Female education and the use of maternal and child health care services in Peru

This dissertation examines the hypothesis that maternal education exercises a direct influence on the use of maternal and child health care services, independent of the household's socioeconomic status and access to services as well as a set of "predisposing" characteristics also known to influence utilization of modern health care services in developing countries. The question of whether prior use of maternal health care services affects the utilization of child health care services and whether female schooling has an independent effect beyond its association with prior health care behavior is also explored. Peru was chosen as a case study because previous research had documented a close association among maternal education, children's nutritional status, use of maternal and child health care services, and infant and child mortality. In 1986, the Demographic and Health Survey Project administered two retrospective surveys on fertility, mortality, contraceptive use and utilization of health care services in Peru. These data made it possible to investigate the association between maternal education and (1) use of health care services during pregnancy and delivery; (2) childhood immunizations; and (3) treatment of diarrhea.;The results of this study support the hypothesis that female education has an independent influence on the use of maternal health care services beyond its association with the household socioeconomic status and a set of predisposing characteristics included in these analyses. Educated women are more likely than less educated mothers to seek the services of modern health care professionals both during pregnancy and at the time of delivery. Furthermore, this result cannot be attributed to the correlation between use of trained health care professionals for prenatal care and assistance at delivery. Thus, maternal education has both a direct and an indirect effect, through prenatal care, on health care behavior at the time of delivery.;Evidence concerning a direct influence of female schooling on child health care services is not as clear cut. In the analyses of both immunization coverage and treatment of diarrhea, maternal education has a significant univariate effect, but in the multivariate analyses maternal education effects become insignificant. With respect to childhood immunizations, however, female education has an indirect effect on immunization coverage through the use of prenatal care and assistance at delivery. Prior use of maternal health care services is a key determinant of children's immunization status. In contrast, the use of maternal health care services has no independent influence on treatment of diarrhea.