Health Programs, Maternal Education, and Differential Child Mortality in Matlab, Bangladesh

Abstract

This study examines the extent to which health interventions affect differences in the relationship between maternal educational status and child mortality. The sample is based on data from the Bangladesh Matlab Demographic Surveillance System for blocks ABC and D. Blocks A and D had intensive interventions. The sample includes 12266 singleton births which occurred during 1981-82 that survived to age one. Findings show that the highest child mortality was in the comparison areas (36.6 per 1000) followed by the nonintensive intervention area (25.7) and the intensive area (16.7). The 1-4 year old death rate decreased with an increase in the intensity of interventions for children of mothers with no schooling. The range of differences in child mortality by level of intensity of services was much lower for children of mothers with some education. At age 1 mortality differences by maternal educational status were small. At age 2 mortality differences were wide between mothers with none or some schooling in the comparison and nonintensive areas but closer in the intensive area. At age 3 differences between mothers with some and no schooling were wide in the comparison area and closer in the other areas. Dysentery was the main cause of death among children aged 1-4 years followed by watery diarrhea and measles. Logistic models reveal that the no schooling subgroup had a higher odds of death from dysentery diarrhea and measles drowning fever and respiratory diseases than the some schooling subgroup. Mortality declined greatly and systematically with the intensity of interventions among the non schooling subgroup. It is concluded that Matlab interventions reduced differences in child mortality related to maternal schooling. Interventions were not as successful in reducing differences by gender and differences attributed to poor economic conditions. Policy should be directed to socioeconomic development and health interventions specifically for dysentery control.