The Role of Maternal Education in Reducing Excess Deaths among Girls in India

Moradhvaj, M., Yildiz, D. ORCID: https://orcid.org/0000-0001-6192-0634, & K.C., S. (2023). The Role of Maternal Education in Reducing Excess Deaths among Girls in India. IIASA Working Paper. Laxenburg, Austria: WP-23-006

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Abstract

India's skewed child–sex ratio (fewer girls than boys) results from excessive female child mortality due to postnatal discrimination against girls and sex-selective abortions. The positive effect of maternal education on child survival is well documented; however, its impact on protecting girls from higher mortality than boys is under-explored in the case of children under five. This study hypothesizes that educated mothers treat their children equally without gender discrimination, which reduces the unduly higher mortality of girls in India.
Data and Methods: Using five rounds of the National Family Health Surveys (NFHS) between 19921993 and 20192021, this study compared mortality for boys and girls in their first five years (0–59 months, under-five mortality) with respect to their mothers' educational attainment. This was disaggregated by ages 0–1 month (neonatal mortality), 1-11 months (post-neonatal mortality), and 12-59 months (child mortality). A mixed-effects Cox proportional hazard (MECPH) model was employed to compare the hazard of death for boys and girls by mothers' education.
Results and conclusion: The mortality rate for boys and girls under the age of five differs significantly by mothers’ educational attainment. In NFHS 19921993, 9 more girls (per 1000 live births) died than boys to mothers with below-primary education; this contrasts with 20 fewer girls dying than boys to mothers with secondary education. This implies that India could have saved 0.27 million girls per year during the NFHS 1992-1993 if the girls born to below-primary-educated mothers had a similar sex difference as those born to secondary-educated mothers. Recent surveys have indicated that girls born to mothers with primary education or lower continued to experience higher mortality than boys aged 12-59 months. MECPH model results based on pooled data from 1992-2021 indicate that girls have an 8% and 18% lower mortality risk than boys during under-five years of age born to primary and secondary educated mothers, respectively, than those born to below-primarily educated mothers.
The survival advantage for girls born to secondary educated mothers is closer to the prevailing biological survival advantage of girls in Western European countries where gender discrimination is negligible. The impact of mothers’ education is stronger at ages when girls are more disadvantaged (i.e., at ages 1-11 months and 12-59 months). Our results show that maternal education significantly protects girls from a higher risk of death, leading to achieving the biological survival advantage for girls in India. There is thus a need to increase focus on women's secondary school education to improve both under-five mortality and the child–sex ratio in India

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