Decades of research have shown that women’s school attainment is correlated with reduced child mortality and fertility in developing countries – without clarifying the processes involved. This book proposes that literate communication skills acquired in Western-type schools constitute a causal link between schooling and maternal behavior in bureaucratic health care settings, contributing to the decline in birth and death rates. The book reviews the history of mass schooling and its diffusion, the evidence on women’s schooling in demographic transition, and the re-conceptualization of literacy ... More

Decades of research have shown that women’s school attainment is correlated with reduced child mortality and fertility in developing countries – without clarifying the processes involved. This book proposes that literate communication skills acquired in Western-type schools constitute a causal link between schooling and maternal behavior in bureaucratic health care settings, contributing to the decline in birth and death rates. The book reviews the history of mass schooling and its diffusion, the evidence on women’s schooling in demographic transition, and the re-conceptualization of literacy in educational research. Then it presents data on the literacy skills and maternal behavior of mothers in four countries – Mexico, Nepal, Venezuela and Zambia – finding that literacy and language skills acquired in school were retained into a woman’s child-bearing years, that literacy mediates the effect of schooling on a mother’s comprehension of health messages in print and broadcast media and on her health navigation skill – with other socioeconomic factors (urban or rural residence, income, husband’s education, parents’ education) controlled. Literacy also influences mothers’ tendencies to talk and read to their young children. The theory of communicative socialization emerging from this research indicates that girls acquire from teacher-pupil interaction the tendencies to act like pupils in health care settings and like teachers with their own children, thus using their literacy skills in ways standardized by classroom experience. This new account of maternal health literacy and health navigation skills is empirically supported by the evidence presented in the book but needs further validation from longitudinal research.