“Female education and maternal mortality: A worldwide survey,”

Faculty of Medicine, Dalhousie University, Halifax, NS.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 12/2006; 28(11):983-90. DOI: 10.1016/S1701-2163(16)32294-0
Source: PubMed


In terms of social and political development, women's human rights have not evolved in many developing countries to the same extent as they have in the developed world. We examined the relationship between women's status and human development and maternal mortality.
Using polynomial regression analysis with a sample of 148 countries, we investigated the impact of gender-related predictors, including education, political activity, economic status, and health, and human development predictors, such as infant mortality and Human Development Index, using data from the United Nations Human Development Report 2003.
The Human Development Index and Gender Development Index are powerful predictors of both maternal and infant mortality rates. Female literacy rate and combined enrolment in educational programs are moderate predictors of maternal mortality rates.
Strategic investment to improve quality of life through female education will have the greatest impact on maternal mortality reduction.


Available from: Chryssa Mcalister, Oct 23, 2015
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    • "In recent years, attention has been paid to the relationship between the morbidity in HDP and the levels of maternal education. Convincing evidence suggests that women with a low level of education are more likely to develop HDP than those who have received a higher level of education [33]–[34]. The present study provides weak evidence in support of the impact of education levels on the risk of HDP (Table S3 in File S1). "
    [Show abstract] [Hide abstract] ABSTRACT: Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "Wife seclusion also greatly limits female economic opportunity, further reducing women’s agency and making them financially dependent on their husbands [95-99]. Lack of formal education further increases this sense of helplessness in the face of obstetrical complications [100,101]. Fistula patients almost invariably have low educational attainments, as noted previously [48]. "
    [Show abstract] [Hide abstract] ABSTRACT: An obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor. Obstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women's agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care. Women in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.
    Full-text · Article · Jul 2012 · BMC Pregnancy and Childbirth
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    • "In this international survey of 287,035 women giving birth in health care institutions in 24 countries, women with lower educational levels are more likely to die than women with higher educational levels. Other studies have also reported an association between female education and maternal mortality [27]. However we have demonstrated that, for women who were able to deliver in hospital facilities, the higher mortality of women with lower levels of education cannot be explained by the level of services available at the institution where they gave birth. "
    [Show abstract] [Hide abstract] ABSTRACT: Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America) and 2007-2008 (in Asia) as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years), those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained in the model. Lower levels of maternal education were associated with higher maternal mortality even amongst women able to access facilities providing intrapartum care. More attention should be given to the wider social determinants of health when devising strategies to reduce maternal mortality and to achieve the increasingly elusive MDG for maternal mortality.
    Full-text · Article · Jul 2011 · BMC Public Health
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