Robert A. LeVine is the Roy E. Larsen Professor of Education and Human Development, Emeritus in the Graduate School of Education and former Professor of Anthropology in the Faculty of Arts and Sciences.
Global health research has long faced a paradox: That the school attainment of mothers is associated – strongly, independently and in most less-developed countries – with reduced child mortality and other beneficial health outcomes, but no consensus has emerged about why or how this happens. A new book from our Project on Maternal Schooling at the Harvard Graduate School of Education – Literacy and Mothering: How Women’s Schooling Changes the Lives of the World’s Children (Oxford University Press, 2012) – tackles this problem directly, not only with a detailed theoretical explanation but also with evidence from literacy assessments of mothers in four countries: Mexico, Nepal, Venezuela and Zambia.
Our answer to this long-standing question is that girls acquire academic literacy skills in school – even in poor schools – that form the basis for the health literacy skills and navigation skills they use as mothers to obtain life-saving services from bureaucratic health services. We find that mothers of young children with more schooling do significantly better on tests of reading comprehension and academic language, and that their scores on those tests predict their abilities to understand messages in the health media and report health narratives in clinical situations, controlling for other socioeconomic factors at the household and community levels. The school-acquired literacy and language skills, we demonstrate, provide a pathway between school attainment on the one hand and health literacy and navigation outcomes on the other. A larger survey of mothers, undertaken with UNICEF Nepal, confirms many findings of the four-country study with different methods of assessing literacy.
Two findings stand out as especially important:
(a) Mothers with higher literacy scores are better able to comprehend radio health messages, though they are not written, suggesting that literacy enhances comprehension in modalities other than reading.
(b) The literacy pathway from schooling to health care was replicated in four diverse countries, and in urban and rural contexts.
We argue that learning in bureaucratized schools facilitates participation in bureaucratized health services because communication in both settings includes the language of written texts, the use of abstract terms and the assumption of an attentive posture – the pupil role – in the face of an authoritative expert. When the pupil is a girl who learns bureaucratic communication in school, the result can be her more effective utilization of health services and health information when she becomes a mother.
Thus the research reported in our book begins to fill the measurement gap left by epidemiological and demographic studies that relate women’s educational attainment to health outcomes without assessing the intervening processes that connect them. Educational research on literacy and classroom interaction has made great progress in the 33 years since women’s schooling effects were first discovered, but public health analysts have largely failed to take note. We hope they will notice our book and incorporate educational assessments in their research, testing the validity of our findings on a larger scale and with longitudinal monitoring of girls and women.