Public-health agencies have long stressed the importance of good education in improving the health of women and young mothers in the developing world. Less focus has been put on the men in these women's lives, however - specifically, how the level of education of partners and fathers, or lack of it, affects how the women care for themselves as sexually active people and expectant mothers.
Now a study by an African demographer at Université de Montréal shows that the more schooling a man has, the more likely his partner will look after her body before and after she gets pregnant, by using contraception, getting prenatal exams or having her child delivered by a health professional. The finding is based on analysis of recent standardized surveys of couples in 32 countries in sub-Saharan Africa and five in Asia.
"My hypothesis going into this study was that many men play an important role in their partner's reproductive and maternal heath," said lead author and UdeM adjunct professor Vissého Adjiwanou, an immigrant from Togo who spends half his academic year at UdeM and the other half at the Centre for Actuarial Research (CARe), at the University of Cape Town, South Africa. "What surprised me was that to have a major effect, the men must actually be better-educated: high school or higher."
By contrast, it matters less whether a woman is less educated. Even if she has only gone to primary school, she will still take care of her body before and during pregnancy, although to a somewhat lesser degree.
"Overall, women whose partners had an above-secondary level of education were 32 per cent more likely to use modern contraceptives, 43 per cent more likely to attend at least four antenatal care visits, and 55 per cent more likely to deliver their most recent baby with a health professional, compared to women whose partner had no education," Adjiwanou writes in his study, published online in the journal Social Science & Medicine.
If men added just one more year to their schooling, even those whose partners have little schooling will be more likely to use contraception, more likely to get check-ups before giving birth, and more likely to give birth in a clinic or hospital staffed by professionals, according to the study.
Along with Adjiwanou, the research paper was co-authored by demographers Moussa Bougma of Université Ouaga I Pr Joseph Ki-Zerbo, in Burkina Faso, and UdeM's Thomas LeGrand, recently appointed head of the International Union for the Scientific Study of Population.
"This study highlights the importance of male education in shaping their wife's health behaviours in developing countries and provides strong impetus for male education beyond primary level (as well as for women), something that has been neglected in past policy discourse," the authors conclude.
Added Adjiwanou: "In general, it's a plea for more research on the role of men in women's health."
Data came from standardized questionnaires used in the USAID-funded ICF International's Demographic and Health Survey conducted in 37 countries; the five Asian ones included two of the world's most populous, India and Indonesia, as well as Bangladesh, Cambodia and Nepal. Typically, the surveys are answered by women; only one-third to one-half, depending on the country, are answered by men as well.
Among the other findings:
- On average, only one woman out of four uses any modern method of contraception, ranging from 3 per cent of women in Guinea to 61 per cent in Zimbabwe.
- Overall, women with a high-school education are 83 per cent more likely to use modern contraceptives, 61 per cent more likely to have antenatal-care visits, and 2.3 times more likely to give birth with a skilled attendant.
- When both the man and the woman are better-educated, it doesn't necessarily mean they'll increase their use to birth control. Many tend to be older when they start to have kids and hence don't use contraceptives.
Social Science & Medicine