View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Carolina Digital Repository THE EFFECT OF FEMALE EDUCATION ON HEALTH IN BANGLADESH Aiko Hattori A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Maternal and Child Health. Chapel Hill 2011 Approved by: Gustavo Angeles, Ph.D. Ilene S. Speizer, Ph.D. Peter M. Lance, Ph.D. Kavita Singh, Ph.D. Chirayath M. Suchindran, Ph.D. ©2011 Aiko Hattori ALL RIGHTS RESERVED ii ABSTRACT AIKO HATTORI: The Effect of Female Education on Health in Bangladesh (Under the direction of Dr. Gustavo Angeles) Female education is believed to affect health through its influence on health behaviors. However, the effect of female education may be estimated incorrectly when female education is correlated with unobserved variables at the community and individual levels that also influence health. This dissertation estimates the causal effect of female education on health in Bangladesh and addresses the potential sources of endogeneity. I apply instrumental variables (IV) constructed from education programs introduced nationwide in the 1990s in Bangladesh to analyze integrated data from the 2007 Demographic and Health Survey, the 1981 population census, and the secondary school census in 2006. In the first paper, I assess the causal effect of female education on adolescent reproductive health outcomes in order to understand the mechanisms through which education influences adolescent fertility. I find that a one-year increase in the highest grade achieved reduced significantly the probability of first marriage by age 15 by .050, the probability of first live birth by age 16 by .013, and the number of live births by age 20 by .072 births. In the second paper, I examine the causal effect of maternal education on sex bias in child survival between the first and fifths birthdays in Bangladesh in order to assess the influence of maternal education on parental son preference and differential parental behaviors by gender of child. I find that a one-year increase in highest grade achieved increased significantly the survival probability for both boys and girls by .012. However, there was no incremental effect of maternal education by gender of child, implying that girls do not benefit any more than boys from educated mothers. iii The difference between the IV and ordinary least squares (OLS) estimates of the effect of female education on health vary depending on the health outcomes. The finding suggests that the direction and magnitude of bias due to endogeneity are not universal across health outcomes and cannot be determined as a priori knowledge. Lastly, the reduced form results of the two papers suggest that the education programs significantly enhanced female education, and reproductive and child health. iv ACKNOWLEDGEMENTS This dissertation was made possible through help and support from many individuals. First and foremost, I would like to acknowledge my dissertation committee members – Drs. Gustavo Angeles (advisor), Ilene S. Speizer (chair), Peter M. Lance, Kavita Singh Ongechi, and Chirayath M. Suchindran – for their continual support, guidance, and encouragement throughout my doctoral program and dissertation work. Their dedication to research and commitment to serving vulnerable populations have fortified my career goals as a researcher. I am grateful to my parents for their love and encouragement to pursue my dream and goals. I could not have come this far without your belief in me. To my two sisters, for bringing me smiles and laugher always and especially during tough times. You are the best sisters I could have ever hoped for. My friends were invaluable as I completed the doctoral program in a culture, language and place entirely new to me. I am grateful to Yukiko Makihara and her husband Joshua Shaffer, Shiho Goto, Kayo Suzuki, and Kathy Chou, for their friendship and all the fun we had together after school. To Yuichi Watanabe, for encouraging me as I wrote the dissertation and sharing honest and insightful comments. To my writing buddies in the writing group, Elizabeth Ku, Emma Wang, Clair Lin, David Wei, and Alvin Wu, and the Writing Center staff, Gigi Taylor and Nigel Caplan, for helping me improve my writing skills in my second language. I would like to extend my gratitude to the Carolina Population Center and Ms. Jan Hendrickson-Smith, for granting me the valuable opportunity of enhancing my skills and deepening my research knowledge in demography and population studies through the Predoctoral Training Program. In addition, the field research was made possible through funding from the Gillings School of Global Public Health Travel Award. v I also gratefully acknowledge Ahsan Abdullah and Md. Mezanur Rahaman at the Bangladesh Bureau of Educational Information and Statistics (BANBEIS) for providing data on education institutions, and the individuals I interviewed in Dhaka, Bangladesh for helping me understand the context unique to the country. Finally, I thank Ndeye Diop, my best friend in Senegal, who fostered all my passion for global health and whom I cannot wait to show myself being a better professional. I look forward to picking up where I left off six years ago to make a difference this time. vi TABLE OF CONTENTS LIST OF TABLES ................................................................................................................................ ix LIST OF FIGURES ................................................................................................................................ x LIST OF ABBREVIATIONS ............................................................................................................... xi CHAPTER 1: INTRODUCTION ........................................................................................................... 1 Statement of the Problem ................................................................................................................... 1 Specific Aims and Hypotheses........................................................................................................... 2 Country Setting .................................................................................................................................. 4 CHAPTER 2: THE EFFECT OF FEMALE EDUCATION ON ADOLESCENT REPRODUCTIVE HEALTH .............................................................................................................................................. 10 Background ...................................................................................................................................... 10 Methods ............................................................................................................................................ 14 Reduced Form Results: Effect of Education Programs .................................................................... 22 Instrumental Variable Method Results: Effect of Education ........................................................... 31 Discussion ........................................................................................................................................ 34 CHAPTER 3: THE EFFECT OF MATERNAL EDUCATION ON SEX BIAS IN CHILD SURVIVAL .......................................................................................................................................... 39 Background ...................................................................................................................................... 39 Methods ............................................................................................................................................ 43 vii Reduced Form Results: Effect of Education Programs .................................................................... 50 Instrumental Variable Method Results: Effect of Maternal Education ............................................ 58 Discussion ........................................................................................................................................ 61 CHAPTER 4: CONCLUSION ............................................................................................................. 66 APPENDICES ...................................................................................................................................... 70 A: Chapter 2 ..................................................................................................................................... 70 B: Chapter 3 ..................................................................................................................................... 73 REFERENCES ..................................................................................................................................... 78 viii LIST OF TABLES Table 1. Regression of the number of secondary schools ......................................................... 9 Table 2. Descriptive statistics ................................................................................................. 15 Table 3. Female educational attainment by a woman’s year of birth and the number of schools............................................................................................................................. 19 Table 4. Reproductive health outcomes by a woman’s year of birth and the number of schools............................................................................................................................