title: Maternal education is associated with reduced female disadvantages in under-five mortality in sub-Saharan Africa and southern Asia.
abstract: BACKGROUND
  The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia.
  
  
  METHODS
  We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0-59), neonatal (month 0), post-neonatal (month 1-11) and child mortality (month 12-59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more 'gender neutral' thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database.
  
  
  RESULTS
  In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06-1.13] among non-educated mothers, 1.14 (95% CI 1.09-1.19) among mothers with some primary education and 1.25 (95% CI 1.16-1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82-0.95), 1.10 (95% CI 0.97-1.25) and 1.13 (95% CI 1.02-1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41-0.72).
  
  
  CONCLUSIONS
  Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a 'gender neutral' situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother.
authors.affiliation: Department of Sociology, University of Oxford, Oxford, UK. christiaan.monden@nuffield.ox.ac.uk
authors.forename: Christiaan W S
authors.initials: CW
authors.lastname: Monden
authors.forename: Jeroen
authors.initials: J
authors.lastname: Smits
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D046688:Child Mortality; D002675:Child, Preschool; D003695:Delivery of Health Care; D003710:Demography; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000193:education*; D017678:Sex Distribution; D012959:Socioeconomic Factors