Maternal education and infant survival in the Dominican Republic, 1984-1986.

Abstract

This study investigates the determinants of infant mortality in the Dominican Republic using data from the 1986 Dominican Republic Demographic and Health Survey (DHS). The sample consisted of all children (1899) born alive during the two years prior to the date of the survey. We studied the relationship between maternal education and child survival in three ways. First, we have developed an analytical causal framework of the determinants of child survival as an extension of the Mosley-Chen model of proximate determinants in order to identify possible intervening mechanisms between maternal education and child survival. Second, we estimated the determinants of both neonatal and post-neonatal infant mortality using a proportional hazards logistic regression approach, in which maternal education and possible confounding variables were included both with and without hypothesized intervening variables. Third, we estimated the determinants of breast-feeding, utilization of maternal health care services, practice of family planning, and maternal employment away from home. Post-primary maternal education was found to have a sizable protective effect during the post-neonatal period, with odds ratios for secondary and higher education of 1.94 and 3.22 respectively without, and 2.23 and 3.73 with the intervening variables included. Contrary to expectations, including the intervening variables in the model increased rather than decreased the effect attributable to maternal education. This was because non-breast-feeding and working away from home significantly increased the risk of infant death and both were more commonly practiced by more educated women. Mother's used of family planning, parity less than six, and receipt of tetanus toxoid injection during pregnancy (an indicator of health services utilization) all were found to be associated both with less risk of infant death and with more education. Maternal education did not act as a proxy for socioeconomic status in influencing child survival. The inclusion of household SES and area of residence reduced the effects of maternal education by about one tenth. However, we were not able to control for the association of education with social class of origin. Finally, policy and research recommendations are made based on the results of the study.