Evidence for Causal Links between Education and Maternal and Child Health: A Systematic Review

Background: While a voluminous literature has established a link between education and health in developing countries, a question remains regarding the degree to which a causal relationship exists. Methods: We conducted a systematic review of the evidence for a causal link between education and maternal and child health in low and middle-income countries. Studies eligible for inclusion controlled for observable and unobservable factors affecting both education and health and were published in English after 1990. To compare study results, reported effects were converted into partial correlations (r) between education and each health outcome. We also summarized the mechanisms linking education to health discussed in each paper. Findings: Of the 4952 papers identified, 14 met the inclusion criteria. The 13 child health papers examined 38 outcomes, 18 of which were significantly linked with education in models that addressed endogeneity. The one maternal morbidity paper identified found significant effects for the two preventable outcomes considered. While there is evidence for a causal link between education and child health, effects are weaker in models that address endogeneity. Interpretation: This review demonstrates that increases in educational attainment of women in the last several decades played a role in improving child health, and likely maternal health. One question for future research is whether the effect of education on health in low and middle-income countries will diminish due to declining school quality, a consequence of the rapid increase in school enrollment in many settings. Trial registry: The protocol was registered on PROSPERO (registry# CRD42017073224). Funding: Bill and Melinda Gates Foundation Conflict of Interest: We declare no competing interests.