The paper explores the ways in which women's education influences domestic hygiene practices and use of health care services in a traditional agricultural village in The Gambia. The “environment of health” is one of poverty, high morbidity and low levels of female literacy. A detailed household survey was undertaken in the rainy season when agricultural work is demanding of people's time and energy and morbidity rates are high. Mothers with and without formal education and with at least one child under 5 were included in the study. Small differences were found between the educated and uneducated group in the knowledge and practice of household hygiene. The healthcare services in the village were utilised by all women regardless of whether or not they had been to school, but educated mothers appeared to have a better understanding of health education messages. The case study illustrates the synergy between health, hygiene and maternal education and discusses the implications of the findings.