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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
0976 6510(Online), Volume 3, Issue 2, May-August (2012)
65
FEMALE LITERACY & ITS RELEVANCE WITH MATERNAL
AND INFANT MORTALITY RATES
Garima Jain
Ph.D. Scholar IET-Lucknow
Email : [email protected]
Dr. Vikram Bisen
Associate Professor IET-Lucknow
ABSTRACT
When a female is educated the next generation is bound to be educated henceeducation has many folds impact on the social and economical development of any nation.
Education as such, results in positive externalities. Not only does it have an intrinsic value inthe sense of the joy of learning, reading etc, but it also has instrumental, social and process
roles. Moreover education may spread through interpersonal motivation. When one family
sends their child to school, their neighbor is likely to do so as well. Womens education too,often spreads this way, more specifically, through same sex effects. i.e. an educated woman is
far more likely to send her daughter to school than an uneducated woman. Also, she is likelyto maintain better conditions of nutrition and hygiene in her household and thereby improve
her familys health (Sen 1997).Literacy is directly related to the status of a woman, her age at marriage, her decision powerand to mention especially capability to access health care services. Literacy not only increases
womens self-confidence but also makes them more exposed to information and thereby
altering the way others respond to them. Female literacy improves the chances that womenwill obtain meaningful employment, reduces their demand for children and improves health-
seeking behavior, makes them aware of Nutritional requirements - all these combinedimprove the chances of survival of both - the mother and the baby.
The present paper focuses on the relationship between the female literacy and mortality rates
(IMR and MMR) and establishes an inverse relationship between them.
INTRODUCTION
Not only might women residing in countries with higher female literacyenjoy greater personal safety and physical integrity, they may also have greater inheritance
rights, ownership rights in land and loans, and labour market rights (Jtting et al., 2008;Magadi, Madise, & Rodrigues, 2000). Countries with higher female literacy may also devote
more resources to the provisioning of maternal health care services along a range of maternalhealth care delivery models, including physicians, nurses, and traditional birth attendants. In
terms of the inverse equity hypothesis, the greater range of services available to women in
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countries with higher female literacy may contribute to lower inequalities in use compared to
those found in countries with lower female literacy.The United Nations Millennium Development Goals have identified improving womens
access to maternal health care as a key target in reducing maternal mortality in the world.Individual socio-demographic and national-level environmental factors may affect womens
use of maternal health care. At the individual level, age, income, education, and urban or rural
residence may all play a role in womens use of maternal health care services (Gyimah,Baffour, & Addai, 2006; Magadi, Agwanda, & Obare, 2007; Magadi, Zulu, & Brockenhoff,
2003; Obermeyer & Potter, 1991). Differences between countries along such dimensions asfemale literacy rates or levels of economic development may play a pivotal role in womens
reproductive health, and maternal and infant mortality (Frey & Field, 2000; Obermeyer,1993;
Shen & Williamson, 1997; Shiffman, 2000; Wang, 2007). National female literacy rates arean important indicator of womens status and autonomy in society (Frey & Field, 2000;
Magadi, Agwanda & Obare, 2007).
Mortality, which is one of the major structural variables of demography, has continuouslybeen affecting the population structure, particularly in developing countries like India. Most
of the countries in the world, developed as well as developing, have experienced drasticimprovement in life expectancy. Among various factors responsible for decline in mortality,
economic factors: increase in per capita income, social factors: improvement in nutrition,housing and clothing, sanitation, water supply, cleanliness, individual hygienic practices and
developments of medical science have played an important role. However, women andchildren do not equally enjoy fruits of these developments. Women and children are still thedeprived sector of the society and maternal and infant mortality remain high in spite of a
striking fall in general mortality rate.
CONCEPTS OF MATERNAL AND INFANT MORTALITY
Maternal mortality is a sensitive indicator of health and general socioeconomic developmentof a community or of a nation. It is one of the leading causes of death among women in their
reproductive age. In India like most developing countries, women of reproductive ages
constitute a little more than one-fifth of the total population and are exposed repeatedly to the
risk of pregnancy. More maternal deaths occur in India in one week than in all of Europe inone year. In a single day in India, the total number of casualties due to pregnancy and child
birth-related complications is more than recorded in one month in the entire developedworld.Maternal mortality is difficult to measure (Campbell and Graham 1990). The tenth
revision of the International Classification of Diseases (ICD- 10) defines a maternal death as
the death of a woman while pregnant or within 42 days of termination of pregnancy,irrespective of the duration and site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management but not from accidental or incidental causes.While many health indicators are required to arrive at a comprehensive assessment of the
health status of a population, a particularly sensitive and widely used summary indicator is theInfant Mortality Rate (Visaria 1985). Infant Mortality refers to death of children in age group
0-1. Infant Mortality Rate (IMR) is the number of infant deaths that occur per thousand livebirths in a population in one calendar year. It is one of the universally accepted indicators of
health status of not only infants but also of the whole population and of socio-economicconditions under which they live.
EDUCATION AS AN INTERVENING VARIABLE IN MATERNAL AND INFANT
MORTALITY DECLINE
It is universally accepted that the higher the female literacy rate, the lower the MMR.
Studying at school /college for a longer period will prevent early marriage and earlymotherhood. Educated women will seek proper antenatal and intra-natal supervision. The
female literacy rates in Sri-Lanka and Thailand are over 80 percent and the MMR in these
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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
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67
two countries is 60 per 100,000 only. Although economically, there is not much of difference
between the MMR of these two countries 340 as compared to 60. Kerala, having the highestfemale literacy rate in India, has the lowest MMR, compared to Bihar < U.P. and M.P.
Mothers residing in countries with higher literacy rates were more likely to use maternal
health care, after adjusting for national economic development and individual socio-
demographic factors. socio-economic status has been linked to more frequent use of maternalhealth clinics (Rabe-Hesketh & Skrondal, 2005).
Although Magadi et al. (2007)found women in high female literacy countries less likely tomake an inadequate number of visits to maternal health care clinics than women in low
female literacy countries.
The reduction of maternal and infant deaths is high priority for the international community,
especially in view of the increased attention on the Millennium Development Goals. Maternal
deaths arise from the risks attributable to pregnancy and childbirth as well as from the poor
quality care from health services.
Ecological analyses have found direct associations between female literacy and nationaleconomic development for outcomes such as maternal and infant mortality in positive
direction (Jtting, Morrisson, Dayton-Johnson & Drechsler, 2008; Wang, 2007).
A number of studies have examined empirical evidences concerning the influence ofdemographic and socio-economic factors of child survival (Gandotra et al. 1980; Clealand
and Ginneken et al. 1988; Miller 1983; Das Gupta 1990; Caldwell 1979; Griffith et al. 2001).All these studies reinforce the existing argument for a greater emphasis on the schooling of
girls to give women themselves and the next generation a greater chance of survival. Severalauthors have discussed the mechanism of literacy influence on infant survival (Caldwell 1979,1986; Cohrane 1980; Hobecraft et al. 1984; United Nations 1985; Ware 1984; Gokhale et al.
2002; Govindasamy and Ramesh 1997). Ruzika and Kanitkar (1 972) found mothers literacy
to be the most effective single factor determining the level of infant mortality in an urban
setting.
Pooled data from the Demographic and Health Surveys (DHS) of South-Asian countries fromthe late 1990s to examine the association between female literacy and antenatal care visits and
found that women in countries with higher female literacy were more likely to start antenatal
care late in their pregnancy, but less likely to make an inadequate number of visits.
Womens literacy and their use of health facilities go hand in hand. Krishnan (1985)
examined overall death rates in terms of literacy, doctor, hospital and bed population ratio,per capita income expenditure on medical and health services. He observed that literacy was
the most important factor while health services also had some explanatory power.
A number of cross-section studies for India have explored the impact of female literacy onmaternal and child death. Sharma and Retherford (1999) have used 1991 Census data,aggregated to district level, for 326 districts. They show that female literacy would have a
significant negative impact on maternal and child deaths.High maternal and infant deaths can be attributed to low status and low capability of women.
These deaths are preventable if more and more women are literate thereby exposing them tonew ideas. Literacy can make them aware of a range of services from antenatal to nutrition,personal hygiene, immunisation, birth spacing, maternal skills, breast-feeding and overall
health.
In order to reduce the high maternal mortality in the developing countries, government
should work on the causes which are multiple, inter-related and tiered. The most superficial of
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International Journal of
0976 6510(Online), Volu
themselves of antenatal care, te
delivery and complete immunizReviews suggest that birth int
mortality than does maternal aassociation is not always foun
complete their family in a short
Afew studies (Jejeebhoy and
that interspouse consultation isregard to family size and the ad
the role of schooling in crea
extensive use and approval ofenhancing female autonomy, i
result in decline in the number
and maternal deaths. More receducation (at least 5-6 years) th
in female autonomy, particularand Basu 1996; Jejeebhoy 1995
The influence of female literexamined using data from the s
as well as microlevel data on ru
3 years. After consideringcomprehensive models were de
underweight, anaemia, and unmodels were low maternal bo
hospitalized deliveries, treatmvaccinations.
Addition of female illiteracy
variables significantly. Mean psignificantly higher (p
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Studies suggests that national
status in India such as progra
may encourage female educatiin maternal health care use. As
with maternal health care use fsystem and the greater resourc
anticipate that the benefits of liexperienced differently by in
income.
There have been efforts to cor
child mortality. In rural areacompared to urban areas. Furth
before reaching the age of 18 y
and level of education. Availablevel of education and her fertil
STATISTICAL RELATION
Table below presents data for IAs hypothesized, the inverse c
literacy and MMR and positive
However, large variations are
levels of female literacy. For e64 in Gujarat and 53 in West B
At the same time, estimates ofappear to be on the lower side
the same band of female literacand 154 in Andhra Pradesh an
be conceived that several facterode the positive influence
evidences to show that educa
factors such as age at marriaginfluenced by socio-cultural no
not reduce the role of womens
as well which enhance women
anagement (IJM), ISSN 0976 6502(Pri
e 3, Issue 2, May-August (2012)
olicies that are able to address female literacy an
s that cover costs for tuition, school uniforms and
n and in the long-run help reduce income-related isuch, female literacy at the national level may be
r all women in the country due to the greater mats and autonomy available to all women. We migh
ving in a country with higher average female literividual women depending on womens relative
relate female literacy with age at marriage, fertilit
, a higher proportion of married women are iller, among illiterates, around two-thirds of women
ars, suggesting a positive correlation between age
le data also suggest an inverse correlation betweenity.
HIPS
MR, MMR and adult female literacy in major statrrelation between (i) female literacy and IMR and
correlation between (iii) IMR and MMR is statistic
seen in mortality rates corresponding to more or l
ample, IMR ranges from 98 in Orissa and Madhyaengal in the same band of female literacy (50 to 6
MR for some states like Gujarat and Tamil NaduSRS 1999). Interstate variations are even greater i
y. For example, it is as low as 29 in Gujarat, 105 ias high as 498 in Madhya Pradesh and 401 in Ass
rs block some of the postulated pathways of inflof womens education (Shivakumar 1995). The
tion leads to favourable shifts in maternal behav
, child spacing, family size and so on appear torms of society (Ware 1984; Cleland 1990). Howe
literacy in any way. It only reiterates to focus on ot
s capabilities.
t), ISSN
womens
textbooks,
nequalitiesassociated
rity of thet therefore
cy will behousehold
rates and
iterates asot married
t marriage
a womans
s of India.(ii) female
lly true.
ss similar
Pradesh toper cent).
rima facieMMR for
Haryana,am. It may
uence andre are no
iour, since
e stronglyer, it does
her factors
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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
0976 6510(Online), Volume 3, Issue 2, May-August (2012)
72
TABLE
Female literacy and mortalities in India:
States Female LiteracyIMR** MMR**
India 54.2 71 408
Andhra Pradesh 51.2 66 154
Assam 56 78 401
Bihar 33.6 67 451
Gujarat 58.6 64 29
Haryana 56.3 69 105
Karnataka 57.5 58 195
Kerala 87.9 16 195
Madhya Pradesh 50.3 97 498
Maharashtra 67.5 49 135
Orissa 51 98 361
Punjab 63.6 54 196
Rajasthan 44.3 83 677
Tamil Naidu 64.6 53 76
Uttar Pradesh 43 85 707
West Bengal 60.2 53 264
Source: * - Census of India, 2001 ** - SRS, Registrar General of India.
0
20
40
60
80
100
120
Female Literacy IMR**
0
100
200
300
400
500
600
700
800
Female literacy and mortalities in India: Female Literacy
Female literacy and mortalities in India: MMR**
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73
Table :- Effect of Female literacy on four RCH indicators [According to Census
2011,Govt Of India]
Location Female
Literacy Rate
Infant
Mortality rate
(No. of death /
1,000 livebirth)
Fertility rate
(No. of child
born/woman)
Maternal
Mortality rate
(No. of
deaths/1,00,000live birth)
Under 5
Mortality
rate (No. of
death /1,000 live
birth)
Year Year Year Year Year
2001 2011 2001 2011 2001 2011 2001 2011 200
1
2011
India 54.20 65.46 63.19 47.57 3.04 2.62 306 230 87 63
Uttar
Pradesh
42.85 59.26 68.45 51.42 3.72 2.81 372 245 91 66
0
10
20
30
40
50
60
70
1 2 3 4
INDIA
Female Literacy Rate / Infant
Mortality Rate
Series
1
0
10
20
30
40
50
60
70
1 2 3 4
INDIA
Female Literacy Rate / Fertility Rate
Series1
0
10
20
30
40
50
60
70
1 2 3 4
INDIA
Female Literacy Rate / MeternalMortality Rate
Series
1
0
10
20
30
40
50
60
70
1 2 3 4
INDIA
Female Literacy Rate / Under 5Morality Rate
Series1
0
10
20
30
40
50
60
70
80
1 2 3 4
UTTAR PRADESH
Female Literacy Rate / InfantMortality Rate
Serie
s1
0
10
20
30
40
50
60
70
1 2 3 4
UTTAR PRADESH
Female Literacy Rate / Fertility Rate
Series1
0
10
20
30
40
50
60
70
1 2 3 4
UTTAR PRADESH
Female Literacy Rate / MeternalMortality Rate
Se
rie
s1
0
10
20
30
40
50
60
70
1 2 3 4
UTTAR PRADESH
Female Literacy Rate / Under 5 MoralityRate
Series1
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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
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74
Table: Effect of Female literacy on four RCH indicators
Location FemaleLiteracy
rate (%)
InfantMortality
rate [No. of
death / 1,000live birth]
Fertility rate[No. of child
born/woman]
Maternal Mortalityrate [No. of
deaths/1,00,000 live
birth]
Under 5Mortality rate
[No. of death
/ 1,000 livebirth]
Kanpur
Nagar
76.89 31.27 1.59 150 6
Lucknow 73.88 34.57 1.68 156 8
Saharanpur 60.72 48.63 3.15 227 18
Jhansi 56.60 53.45 3.24 235 21
Budaun 40.92 69.35 3.63 339 69
Shrawasti 37.07 72.18 4.02 363 72
There exists a direct correlation between Female Literacy and Infant Mortality.
0
10
20
3040
50
60
70
80
90
1 2
Kanpur Nagar
Female Literacy Rate / InfantMorality Rate
0
10
20
30
40
50
60
70
80
90
1 2
Kanpur Nagar
Female Literacy Rate /Fertility Rate
0
10
20
30
40
50
60
70
80
90
1 2
Kanpur Nagar
Female Literacy Rate/Maternal Morality Rate
0
10
20
30
4050
60
70
80
90
1 2
Kanpur Nagar
Female Literacy Rate / InfantMorality Rate
S
e
Female Literacy Rat e / InfantM oral i ty Rate
0
20
40
60
80
1 2
Lucknow
Series1
Female Literacy Rate /Fert i l i ty Rate
0
20
40
60
80
1 2
Lucknow
Series1
Female Literacy Rate /MaternalMorality Rate
0
10
20
30
40
50
60
70
80
1 2
Lucknow
Series1
Female Literacy Rate /Under 5 Moral i ty Rate
0
20
40
60
80
1 2
Lucknow
Series1
Female Literacy Rate / InfantM oral i ty Rate
0
20
40
60
80
1 2
Saharanpur
Series1
Female Literacy Rate /Fert i l i ty Rate
0
20
40
60
80
1 2
Saharanpur
Series1
Female Literacy Rate/M aternal Moral i ty Rate
0
20
40
60
80
1 2
Saharanpur
Series1
Female Literacy Rate /Under 5 M orality Rate
0
20
40
60
80
1 2
Saharanpur
Series1
51.5
52
52.5
5353.5
54
54.5
55
55.5
56
56.5
57
1 2
Jhansi
Female Literacy Rate / InfantMorality Rate
0
10
20
30
40
50
60
1 2
Jhansi
Female Literacy Rate / FertilityRate
Series1
0
10
20
30
40
50
60
1 2
Jhansi
Female Literacy Rate/Maternal Morality Rate
0
10
20
30
40
50
60
1
Jhansi
Female Literacy Rate / Under5 Morality Rate
0
10
20
30
40
50
60
70
80
1
Badaun
Female Literacy Rate / InfantMorality Rate
0
5
10
15
20
25
30
35
40
45
1
Badaun
Female Literacy Rate / FertilityRate
S
e
ri
e
0
5
10
15
20
25
30
35
40
45
1
Badaun
Female Literacy Rate /MaternalMorality Rate
S
e
ri
e
0
10
20
30
40
50
60
70
80
1
Badaun
Female Literacy Rate / Under5 Morality Rate
S
e
ri
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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
0976 6510(Online), Volume 3, Issue 2, May-August (2012)
Effect of Literacy Rate
District FL R.A. GP & LB EA
Kanpur 76.89 84.57 86.11 88.42
Lucknow 73.88 81.26 82.74 84.96
Saharanpur 60.72 66.79 68 69.8
Jhansi 56.6 62.26 63.39 65.09
Budhaun 40.92 4.01 45.83 47.05
Shrawasti 37.07 40.77 41.51 42.63
0
10
20
30
40
50
60
70
80
1
Shrawasti
Female Literacy Rate / InfantMorality Rate
S
e
ri
0
5
10
15
20
25
30
35
40
1
Shrawasti
Female Literacy Rate /Fertility Rate
0
5
10
15
20
25
30
35
40
1 2
Shrawasti
Female Literacy Rate /MaternalMorality Rate
S
e
rie
0
10
20
30
40
50
60
70
80
1
Shrawasti
Female Literacy Rate / Under5 Morality Rate
S
e
ri
FL - Female Literacy.RA - Female Literacy Promotion in Rural Area.GP & LB - Female Literacy Promotion y Gram Pradhan and LocalBody.
EA - Female Literacy Promotion economicAspect.
FL / R.A.
0
10
20
30
40
50
60
70
80
90
1 2
Kanpur Nagar
Series1
FL / GP & LB
0
10
20
30
40
50
60
70
80
90
1 2
Kanpur Nagar
Series1
FL / R.A.
0
10
20
30
40
50
60
70
80
1 2
Lucknow
Series1
FL / GP & LB
0
10
20
30
40
50
60
70
80
1 2
Lucknow
Series1
FL / EA
0
10
20
30
40
50
60
70
80
1 2
Lucknow
Series1
F L / EA
0
10
20
30
40
50
60
70
1 2
Saharanpur
Series1
FL / GP & LB
0
10
20
30
40
50
60
70
1 2
Saharanpur
Series1
FL / EA
0
10
20
30
40
50
60
70
1 2
Saharanpur
Series1
FL / EA
0
10
20
30
40
50
60
70
80
90
1 2
Kanpur Nagar
Series1
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International Journal of Management (IJM), ISSN 0976 6502(Print), ISSN
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CONCLUSION
There are a number of factors including economic, social, cultural, biological and medical,which influence infant and maternal deaths. It is the product of an enormous number of
complex and interrelated forces. However, they are intimately connected with maternal
capabilities. It is a sorry state of affairs that the majority of maternal and infant deathsoccurring in India arepreventable and yet consistently remain on unacceptably high levels.
Given the close, strong and direct association of maternal and infant survival to thecapabilities of the mother, it only reflects the lack of seriousness of government and society in
addressing the issues of primary concerns. A large number of studies throwing light on themechanisms whereby female literacy is converted to low maternal and infant mortality have
shown almost convincingly that a dramatic universal exists relationship between them.However, the actual behaviour or attitudes or abilities that work behind them remain an areaof social research.
Female literacy is the one, which may go a long way not only in reducing mortalities but alsoindirectly influencing the number of economic, sociocultural, and health conditions related to
the low status of women. Thus, increasing female literacy leads to a win-win situation. India
spends far less on health and education compared to many other countries. Taking cognisanceof the multiple channels through which female education is translated into lower infant and
maternal mortality, its significance hardly needs to be emphasized. It is high time that the
0
20
40
60
80
1 2Shrawasti
FL / R.A. FL / G P & LB
0
10
20
30
40
50
60
1 2
Jhansi
Series1
FL / G P & LB
0
5
10
15
20
25
30
35
40
45
1 2
Badaun
Series1
FL / R.A.
0
10
20
30
40
50
60
70
80
1 2
Badaun
Series1
FL / R.A.
0
10
20
30
40
50
60
70
80
1 2
Shrawasti
Series1
FL / G P & LB
0
5
10
15
20
25
30
35
40
1 2
Shrawasti
Series1
FL / EA
0
5
10
15
20
25
30
35
40
45
1 2
Badaun
Series1
FL / EA
0
5
10
15
20
25
30
35
40
1 2
Shrawasti
Series1
0
10
20
30
40
50
60
70
1 2Jhansi
FL / EA
S
s
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77
government, nongovernment organisations and civil society, all take up a challenge for a
better tomorrow.
REFERENCES
1- Caldwell, John C., 1979, Education as Factor in Mortality Decline: An Examination of
Nigerian Data, Population Studies, No. 33.2- Caldwell, John C. June 1986. Routes to Low Mortality in Poor Countries, Population and
Development Review, 12, (2).3- Campbell, O.M.A. and Graham, W.J. 1990, Measuring Maternal Mortality and
Morbidity: Levels and Trends, London School of Hygiene and Tropical Medicine,
London.4- Cleland, John. 1990, Maternal Education and Child Survival: Further Evidence and
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