The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education

Abstract

Background: Most existing research on the association of parental education with childhood undernutrition focuses on maternal education and often ignores paternal education. We systematically investigate differences in maternal and paternal education and their association with childhood undernutrition.

Methods: One hundred and eighty Demographic and Health Surveys from 62 countries performed between 1990 and 2014 were analysed. We used linear-probability models to predict childhood undernutrition prevalences, measured as stunting, underweight and wasting, for all combinations of maternal and paternal attainment in school. Models were adjusted for demographic and socio-economic covariates for the child, mother and household, country-level fixed effects and clustering. Additional specifications adjust for local area characteristics instead of country fixed effects.

Results: Both higher maternal and paternal education levels are associated with lower childhood undernutrition. In regressions adjusted for child age and sex as well as country-level fixed effects, the association is stronger for maternal education than for paternal education when their combined level of education is held constant. In the fully adjusted models, the observed differences in predicted undernutrition prevalences are strongly attenuated, suggesting a similar importance of maternal and paternal education. These findings are confirmed by the analysis of composite schooling indicators.

Conclusions: We find that paternal education is similarly important for reducing childhood undernutrition as maternal education and should therefore receive increased attention in the literature.

Keywords: child undernutrition; parental education; stunting, wasting; underweight.

Figure 1.

Sample deduction Note: Out of the missing data for the outcome variables, 63 812 observations in the case of stunting, 38 359 for underweight and 24 158 for wasting were due to biologically implausible values as defined by the WHO.

Figure 2.

Undernutrition prevalence in percent by parental education level All depicted numbers are unweighted pooled undernutrition prevalences for the entire sample.

Figure 3.

Marginal effects for binary indicator that the mother completed more years of schooling than the father (country-wise regressions) This figure depicts point estimates (marginal effects in percentage points) and 95% confidence intervals for the binary exposure that the mother completed more years of schooling than the father from country-wise regressions. The estimated model corresponds to the last specification from Table 4. All regressions include the full set of covariates and local area characteristics (PSU-level fixed effects). Two countries are excluded: no marginal effects could be obtained for the Maldives, as the available number of observations was too low. Similarly, Kazakhstan was excluded due to very long confidence intervals (overlapping with the zero line).