32 IMP-Role of maternal education

Dr. Meenal Dhall

CONTENT

1. Introduction

1.1. Defining maternal education

1.2. Need to study the role of maternal education

1.3. Health theories associated with education

2. Role of maternal education

2.1. Maternal education influences child survival

2.2. Maternal education leads to child’s socio-behavioral & cognitive development

2.3. Maternal education and child’s nutritional status or physical development

2.4. Maternal education and child mortality rates

2.5. Maternal education and immunization/vaccination process of child

2.6. Maternal education and maternal health status 

3. Indian motherhood programs

4. Millennium Developmental Goals (MDGs)

5. Conclusion

LEARNING OBJECTIVE

The main objective of this module is to bring out the strength that education has in women’s life which could completely modify and bring a shift. At the end of the reading, one will get to know:

• What is maternal education
• The need to study the role of maternal education
• Affect of maternal education on child’s health
• Affect of maternal education on maternal health
• What are MDGs in respect to health of child and women
• What programs have been initiated by goverment to promote maternal education

1. INTRODUCTION

1.1.   Defining “maternal education”

Maternal education is generally defined as the number of years of schooling a mother has completed or in other words, the highest educational degree or diploma a mother has achieved (U.S. Census Bureau, 2004). Various dimensions of child’s life get affected with the influence of maternal education in both positive and negative ways. Most of all, it affects the social and emotional development, cognitive development, academic score, grades and most essential of all, mother’s life itself. [2]

Generally, in demographic researches, it is observed that child mortality differentials are highly dependent on the relationship status of maternal education and child survival which in turn yields the socio-economic-behavioral factor affecting the mortality rates. But in anthropological research work, we are less concerned about this kind of relationship and would find this task of studying “role of culture and social change” in terms of individual characteristics as surprising! Henceforth, anthropological definition of the phrase “maternal education” suggests a rational actor model where a person or an actor makes decision about behavior based on rational analysis on advantages and disadvantages linked with possible actions or inaction. In simpler terms, the phrase identifies a central individual- the mother and the word ‘education’ implies knowledge and skills associated with logical decision making. [1]

Demographic findings yield consistent and persuasive monotonic decline in infant and child mortality rates which are associated with the increasing educational status of mothers. However, it is not clear whether education should have such a universal effect on risks of child death and most importantly what constitutes the essential components of such a strong association. This rises up the need to unfold the packaging of this complex association. On the other hand, anthropologists are concentrating on the acquisition of literacy among the women, and show that rationality exists as an essential parameter of all societies.

1.2. Need to study the role maternal education

Education should not be seen as a single act, but as a ‘social process involved in instructing, acquiring and transforming knowledge’ (Pelissier, 1991). Apart from being a process associated with socio-economic development, education can transform demographic regimes through changes in individual actions. It has transformative action on one’s social relations and actions. When associated with ‘women’ it yields self esteem and self-worthy nature of an individual attaining it. Its consequences are hard to evaluate, but evidences show that educated women are likely to be a better service users than less educated women. Women often need to be very resourceful and it seems that educations acts as an asset here. Being educated, enhances the ability of a woman to express herself, communicate effectively and evaluate and analyze each and every component of human life. Therefore it becomes possible to explain why, for instance, the difference in childhood survival related to maternal education that persists in urban areas where there is a much greater availability of health services. Thus the positive effect of education on women’s care for their children manifests less in direct changes in domestic behavior but more in general transformations of woman’s social value. In this sense education continues to remain a proxy for other social factors. The question could be turned round by seeing, not an educated woman as the product, but education as part of an individual process. Why do some women in adverse circumstances persist in getting educated? Do the same characteristics that led them to study make them more confident, more able to confront recalcitrant health-workers?

As Das Gupta (1990:490) says-

‘…women’s basic abilities and personality characteristics…independently of education, occupation, income and wealth ‘can alone explain to a large extent the survival chances of their children. This leads us to posit that one reason, though not the only one, for the strong association between maternal schooling and child survival is that education is acting to reinforce pre-existing circumstances and traits that are favorable to effective mothering in later life .[5]

1.3. Health theories associated with education

One theory, developed by economist Michael Grossman, focuses on education and schooling as a central factor in the demand for health (Grossman, 1972a, 1972b). The Grossman theory asserts that those who have obtained higher levels of education (schooling) are more efficient producers of health. Given that health is a function of medical care, environment, and lifestyle, the health production function shifts up and becomes steeper with more education because people can produce it more efficiently.

For example, those who are educated have acquired the understanding of technology and knowledge of medical and other market inputs that are necessary in producing positive health outcomes. Thus, the demand for health of those obtaining higher levels of education is greater.

Another theory, developed by Victor Fuchs (1982), focuses on time discounting as a method in which people choose to invest in both education and health. Those who possess high discount rates favor investments that produce immediate returns, while those with low discount rates prefer investments with long-term benefits. [7]

1.4. Predictions through studies on maternal education

Education is believed to be the key to upward social mobility of child as well a family unit.

• It predicts child’s academic achievement (including reading skills, mathematical thinking skills).
• It proves to be a good indicator of one’s peer relationships.
• It would also predict child’s externalizing and internalizing behavioral problems.

2. ROLE OF MATERNAL EDUCATION:

Clearly, mother has essential role in child’s, family’s and her own health-life, where her education acts as a valuable add-on. Therefore, at this point of time it becomes necessary to assess the degree of influence that the add-on has on other intervening variables such as: the probability of child survival, child’s social, behavioral, emotional and cognitive development, child’s nutritional status, immunization and vaccination events associated to a child’s healthy life, child’s mortality rates, fertility rates, and most important of all the maternal health itself.

2.1. Maternal education influences child survival-

The influence and role of mother’s education in the event of child upbringing through various pathways, other than some socio-economic determinants were firstly put into action by Cladwell in 1979. He suggested three main pathways through which mother’s education might enhance child’s healthy survival:

• shift from ‘fatalistic’ acceptance of health outcomes towards implementation of simple health knowledge;
• Increased capability to manipulate the modern world including interaction with medical personnel; and
• Shift in familial power structure permitting educated woman to exert greater control over health choices for the children.

Such an association is found to prevail in similar consistency in both rural and urban settings. [5]

There are few empirical evidences that help in understanding that children of an educated mother are more likely to survive in infancy than that of an uneducated mother. This approach is based on social and economic differences as well and the actual and direct could not be well specified. Usually, the educated mother either belong to the city or urban setting or to the powerful elite clan or tribal family and therefore tends to have a better access and availability of resources as food, water, sanitation which ultimately gives a positive mark on the health status of the child and other members of the family.

In a general set-up, we see that educated mothers have the following specialties while considering health-related aspect of a family-

• Able to access medical services and follow advice as prescribed by medical practitioners.
• Have greater power of fulfilling the responsibility of giving proper care to unhealthy child or other member of family.
• Engage in child-care practices and enhance child health.

According to a paper published by United Nations, John Hobcraft stresses on his findings saying that-

“…in all models considered, maternal education appears as a very powerful and pervasive correlate of child survival…Moreover the association of child survival with maternal education remains strong in the face of a wide range of other controls…These nearly universal findings in association with the child survival reinforce the importance of improving education systems”. [15]

Maternal education affects child survival in two main ways:

• The first way is known as ‘the household production of health‘ in the health-economics literature. It happens through better child-care practices and higher standards of hygiene at home, and more rational and greater use of preventive and curative medical services. It is hypothesized that the effectiveness with which basic child-health-promoting inputs, such as personal hygiene, prenatal and postnatal care, and feeding practices are combined, improves with the level of education of the mother. It is also argued that education gives greater independence to the mother who will help her take child-health-promoting decisions without any hindrance (Caldwell 1986).
• The second important pathway of influence is through the superior health-seeking behavior of educated mothers. There is considerable empirical evidence, from the less developed countries in all parts of the world, that the propensity to use preventive and curative health services for self and children are high among educated mothers. Educated mothers are also found to have superior knowledge of diseases and they seek timely treatment more often. However, some studies deny superior health-care knowledge on the part of educated mothers, particularly among those with lower levels of education.

Following are some of the associations of child survival with women’s education that are not considered in demographic literature:

• Increase in ‘age at marriage‘ leads to improved maternal health during ‘age at first birth’ and thus a healthy child is born.
• Decrease in maternal mortality rates, due to proper education system that tends women to go for regular health check-ups and let the woman know about the hazardous situations.
• An educated woman receives trained and professionally handled delivery thereby reduces morbidity frequency and maternal mortality rates.
• Moreover, and most important of al, an educated women is aware of prenatal care and benefits that she and her child could obtain from immunization and vaccination.[3]

To sum up, the available evidence indicates a strong and independent association between mother’s education and child health, but the exact mechanisms through which it operates are not yet clear.

2.2. Maternal education leads to child’s socio-behavioral & cognitive development-

Education is believed to reduce inter- and intra-generational transmission of social inequalities. It not only acts as a tool of empowering women, but also helps them to bring up their children in a more efficient manner.

In terms of cognitive development of a child, education can enable women to:

• provide a cognitively stimulating environment for their children,
• use language which is developmentally enhancing, and
• Support the physical, social, and emotional development of their children

However, in the delicate equilibrium of intra-household relations, the mother-child interactions can be heavily affected by the mental health of the mother. Mental disorder during pregnancy and the months following childbirth can alter the home environment. It can also reduce mothers’ engagement with, and alter mothers’ speech towards, the child and impact on the overall quality of parenting provision. As a result, children of mothers who suffer from mental disorders tend to be affected in their growth show emotional and behavioral, as well as high rates of insecure attachment and depressive behaviors. Poor maternal mental health also has important consequences on children’s cognitive functioning and their overall school achievements.

Given that maternal education is a key factor for enhancing child development and that maternal mental health problems can hinder this process, the role of maternal education as a protective factor becomes crucial. Generally speaking, there are three hypotheses pertaining to the role of maternal education on cognitive development of the child.

First, education can reduce the risk of mental health disorders, in particular depression. This is because education has direct effects on self-esteem, confidence and locus of control which impacts on the overall mental wellbeing. Previous studies have found that education has a direct association with depression, in particular for Women), that the impact of education on mental health strengthens with age and that the relationship between education and women’s mental health is particularly important during motherhood. Second hypothesis is that maternal education can attenuate the negative effects of maternal mental health disorders on child development. Due to their education, mothers who suffer from minor psychiatric disorders can be empowered to better manage their health condition. . In other words, the magnitude of the relationship between maternal depression and children’s school attainment is reduced when maternal education is introduced as a control in the analysis.

Importantly, third hypothesis states that education can change the nature of the relationship between maternal mental health problems and child development, moderating the consequences of maternal mental health for children and hence affecting the inter-generational transmission of disadvantage. The association between maternal mental disorders in the post-birth period and child development is stronger among families living in socio-economic deprivation.

This suggests that maternal mental illness does not affect children equally within the population. It is possible that maternal education can enhance or hinder existing inequalities.

2.3. Maternal education and child’s nutritional status or physical development-

In developing countries, maternal education has a positive impact on the nutritional status of child. In most of the planning and developmental strategies, education remains as an essential element. The effect is particularly strong for female education. Particularly in India, education has been shown to explain the downfall of malnutrition and death, and even low levels of education have been shown to increase child survival prospects and health-related behaviors. But the situation doesn’t prevail as it is throughout the world.

“Exposure time” plays as an essential factor that affects the childcare. The overall quality of childcare gets enhanced when there are other household members, other than mother who are capable enough to offer this potential. Moreover, positive association between child nutrition and community level maternal education gives evidence that children benefits from living in a literate communities as there are lower frequencies of child stunted growth or undernourishment. [4]

2.4. Maternal education and child mortality rates-

Some statistical evidence supports that maternal education improves child health and decreases the risk of child mortality. Studies evidence negative relationship between maternal education and child mortality rates and this type of relationship is universal. Therefore one needs to answer, what could be the causal mechanisms that underlie it, especially in spatial, cultural and temporal contexts. Generally, this type of relationship is improbable and to a large extent depends on socio-economic and cultural settings in which women may acquire some education, schooling or teaching process.

Relationships between woman’s role and mortality of children are harder to obtain and interpret, especially in the developing countries. It is a genuine case, that education gives women the power and confidence to take decisions. Caldwell (1979) argued that three factors are of great importance in this respect as-

a) Reduction in fatalism in face of children’s ill health.

b) Capability in manipulating the world.

c) Change in traditional balance of family relationships that shifts the focus of power away from patriarch and mother-in-law and ensures that a greater share of available resources is devoted to children. (Cladwell,1979) [9]

In September 1994, 186 national delegations and thousands of NGOs met in Cairo for UN, “International Conference in Population and development”. Most of the participants agreed upon having urgent need to invest on imparting education to female section of society. The Program of Action argues that raised levels of women’s education will ultimately reduce mortality (IMR and CMR) rates along with fertility level and thereafter will act as cornerstone of demographic and healthy policy in developing nations.

Cause of child illness and death:

Most important and influencing factors leading to child morbidity and mortality are:

a) Poverty

b) Under-nutrition and malnutrition

c) High fertility, and

d) Short birth intervals.

Infant Mortality Rate (IMR) defined as the number of infant deaths per 1,000 live births in a population measures an ‘outcome’ of the development process as it is known to be the result of a wide variety of inputs:

• nutritional status and the health knowledge of mothers;
• level of immunization and oral rehydration therapy;
• availability of maternal and child health services (including prenatal care)
• Income and food availability in the family
• Availability of safe drinking water and basic sanitation;
• Safety of the child’s environment, among other factors

2.5. Maternal education and immunization/vaccination process of child-

Immunization is a vital key to the health and survival of infants and children in the United States and around the world. According to the Global Alliance for Vaccines and Immunization (GAVI) “of the over 10 million deaths among children under five in 2002, about one-quarter were attributable to diseases that are already or soon will be vaccine preventable”.

WHO in 2001 defined “health” is a complete physical, mental and social well-being state and not only absence of disease or ailment.

Four of the major vaccines needed to reduce the risk of poor health in children include: Diphtheria-Tetanus Toxoids-Acellular Pertussis vaccine (DTP), Inactivated Polio virus vaccine (IPV), Measles, Mumps and Rubella vaccine (MMR), and Haemophilus Influenzae type B vaccine (Hib). The National Network for Immunization Information reports that the likelihood of contracting the disease and becoming violently ill is thirty times greater if not immunized. [7]

Now, the question arises that how does the level of education of a woman affect the immunization process of her child? In countries where child malnutrition is generally low, frequency of immunization provides a good indicator of actively induced and promoted child health post pregnancy. There is a standardized “levels of completeness” directing with respect to overall age structure of woman that is applied to age-specific immunization and over age rate in each educational category. Moreover, there exists driving forces behind the immunization processes when women classified on the basis of degree of attainment of education. Streatfield’s study reflected two different sets for this as-

For educated women, it occurs due to knowledge about the profits of immunization and its protective action ;Social conformity and compliance with local authority were the influencing forces for immunization process in case of uneducated women.[6]

Hence, conducting more and more of health education campaign and programs aiming at maternal-child health and child-survival should be given a widespread approach, so that every woman from every household gets educated at their best and made aware about the beneficial immunization processes.

2.6. Maternal education and maternal health status-

Maternal education as a concept encompasses the process of family planning, preconception, prenatal, and post-natal care. Maternal health is depicted through:

• Health of women during pregnancy, childbirth and the postpartum period.
• Motherhood, for too many women it is associated with suffering, ill-health and death.
• Haemorrhage, infection, HBP, unsafe abortion and obstructed labour still are major direct causes of maternal morbidity and mortality.

Preconception care may include providing education, health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies while prenatal care is the comprehensive care that women receive and provide for themselves throughout their pregnancy. Women who begin prenatal care early in their pregnancies have better birth outcomes than women who receive little or no care during their pregnancies. Postnatal care includes recovery from childbirth, concerns about newborn care, nutrition, breastfeeding and family planning.

Immediately after delivery, occurs a very critical period for newborns and mothers. Two-thirds of all maternal deaths occur in this postnatal period. Most women do not have good access to the health care and sexual health education services.

According to a survey, a woman in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth, compared to a 1 in 4,000 risk in a developing country – the largest difference between poor and rich countries of any health indicator. Lesser percentage of deaths occur in developed countries, showing that they could be avoided if resources and services are easily and sufficiently available.

At least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as quality of care at delivery and during the newborn period. Yearly 8 million babies die before or during delivery or in the first week of life. Further, many children are tragically left motherless each year. These children are 10 times more likely to die within two years of their mothers’ death.

Maternal and child health and disease have multi-factor origin and can exist of sequential and continuous form. Poor maternal conditions accounts to the fourth leading cause of deaths for women after HIV/AIDS, malaria, and tuberculosis.

Uneducated women especially belong to undeveloped rural settings, where the delivery of new born occurs at home through unprofessional person and untrained support. Many girls die during labor, most importantly the teenage mothers whose newborns are at higher risk of suffering from malnutrition or death. In fact, girls giving birth before the age of 15 are five times more likely to die during childbirth than women in twenties or more. Globally, more than 120 million women (aged 15 -49) cannot delay or avoid pregnancy due to a lack of contraceptives while 40% of all pregnancies are unintended, with higher rates among poor, young, uneducated women. A lack of educational services contributes to keeping women out of school and out of the marketplace, further increasing the health risks for themselves and their children.

Maternal mortality ratio is measured per 100 000 live births. Measuring maternal mortality accurately is difficult except where comprehensive registration of deaths and of causes of death exists. Maternal deaths are clustered around the intrapartum (labor, delivery and the immediate postpartum); the most common direct cause globally is obstetric haemorrhage. Other major causes are: obstetric haemorrhage; anaemia; sepsis/infection obstructed labor; hypertensive disorders and unsafe abortions.

Some of the major maternal health associated risk factors:

• High Frequency and less spacing of births.
• Low Nutrition level (maternal under nutrition)
• Stature and low maternal age.
• Inappropriate medical and midwife support.
• Unavailability of emergency and intensive treatment if were necessary.
• Lack of management capacity in the health system.
• Another risk to expectant women is malaria. It can lead to anaemia, which increases the risk for maternal and infant mortality and developmental problems for babies.
• HIV infection is an increasing threat. Mother-to-child transmission of HIV continues to be a major problem, with up to 45 per cent of HIV-infected mothers transmitting infection to their children. Further, HIV is becoming a major cause of maternal mortality in highly affected countries in Southern Africa, especially with the TB re-emergency.

When we have such an alarming level of maternal death rates, educated women behave in a more matured and a responsible manner. Let’s discuss what interventions an educated mother adopts when she happens to face any of the health-associated risk factors. Some of them are discussed below:

• Educated mother is aware of positive impact of immunization and vaccination for healthy mother and healthy child.
• She could easily communicate to a medical practitioner about the symptoms of anaemia, and after knowing it, goes for proper Folic acid supplementations.
• An educated mother goes for Syphilis screening and proper treatment to avoid any kind of harm to the baby.
• She learns all the complications and symptoms that could be faced by her during Pre-eclampsia and eclampsia and goes for its prevention through calcium supplementations.
• She follows intermittent presumptive treatment for malaria in pregnancy.
• Learns about antibiotics for premature rupture of membranes.
• Goes for detection and management of breech (caesarian section)
• She undergoes Labor surveillance
• She adopts to clean and hygeinic delivery practices.
• She is well aware about the importance, mechanism and duration of breast-feeding her newborn.
• She goes for prevention and management of hypothermia.
• She knows the relevance of “Kangaroo mother care” (skin-to-skin contact) for low birth-weight newborn.
• Regularly checks newborn temperature for their health management.
• Proper regulation and checks of pure water, sanitation, hygiene around the baby and herself to avoid any diseases borne out of air and water
• Detection and treatment of asymptomatic bacteriuria.
• She is well aware of how to resuscitate a newborn.
• Knows about community-based pneumonia case management, including antibiotics
• Adapts to Oral rehydration therapy while the young one is suffering from dehydration.

Therefore, we conclude that women who are educated about reproduction and reproductive health are able to make better decisions for their families, make better use of existing social services, and make a higher contribution to household income. Furthermore, women with some formal education are more likely to ensure that their children are immunized and are better informed about nutrition

3. INDIAN MOTHERHOOD PROGRAMS:

There have been several initiatives taken up by government as well as on-government organization that are focused in women empowerment through educational programs as well as health-related programs.

• EDUSAT: it is a program that enhances the current knowledge of diarrhoea management by facilitating lectures and training courses which will allow for dialogue and interaction of hundreds of people simultaneously. Key health issues are to be taught and discussed by doctors, medical specialists, medical students, and health care providers at the existing 100 virtual learning centers in Maharashtra with video conferencing facilities linked by satellite.
• The Mother and Child Protection Card (MCP Card) has been introduced through a collaborative effort of the Ministry of Women and Child Development and the Ministry of Health & Family Welfare, Government of India. The MCP card is a tool for informing and educating the mother and family on different aspects of maternal and child care and linking maternal and childcare into a continuum of care through the Integrated Child Development Services (ICDS) scheme of Ministry of Women and Child Development and the National Rural Health Mission (NRHM) of the Ministry of Health & Family Welfare (MoHFW). The card also captures some of key services delivered to the mother & baby during Antenatal, Intra-natal & Post natal care for ensuring that the minimum package of services are delivered to the beneficiary.
• Measles immunization: Reduce incidence of diarrhoea by promoting measles vaccination within the first year of a child’s life. 100% immunization coverage against measles is the program goal.
• IAP-Immunize India is the world’s largest vaccination reminder service, and is available free of cost to parents anywhere in India. It is a national non-profit initiative, promoted by Indian Academy Of Pediatrics. It aims to prevent half a million child deaths and disabilities by 2018.
• UNICEF’s India Ammaji videos on health phone: The Ammaji health and nutrition education series of

42 videos help improve and save children’s’ and mothers’ lives. They aim to promote changes in knowledge, attitudes, practices and beliefs through key messages in the major health topics. It is the expectation from these videos that they will help rural women: understand the benefits of recommended behaviors address some of the constraints in their social environments adopt simple household behaviors and access frontline workers (like Anganwadi Workers, ANMs, ASHAs, Panchayats, etc) in their communities. They are designed to be used as interpersonal communication tools by individuals and frontline workers in giving out important information to women and caregivers.

• UNICEF “awaaz do” program to raise voice for the right to education for every children in India.
• Mahila Samakhya Programme: This programme was launched in 1988 as a result of the New Education Policy (1968). It was created for the empowerment of women from rural areas especially socially and economically marginalized groups. When the SSA was formed, it initially set up a committee to look into this programme, how it was working and recommends new changes that could be made.
• Kasturba Gandhi Balika Vidyalaya Scheme (KGBV): This scheme was launched in July, 2004, to provide education to girls at primary level. It is primarily for the underprivileged and rural areas where literacy level for females is very low. The schools that were set up have 100% reservation: 75% for backward class and 25% for BPL (below Poverty line) females.
• Beti-Bachao Beti-Padhao mission has been initiated to decrease the rates of female foeticide and female infanticide keeping in mind the low sex ratio and better performances of females in different areas. Thus the aim is to promote the education amongst girls who can take the levels of success and achievement across the globe, and it is possible if anti-social practices and controlled.
• National Programme for Education of Girls at Elementary Level (NPEGEL): This programme was launched in July, 2003. It was an incentive to reach out to the girls who the SSA was not able to reach through other schemes. The SSA called out to the “hardest to reach girls”. This scheme has covered 24 states in India. Under the NPEGEL, “model schools” have been set up to provide better opportunities to girls. One notable success came in 2013, when the first two girls ever scored in the top 10 ranks of the entrance exam to the Indian Institutes of Technology (IITs).Sibbala Leena Madhuri ranked eighth, and Aditi Laddha ranked sixth.
• Child survival and safe motherhood program (CSSM), 1992: to reduce mortality rates and increase the health of mother and child.

Some of the other programs emphasizing on maternal education and maternal health are: Rural Child Health (RCH) and National Rural Health Mission (NHRM) (2005); Janani Sraksha Yojana (2006); Asha Schemes etc.

4. MILLENIUM DEVELOPMENTAL GOALS (MDGs):

The Millennium Development Goals (MDGs) are the eight international development goals that were established following the Millennium Summit of United Nations in 2000, following the adoption of the United Nations Millennium Declaration. All 189 United Nations member state at the time committed to help achieve the following Millennium Development Goals by 2015:

• To eradicate extreme poverty and hunger
• To achieve universal primary education
• To promote gender equality
• To reduce child mortality
• To improve maternal health
• To combat HIV/AIDS, Malaria, and other diseases
• To ensure environmental sustainability
• To develop a global partnership for development

The fifth Millennium Development Goal (MDG) put forward by the United Nations (MDG-5) proposes to reduce the world’s maternal mortality ratio by 75%, by 2015. Many pregnancy-related deaths are preventable, and maternal mortality remains high in Latin America. Nevertheless, according to a recent independent study of 181 countries by Hogan et al., and contrary to previous reports that showed very little decrease in the maternal mortality ratio (MMR, the number of maternal deaths related to childbearing divided by the number of live  births) over decades, the global MMR declined from 422 to 251 per 100,000 live births between 1980 and 2008. In particular, low-income Latin American developing countries, such as El Salvador, Guatemala, Nicaragua, Ecuador, and Bolivia, have made substantial progress in reducing the MMR.

Factors such as fertility rate (a proxy for reproductive behavior), per capita income (an indicator of material resources in adult life), educational attainment of the female population (an indicator of early life experiences, acquired knowledge and skills), access to adequate maternal health facilities and personnel (e.g. skilled attendants) are all thought to be important determinants of maternal health. Additionally, it has been suggested that abortion prohibition may contribute to high maternal mortality rates. Finally, although the influence of other development process indicators such as clean water supply and sanitary sewer access on maternal mortality is virtually unknown, these factors likely influence population health by decreasing epidemics and mortality from diarrhoeal infectious diseases.

Interestingly, research has consistently observed an inverse correlation between women’s education level and maternal mortality in the developing world. Recent studies have corroborated the finding that educational attainment is a strong independent predictor of all-cause mortality having simultaneously a modulating effect on other factors. Although it has been suggested that increasing women’s education level contributes to the modulation of other variables known to influence maternal health such as the reproductive behavior (e.g. fertility rate, birth order, delayed marriage and motherhood, family size, contraceptive use, etc.) and access to maternal health facilities (e.g. access to prenatal and postnatal care, and delivery by skilled attendants), this effect on the MMR decline has yet to be demonstrated mathematically; however, this may be severely limited by the paucity of large and continuous parallel time series in developing countries.

A recent review of MDG progress, shows that the world have only 32% of the way to achieving the child health goal and less than 10% of the way to achieving the goal for maternal health. Unfortunately, on present trends, most countries are unlikely to achieve either of these goals. Millennium Development Goal 4 aimed at reducing child deaths by two-thirds between 1990 and 2015. Millennium Development Goal 5 has the target of reducing maternal deaths by three-quarters over the same period.

5.      CONCLUSION :

The world on progression, the nation is on progression but the fact is that this progress occur only on socio-economic front ! We still have the low health status of females all across the globe, particularly India. Although, goverment has been taking various initiatives since so many years to improve the health of females, there has been lack of its proper implementation, and many people are still beyond the outreach of these programs and plannings. Even today, people fear their child being vaccinated or going to medical professionals for their delivery ans so much.

The need of the hour is to create proper awareness among people, to provide them with proper amneties and most imporant of all promoting women education. There should be such policies and programs designed to implement evidence-based strategies and detailed micro level planning. We need:

• Proper management to keep an eye on all governmental programs and others, assessing their achievements and developmental records on regular basis.
• Improvement in health and education infrastructure
• Promoting gender equality so that girls may attain same status and responsibilities that a boy can.

But this is not a day’s work, such kind of proper planning and implementation will take a decade or so!