Background. The gross longitudinal relationship between female literacy and maternal mortality ratios has not been adequately investigated even though the knowledge of the relationship is crucial for designing maternal mortality reduction programs through female literacy campaigns and improvements. The objective of the study was to examine the dynamic relationship between female literacy and mortality ratios. A longitudinal study design spanning three decades, 1970–2000, was used. Country level data on 143 nations belonging to six geographical regions for the duration 1970–2000 were secured from websites hosted by global agencies such as World Bank and the United Nations were utilized. Maternal mortality ratios (1970–2000) ranged from 147 to 271 across the six regions. The longitudinal relationship between female literacy rates and maternal mortality ratios was examined using a latent growth curve approach. The study found that rates of change in female literacy and maternal mortality ratios are negatively related. Steady rates of increase in female literacy were associated with declining maternal mortality ratios as well. We find that female literacy programs are of immense value in reducing maternal mortality ratios given their ability to yield sustained reductions in mortality levels in developing countries. 1. Introduction Each year, globally, about 210 million women become pregnant [1]. Only about 75 percent of these pregnancies are safe without life threatening complications. As a result, annually an estimated half a million women die of either pregnancy or child birth [2]. One in 350 pregnancies carries a high mortality risk due to causes such as hemorrhage, infection, unsafe abortion, eclampsia, and obstructed labor [3]. These five problems contribute to almost 70 percent of maternal deaths [4, 5]. In developing countries, the likelihood of women dying from pregnancy related causes is nearly 1 in 50 [6]. Bezruchka [7] presents three categories of general sources of threat to the life of the mother during pregnancy and child birth. The first of the three, poor accessibility to health services in supply, is often the most immediate cause of death during child birth. The second category includes a large number of indicators of health status including woman’s constitution, age, and parity. The last risk category is composed of several social economic and environmental factors such as literacy status income and cultural factors. Even though causes of maternal mortality are health related complications, unavailable, inaccessible, and unaffordable
References
[1]
D. Wulf, Sharing Responsibility: Women, Society and Abortion, Alan Guttmacher, New York, NY, USA, 1999.
[2]
N. Chaya, B. Johnston, R. Engelman, S. Ethelston, and M. Greene, A World of Difference: Sexual and Reproductive Health and Risks, Population Action International, Washington, DC, USA, 2001.
[3]
L. Ashford, Hidden Suffering: Disabilities from Pregnancy and Childbirth in Less Developed Countries, Population Reference Bureau, Bethesda, Md, USA, 2002.
[4]
T. Ensor and S. Cooper, “Overcoming barriers to health service access: influencing the demand side,” Health Policy and Planning, vol. 19, no. 2, pp. 69–79, 2004.
[5]
C. R. Janes and O. Chuluundorj, “Free markets and dead mothers: the social ecology of maternal mortality in post-socialist Mongolia,” Medical Anthropology Quarterly, vol. 18, no. 2, pp. 230–257, 2004.
[6]
World Health Organization, Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF, World Health Organization, Geneva, Switzerland, 1996, http://whqlibdoc.who.int/hq/1996/WHO_FRH_MSM_96.11.pdf.
[7]
S. Bezruchka, “The hurrider i go the behinder i get: the deteriorating international ranking of U.S. health status,” Annual Review of Public Health, vol. 33, pp. 157–173, 2012.
[8]
J. McCarthy and D. Maine, “A framework for analyzing the determinants of maternal mortality,” Studies in Family Planning, vol. 23, no. 1, pp. 23–33, 1992.
[9]
I. H. Yen and S. L. Syme, “The social environment and health: a discussion of the epidemiologic literature,” Annual Review of Public Health, vol. 20, pp. 287–308, 1999.
[10]
S. M. Kneipp and D. J. Drevdahl, “Problems with parsimony in research on socioeconomic determinants of health,” Advances in Nursing Science, vol. 26, no. 3, pp. 162–172, 2003.
[11]
A. T. N. Tita, J. S. A. Stringer, R. L. Goldenberg, and D. J. Rouse, “Two decades of the safe motherhood initiative: time for another wooden spoon award?” Obstetrics and Gynecology, vol. 110, no. 5, pp. 972–976, 2007.
[12]
F. C. Pampel Jr. and V. K. Pillai, “Patterns and determinants of infant mortality in developed nations, 1950–1975,” Demography, vol. 23, no. 4, pp. 525–542, 1986.
[13]
D. Conley and K. W. Springer, “Welfare state and infant mortality,” The American Journal of Sociology, vol. 107, no. 3, pp. 768–807, 2001.
[14]
C. W. Monden and J. Smits, “Maternal height and child mortality in 42 developing countries,” The American Journal of Human Biology, vol. 21, no. 3, pp. 305–311, 2009.
[15]
K. P. Gbesemete and U. G. Gerdtham, “Determinants of health care expenditure in Africa: a cross-sectional study,” World Development, vol. 20, no. 2, pp. 303–308, 1992.
[16]
S. Gupta, M. Verhoeven, and E. R. Tiongson, “The effectiveness of government spending on education and health care in developing and transition economies,” European Journal of Political Economy, vol. 18, no. 4, pp. 717–737, 2002.
[17]
Z. A. Bhutta, G. L. Darmstadt, B. S. Hasan, and R. A. Haws, “Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence,” Pediatrics, vol. 115, no. 2, supplement, pp. 519–617, 2005.
[18]
H. E. Burchett and S. H. Mayhew, “Maternal mortality in low-income countries: what interventions have been evaluated and how should the evidence base be developed further?” International Journal of Gynecology and Obstetrics, vol. 105, no. 1, pp. 78–81, 2009.
[19]
M. C. Hogan, K. J. Foreman, M. Naghavi et al., “Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards millennium development goal,” The Lancet, vol. 375, no. 9726, pp. 1609–1623, 2010.
[20]
C. Ronsmans, A. M. Vanneste, J. Chakraborty, and J. van Ginneken, “Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale,” The Lancet, vol. 350, no. 9094, pp. 1810–1814, 1997.
[21]
D. Brady, Y. Kaya, and J. Beckfield, “Reassessing the effect of economic growth on well-being in less-developed countries, 1980–2003,” Studies in Comparative International Development, vol. 42, no. 1-2, pp. 1–35, 2007.
[22]
J. Rice, “Material consumption and social well-being within the periphery of the world economy: an ecological analysis of maternal mortality,” Social Science Research, vol. 37, no. 4, pp. 1292–1309, 2008.
[23]
K. A. S. Wickrama and F. O. Lorenz, “Women's status, fertility decline, and women's health in developing countries: direct and indirect influences of social status on health,” Rural Sociology, vol. 67, no. 2, pp. 255–277, 2002.
[24]
D. Gil-González, M. Carrasco-Porti？o, and M. T. Ruiz, “Knowledge gaps in scientific literature on maternal mortality: a systematic review,” Bulletin of the World Health Organization, vol. 84, no. 11, pp. 903–909, 2006.
[25]
J. Shiffman, “Can poor countries surmount high maternal mortality?” Studies in Family Planning, vol. 31, no. 4, pp. 274–289, 2000.
[26]
R. N. Grosse and C. Auffrey, “Literacy and health status in developing countries,” Annual Review of Public Health, vol. 10, pp. 281–297, 1989.
[27]
P. Sandiford, J. Cassel, M. Montenegro, and G. Sanchez, “The impact of women's literacy on child health and its interaction with access to health services,” Population Studies, vol. 49, no. 1, pp. 5–17, 1995.
[28]
A. Pinto, P. Scheer, S. Tuqa, G. J. Ebrahim, R. Abel, and D. S. Mukherjee, “Does health intervention ameliorate the effects of poverty related diseases? II. The role of female literacy,” Journal of Tropical Pediatrics, vol. 31, no. 5, pp. 257–262, 1985.
[29]
L. Haddad, “Women's status: levels, determinants, consequences for malnutrition, interventions, and policy,” Asian Development Review, vol. 17, no. 1-2, pp. 96–131, 1999.
[30]
S. Thaddeus and D. Maine, “Too far to walk: maternal mortality in context,” Social Science and Medicine, vol. 38, no. 8, pp. 1091–1110, 1994.
[31]
S. McTavish, S. Moore, S. Harper, and J. Lynch, “National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa,” Social Science and Medicine, vol. 71, no. 11, pp. 1958–1963, 2010.
[32]
R. A. LeVine, S. E. LeVine, and B. Schnell, “Improve the women: mass schooling, female literacy, and worldwide social change,” Harvard Educational Review, vol. 71, no. 1, pp. 1–51, 2001.
[33]
F. Vavrus, “Girls' schooling in Tanzania: the key to HIV/AIDS prevention?” AIDS Care, vol. 18, no. 8, pp. 863–871, 2006.
[34]
N. M. Nwakeze, “The demand for children in Anambra State of Nigeria: a logit analysis,” Etude de la Population Africaine, vol. 22, no. 2, pp. 175–201, 2007.
[35]
The World Bank, How We Classify Countries, vol. 23, The World Bank, 2011, http://data.worldbank.org/about/country-classifications.
[36]
J. E. Mill and J. K. Anarfi, “HIV risk environment for Ghanaian women: challenges to prevention,” Social Science and Medicine, vol. 54, no. 3, pp. 325–337, 2002.
[37]
K. Stinson and L. Myer, “HIV-infected women's experiences of pregnancy and motherhood in Cape Town, South Africa,” Vulnerable Children and Youth Studies, vol. 7, no. 1, pp. 36–46, 2012.
[38]
S. Raghupathy, “Education and the use of maternal health care in Thailand,” Social Science and Medicine, vol. 43, no. 4, pp. 459–471, 1996.
[39]
L. T. T. Trinh, M. J. Dibley, and J. Byles, “Determinants of antenatal care utilization in three rural areas of Vietnam,” Public Health Nursing, vol. 24, no. 4, pp. 300–310, 2007.
[40]
Y. M. Adamu, H. M. Salihu, N. Sathiakumar, and G. R. Alexander, “Maternal mortality in Northern Nigeria: a population-based study,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 109, no. 2, pp. 153–159, 2003.
[41]
K. M. Osubor, A. O. Fatusi, and J. C. Chiwuzie, “Maternal health-seeking behavior and associated factors in a rural Nigerian community,” Maternal and Child Health Journal, vol. 10, no. 2, pp. 159–169, 2006.
[42]
D. Shaw, “Women's right to health and the millennium development goals: promoting partnerships to improve access,” International Journal of Gynecology and Obstetrics, vol. 94, no. 3, pp. 207–215, 2006.
[43]
P. M. Davidson, S. J. McGrath, A. I. Meleis et al., “The health of women and girls determines the health and well-being of our modern world: a white paper from the international council on women's health issues,” Health Care for Women International, vol. 32, no. 10, pp. 870–886, 2011.
[44]
M. Hvistendahl, Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men, Public Affairs, New York, NY, USA, 2011.
[45]
A. Bandarage, Women, Population and Global Crisis: A Political-Economic Analysis, Zed Books, Totowa, NJ, USA, 2011.
[46]
R. E. Ford and K. T. Andamson, “The population-environment nexus and vulnerability assessment in Africa,” GeoJournal, vol. 35, no. 2, pp. 207–216, 1995.
[47]
C. H. Kahl, States, Scarcity, and Civil Strife in the Developing World, Princeton University Press, Princeton, NJ, USA, 2006.
[48]
H. Urdal, “Population, resources, and political violence: a subnational study of India, 1956–2002,” Journal of Conflict Resolution, vol. 52, no. 4, pp. 590–617, 2008.
[49]
L. P. Freedman and S. L. Isaacs, “Human rights and reproductive choice,” Studies in Family Planning, vol. 24, no. 1, pp. 18–30, 1993.
[50]
B. Nowrojee, D. Q. Thomas, and J. Fleischman, Shattered Lives: Sexual Violence During the Rwandan Genocide and Its Aftermath, Human Rights Watch, New York, NY, USA, 1996.
[51]
B. Hartmann, Reproductive Rights and Wrongs (Revised Edition): The Global Politics of Population Control, South End Press, Boston, Mass, USA, 1999.
[52]
G. Nanda, K. Switlick, and E. Lule, Accelerating Progress Towards Achieving the MDG to Improve Maternal Health: A Collection of Promising Approaches, HNP, 2012, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/NandaAcceleratingProgresswithCover.pdf.
[53]
P. Baraté and M. Temmerman, “Why do mothers die? The silent tragedy of maternal mortality,” Current Women's Health Reviews, vol. 5, no. 4, pp. 230–238, 2009.
[54]
P. Williams, “What will it take to stop the needless deaths of millions of women and children each year?” Journal of Paediatrics and Child Health, vol. 47, no. 5, pp. 249–256, 2011.
[55]
R. K. Rai and T. H. Tulchinsky, “Addressing the sluggish progress in reducing maternal mortality in India,” Asia-Pacific Journal of Public Health, 2012.
[56]
R. K. Rai, P. K. Singh, and L. Singh, “Utilization of maternal health care services among married adolescent women: insights from the Nigeria demographic and health survey, 2008,” Women's Health Issues, vol. 22, no. 4, pp. e407–e414, 2012.
[57]
L. Freedman, “Strategic advocacy and maternal mortality: moving targets and the millennium development goals,” Gender and Development, vol. 11, no. 1, pp. 97–108, 2003.
[58]
C. AbouZahr, “Safe Motherhood: a brief history of the global movement 1947–2002,” The British Medical Bulletin, vol. 67, no. 1, pp. 13–25, 2003.
[59]
K. Gill, R. Pande, and A. Malhotra, “Women deliver for development,” The Lancet, vol. 370, no. 9595, pp. 1347–1357, 2007.
[60]
H. de Pinho, “On the rights track: the importance of a rights-based approach to reducing maternal deaths,” in Realizing the Right to Health, A. Clapham and M. Robinson, Eds., pp. 111–119, Rüffer & Rub, Zurich, Switzerland, 2009.
[61]
R. Dixon-Mueller, “The sexuality connection in reproductive health,” Studies in Family Planning, vol. 24, no. 5, pp. 269–282, 1993.
[62]
A. Rahman and R. N. Pine, “An international human right to reproductive health care: toward definition and accountability,” Health and Human Rights, vol. 1, no. 4, pp. 400–427, 1995.
[63]
V. K. Pillai and G. Z. Wang, Women's Reproductive Rights in Developing Countries, Ashgate Publishers, Burlington, Vt, USA, 1999.
[64]
M. F. Fathalla, S. W. Sinding, A. Rosenfield, and M. M. Fathalla, “Sexual and reproductive health for all: a call for action,” The Lancet, vol. 368, no. 9552, pp. 2095–2100, 2006.
[65]
A. Glasier, A. M. Gülmezoglu, G. P. Schmid, C. G. Moreno, and P. F. van Look, “Sexual and reproductive health: a matter of life and death,” The Lancet, vol. 368, no. 9547, pp. 1595–1607, 2006.
[66]
M. J. Hindin and A. O. Fatusi, “Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions,” International Family Planning Perspectives, vol. 35, no. 2, pp. 58–62, 2009.
[67]
C. C. Ibeh, “Is poor maternal mortality index in Nigeria a problem of care utilization? A case study of Anambra State,” African Journal of Reproductive Health, vol. 12, no. 2, pp. 132–140, 2008.
[68]
J. D. G. Goldman, “Sexuality education for young people: a theoretically integrated approach from Australia,” Educational Research, vol. 52, no. 1, pp. 81–99, 2010.
