Maternal education reduces sex-differentials in under-five mortality in southern Asia and sub-Saharan Africa

Christiaan W. S. Monden, University of Oxford
Jeroen Smits, Radboud Universiteit Nijmegen

Background: The sex-differential in under-five mortality varies considerably across and within societies. Maternal education has been linked to lower sex-differentials, but the evidence is mixed. We examined how the sex-differential in under-five mortality varies by maternal education at the individual level and context level in Southern Asia and Sub-Saharan Africa. Methods: We employ recent Demographic and Health Surveys from 31 Sub-Saharan African and 4 Southern Asia countries. Male:Female mortality ratios were determined using information on 49,626 deaths among 521,541 under-five children. We estimate Male:Female mortality ratios by maternal education and average female education at the context level while controlling for household characteristics. Results: Both regions show a clear pattern of gender bias by maternal education. In Sub-Saharan Africa, the M:F ratio for under-five mortality is 1.07 (95%CI 1.03-1.10) among non-educated women, 1.11 (1.07-1.16) among women with some primary education and 1.21 (1.14-1.29) among women with some secondary or more education. For Southern Asia the ratio are 0.84 (0.79-0.89), 1.03 (0.92-1.15) and 1.06 (0.96-1.17) respectively. The M:F child mortality ratio is significantly more biased against girls among non-educated mothers. Context level female education is not associated with the sex-differential. Conclusions: Even in regions with excess male mortality, mortality chances are positively biased in favour of boys. This gender bias is most clearly visible among children with an uneducated mother. Girls benefit in absolute and relative terms girls from having a more educated mother.