A new paper shows that educating girls has a direct effect on child mortality rates
A new paper shows that educating girls has a direct effect on child mortality rates, estimating that the lives of 4 million children under-5 have been saved by efforts over the last four decades to get girls to school and keep them there for longer.
Education is a wonderful thing. Teach children to read and write and use numbers and you open up the world for them. Give girls an education in poor countries and you increase their chances of marrying later and being treated with greater respect in their communities, even if they never get the sort of qualification that leads to a job. And according to a paper in today's Lancet medical journal, educating girls has another, hugely beneficial effect - it leads directly to a cut in the numbers of deaths of small children.
It sounds too good to be true, but the authors of the paper, Emmanuela Gakidou and colleagues from the Institute of Health Metrics and Evaluation in Seattle - which has brought us a number of interesting papers lately - have done a very careful analysis of the relationship between women's education and child mortality over the last 40 years. They have calculated the relative contribution of a country's economic growth and allowed for the impact of HIV - and they find that the increased education of women of reproductive age (15-44 years old) between 1970 and 2009 was responsible for half the total reduction in deaths of under-5s. In fact, they say, keeping girls in school longer has saved more than 4 million children's lives.
In an accompanying editorial, John Cleland from the London School of Hygiene and Tropical Medicine says the relationship is well established. Even a few years of primary schooling for girls helps their children survive. Exactly why the link is so strong is still the subject of some speculation. The obvious reason - that the mother better understands how diseases are caused and prevented and cured - might be only part of it, he says. Better hygiene in the home, more intense mother-child interactions and "greater maternal decision-making power among mothers who are more educated" may all play a part, but, he says, the biggest factor is probably the mother's greater willingness to seek preventive healthcare such as vaccinations and take the child to a clinic when he or she is unwell.
It is likely that the symbiotic effect of schooling and health-service use underlies the striking result of Gakidou and colleagues' paper.
Symbiotic is a good word. This relationship between education and health and child mortality brings home the nonsense of the silo approach to aid and development in poor countries. There may be eight separate Millennium Development Goals, which will be the subject of next week's summit at the UN in New York, but arguing that some matter more than others is absurd. They are all inter-linked.
Unicef publishes the latest child mortality statistics also in the Lancet today - with an analysis of progress towards the goal of cutting the deaths of under-5s by two-thirds between 1990 and 2015. It finds there has been progress - deaths have fallen from 12.4 million to 8.1 million last year. But 22,000 small children still die every day. The world is not on track for reaching MDG4. While there have been reductions of at least 50% in mortality in most regions, sub-Saharan Africa, southern Asia and Oceania are lagging. One in every eight children in sub-Saharan Africa dies before his or her 5th birthday, which is double the rate for other developing countries.
Basic public health interventions work. The countries that have done best, especially in sub-Saharan Africa, are those that have experienced rapid expansion of such interventions as immunisation, breast feeding, vitamin A supplementation, and safe drinking water. But diarrhoea and malaria remain big problems.