of

0976 6510(Online), Volu

Studies suggests that national

status in India such as progra

may encourage female educatiin maternal health care use. As

with maternal health care use fsystem and the greater resourc

anticipate that the benefits of liexperienced differently by in

income.

There have been efforts to cor

child mortality. In rural areacompared to urban areas. Furth

before reaching the age of 18 y

and level of education. Availablevel of education and her fertil

STATISTICAL RELATION

Table below presents data for IAs hypothesized, the inverse c

literacy and MMR and positive

However, large variations are

levels of female literacy. For e64 in Gujarat and 53 in West B

At the same time, estimates ofappear to be on the lower side

the same band of female literacand 154 in Andhra Pradesh an

be conceived that several facterode the positive influence

evidences to show that educa

factors such as age at marriaginfluenced by socio-cultural no

not reduce the role of womens

as well which enhance women

anagement (IJM), ISSN 0976 6502(Pri

e 3, Issue 2, May-August (2012)

olicies that are able to address female literacy an

s that cover costs for tuition, school uniforms and

n and in the long-run help reduce income-related isuch, female literacy at the national level may be

r all women in the country due to the greater mats and autonomy available to all women. We migh

ving in a country with higher average female literividual women depending on womens relative

relate female literacy with age at marriage, fertilit

, a higher proportion of married women are iller, among illiterates, around two-thirds of women

ars, suggesting a positive correlation between age

le data also suggest an inverse correlation betweenity.

HIPS

MR, MMR and adult female literacy in major statrrelation between (i) female literacy and IMR and

correlation between (iii) IMR and MMR is statistic

seen in mortality rates corresponding to more or l

ample, IMR ranges from 98 in Orissa and Madhyaengal in the same band of female literacy (50 to 6

MR for some states like Gujarat and Tamil NaduSRS 1999). Interstate variations are even greater i

y. For example, it is as low as 29 in Gujarat, 105 ias high as 498 in Madhya Pradesh and 401 in Ass

rs block some of the postulated pathways of inflof womens education (Shivakumar 1995). The

tion leads to favourable shifts in maternal behav

, child spacing, family size and so on appear torms of society (Ware 1984; Cleland 1990). Howe

literacy in any way. It only reiterates to focus on ot

s capabilities.

t), ISSN

womens

textbooks,

nequalitiesassociated

rity of thet therefore

cy will behousehold

rates and

iterates asot married

t marriage

a womans

s of India.(ii) female

lly true.

ss similar

Pradesh toper cent).

rima facieMMR for

Haryana,am. It may

uence andre are no

iour, since

e stronglyer, it does

her factors


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72

TABLE

Female literacy and mortalities in India:

States Female LiteracyIMR** MMR**

India 54.2 71 408

Andhra Pradesh 51.2 66 154

Assam 56 78 401

Bihar 33.6 67 451

Gujarat 58.6 64 29

Haryana 56.3 69 105

Karnataka 57.5 58 195

Kerala 87.9 16 195

Madhya Pradesh 50.3 97 498

Maharashtra 67.5 49 135

Orissa 51 98 361

Punjab 63.6 54 196

Rajasthan 44.3 83 677

Tamil Naidu 64.6 53 76

Uttar Pradesh 43 85 707

West Bengal 60.2 53 264

Source: * - Census of India, 2001 ** - SRS, Registrar General of India.

0

20

40

60

80

100

120

Female Literacy IMR**

0

100

200

300

400

500

600

700

800

Female literacy and mortalities in India: Female Literacy

Female literacy and mortalities in India: MMR**


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Table :- Effect of Female literacy on four RCH indicators [According to Census

2011,Govt Of India]

Location Female

Literacy Rate

Infant

Mortality rate

(No. of death /

1,000 livebirth)

Fertility rate

(No. of child

born/woman)

Maternal

Mortality rate

(No. of

deaths/1,00,000live birth)

Under 5

Mortality

rate (No. of

death /1,000 live

birth)

Year Year Year Year Year

2001 2011 2001 2011 2001 2011 2001 2011 200

1

2011

India 54.20 65.46 63.19 47.57 3.04 2.62 306 230 87 63

Uttar

Pradesh

42.85 59.26 68.45 51.42 3.72 2.81 372 245 91 66

0

10

20

30

40

50

60

70

1 2 3 4

INDIA

Female Literacy Rate / Infant

Mortality Rate

Series

1

0

10

20

30

40

50

60

70

1 2 3 4

INDIA

Female Literacy Rate / Fertility Rate

Series1

0

10

20

30

40

50

60

70

1 2 3 4

INDIA

Female Literacy Rate / MeternalMortality Rate

Series

1

0

10

20

30

40

50

60

70

1 2 3 4

INDIA

Female Literacy Rate / Under 5Morality Rate

Series1

0

10

20

30

40

50

60

70

80

1 2 3 4

UTTAR PRADESH

Female Literacy Rate / InfantMortality Rate

Serie

s1

0

10

20

30

40

50

60

70

1 2 3 4

UTTAR PRADESH

Female Literacy Rate / Fertility Rate

Series1

0

10

20

30

40

50

60

70

1 2 3 4

UTTAR PRADESH

Female Literacy Rate / MeternalMortality Rate

Se

rie

s1

0

10

20

30

40

50

60

70

1 2 3 4

UTTAR PRADESH

Female Literacy Rate / Under 5 MoralityRate

Series1


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Table: Effect of Female literacy on four RCH indicators

Location FemaleLiteracy

rate (%)

InfantMortality

rate [No. of

death / 1,000live birth]

Fertility rate[No. of child

born/woman]

Maternal Mortalityrate [No. of

deaths/1,00,000 live

birth]

Under 5Mortality rate

[No. of death

/ 1,000 livebirth]

Kanpur

Nagar

76.89 31.27 1.59 150 6

Lucknow 73.88 34.57 1.68 156 8

Saharanpur 60.72 48.63 3.15 227 18

Jhansi 56.60 53.45 3.24 235 21

Budaun 40.92 69.35 3.63 339 69

Shrawasti 37.07 72.18 4.02 363 72

There exists a direct correlation between Female Literacy and Infant Mortality.

0

10

20

3040

50

60

70

80

90

1 2

Kanpur Nagar

Female Literacy Rate / InfantMorality Rate

0

10

20

30

40

50

60

70

80

90

1 2

Kanpur Nagar

Female Literacy Rate /Fertility Rate

0

10

20

30

40

50

60

70

80

90

1 2

Kanpur Nagar

Female Literacy Rate/Maternal Morality Rate

0

10

20

30

4050

60

70

80

90

1 2

Kanpur Nagar


S

e

Female Literacy Rat e / InfantM oral i ty Rate

0

20

40

60

80

1 2

Lucknow

Series1

Female Literacy Rate /Fert i l i ty Rate

0

20

40

60

80

1 2

Lucknow

Series1

Female Literacy Rate /MaternalMorality Rate

0

10

20

30

40

50

60

70

80

1 2

Lucknow

Series1

Female Literacy Rate /Under 5 Moral i ty Rate

0

20

40

60

80

1 2

Lucknow

Series1

Female Literacy Rate / InfantM oral i ty Rate

0

20

40

60

80

1 2

Saharanpur

Series1

Female Literacy Rate /Fert i l i ty Rate

0

20

40

60

80

1 2

Saharanpur

Series1

Female Literacy Rate/M aternal Moral i ty Rate

0

20

40

60

80

1 2

Saharanpur

Series1

Female Literacy Rate /Under 5 M orality Rate

0

20

40

60

80

1 2

Saharanpur

Series1

51.5

52

52.5

5353.5

54

54.5

55

55.5

56

56.5

57

1 2

Jhansi


0

10

20

30

40

50

60

1 2

Jhansi

Female Literacy Rate / FertilityRate

Series1

0

10

20

30

40

50

60

1 2

Jhansi

Female Literacy Rate/Maternal Morality Rate

0

10

20

30

40

50

60

1

Jhansi

Female Literacy Rate / Under5 Morality Rate

0

10

20

30

40

50

60

70

80

1

Badaun


0

5

10

15

20

25

30

35

40

45

1

Badaun

Female Literacy Rate / FertilityRate

S

e

ri

e

0

5

10

15

20

25

30

35

40

45

1

Badaun


S

e

ri

e

0

10

20

30

40

50

60

70

80

1

Badaun


S

e

ri


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Effect of Literacy Rate

District FL R.A. GP & LB EA

Kanpur 76.89 84.57 86.11 88.42

Lucknow 73.88 81.26 82.74 84.96

Saharanpur 60.72 66.79 68 69.8

Jhansi 56.6 62.26 63.39 65.09

Budhaun 40.92 4.01 45.83 47.05

Shrawasti 37.07 40.77 41.51 42.63

0

10

20

30

40

50

60

70

80

1

Shrawasti


S

e

ri

0

5

10

15

20

25

30

35

40

1

Shrawasti

Female Literacy Rate /Fertility Rate

0

5

10

15

20

25

30

35

40

1 2

Shrawasti


S

e

rie

0

10

20

30

40

50

60

70

80

1

Shrawasti


S

e

ri

FL - Female Literacy.RA - Female Literacy Promotion in Rural Area.GP & LB - Female Literacy Promotion y Gram Pradhan and LocalBody.

EA - Female Literacy Promotion economicAspect.

FL / R.A.

0

10

20

30

40

50

60

70

80

90

1 2

Kanpur Nagar

Series1

FL / GP & LB

0

10

20

30

40

50

60

70

80

90

1 2

Kanpur Nagar

Series1

FL / R.A.

0

10

20

30

40

50

60

70

80

1 2

Lucknow

Series1

FL / GP & LB

0

10

20

30

40

50

60

70

80

1 2

Lucknow

Series1

FL / EA

0

10

20

30

40

50

60

70

80

1 2

Lucknow

Series1

F L / EA

0

10

20

30

40

50

60

70

1 2

Saharanpur

Series1

FL / GP & LB

0

10

20

30

40

50

60

70

1 2

Saharanpur

Series1

FL / EA

0

10

20

30

40

50

60

70

1 2

Saharanpur

Series1

FL / EA

0

10

20

30

40

50

60

70

80

90

1 2

Kanpur Nagar

Series1


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CONCLUSION

There are a number of factors including economic, social, cultural, biological and medical,which influence infant and maternal deaths. It is the product of an enormous number of

complex and interrelated forces. However, they are intimately connected with maternal

capabilities. It is a sorry state of affairs that the majority of maternal and infant deathsoccurring in India arepreventable and yet consistently remain on unacceptably high levels.

Given the close, strong and direct association of maternal and infant survival to thecapabilities of the mother, it only reflects the lack of seriousness of government and society in

addressing the issues of primary concerns. A large number of studies throwing light on themechanisms whereby female literacy is converted to low maternal and infant mortality have

shown almost convincingly that a dramatic universal exists relationship between them.However, the actual behaviour or attitudes or abilities that work behind them remain an areaof social research.

Female literacy is the one, which may go a long way not only in reducing mortalities but alsoindirectly influencing the number of economic, sociocultural, and health conditions related to

the low status of women. Thus, increasing female literacy leads to a win-win situation. India

spends far less on health and education compared to many other countries. Taking cognisanceof the multiple channels through which female education is translated into lower infant and

maternal mortality, its significance hardly needs to be emphasized. It is high time that the

0

20

40

60

80

1 2Shrawasti

FL / R.A. FL / G P & LB

0

10

20

30

40

50

60

1 2

Jhansi

Series1

FL / G P & LB

0

5

10

15

20

25

30

35

40

45

1 2

Badaun

Series1

FL / R.A.

0

10

20

30

40

50

60

70

80

1 2

Badaun

Series1

FL / R.A.

0

10

20

30

40

50

60

70

80

1 2

Shrawasti

Series1

FL / G P & LB

0

5

10

15

20

25

30

35

40

1 2

Shrawasti

Series1

FL / EA

0

5

10

15

20

25

30

35

40

45

1 2

Badaun

Series1

FL / EA

0

5

10

15

20

25

30

35

40

1 2

Shrawasti

Series1

0

10

20

30

40

50

60

70

1 2Jhansi

FL / EA

S

s


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77

government, nongovernment organisations and civil society, all take up a challenge for a

better tomorrow.

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Documents

Female Literacy & Its Relevance With Maternal and Infant Mortality Rates