Education and micronutrient deficiencies: an ecological study exploring interactions between women's schooling and children's micronutrient status

Abstract

Background: Formal education can be a nutrition-sensitive intervention that supports the scale-up and impact of nutrition-specific actions. Maternal education has long been linked to child survival, growth, and development while adult earnings and nutrition are tied to years in school as a child. However, less is known about the relationship between maternal education and the micronutrient status of children, women and the general population.

Methods: Using country-level data and an ecological study design, we explored the global associations between women's educational attainment and: a) anemia and vitamin A deficiency (VAD) in children aged 6-59 months; b) anemia in non-pregnant women; and c) zinc deficiency, urinary iodine excretion (UIE), and the proportion of infants protected against iodine deficiency in the general population Cross-sectional relationships (2005-2013) were assessed using linear regression models.

Results: Percentage of women without schooling was negatively associated with all outcomes. Number of years of schooling among women was positively associated with all outcomes except for UIE and the proportion of infants protected against iodine deficiency. Income level was a significant effect modifier of the effect of years of women's schooling on child anemia as well as of the proportion of women without formal education on zinc deficiency in the population. The relationship was strongest in low-income countries for child anemia, and was not significant in upper middle-income countries. For zinc deficiency, the relationship was not significant in low or lower middle income countries, which may suggest that a minimum threshold of resources needs to be reached before education can influence zinc status.

Conclusions: While relationships between maternal schooling and micronutrient outcomes vary around the globe, more schooling is generally linked to lower rates of deficiency. These findings draw policy-relevant connections between formal education and anemia and micronutrient status globally. It is necessary to examine the mechanisms through which this relationship may be working at both household and country level.

Keywords: Anemia; Economic development; Iodine; Maternal education; Micronutrient deficiencies; Micronutrients; Nutrition; Vitamin A; Women’s education; Zinc.

Fig. 1

Most recent relationship for nutritional outcomes by women’s years in schooling and percentage of no schooling among countries, by income level. a Prevalence of anemia among < 5yo (2012) by women’s schooling (2010). b Prevalence of anemia among non-pregnant women (2012) by women’s schooling (2010). c Prevalence of VAD among < 5 yo (2013) by women’s schooling (2010). d Prevalence of zinc deficiency (2005) by women’s schooling (2000). e Median UIE of a country (μg/L) (2012) by women’s schooling (2010). f Proportion of infants protected against iodine deficiency (2012) by women’s schooling (2010)

Fig. 2

Nutritional outcomes by women’s years in schooling and percentage of no schooling at a country level, across time. a Prevalence of anemia among < 5yo by women’s schooling, across time (1985 to 2005). b Prevalence of anemia among non-pregnant women by women’s schooling, across time (1985 to 2005). c Prevalence of VAD by women’s schooling, across time (1990 to 2005). d Prevalence of zinc deficiency by women’s schooling, across time (1985 to 2000)