Home/ Opinion / Online-views/  Educating girls can improve India’s health outcomes

India has some of the world’s worst public health outcomes, but educating girls can change that. Nationally, according to 2017 government data, 34 out of every 1,000 newborns will not survive till their first birthday, of whom 25 would not have lived beyond their first 28 days. These figures are improving, because of concerted efforts by the national programme—but the gap is much too large for a country aspiring to be a world-beater on most fronts.

Female literacy is one of the most powerful levers to improve a society’s health and economic well-being. Ensuring that the girl child is educated sets off a virtuous chain reaction—improved literacy leading to delayed age of marriage, fewer and heathier children and corresponding reduction in poverty. Data comparing two states that lead in terms of welfare indicators (Kerala and Tamil Nadu) and two that lag (Bihar and Uttar Pradesh) is revealing. All figures cited here are the most recent government data.

Female literacy = Delayed marriage

Female literacy rates in Kerala and Tamil Nadu are 92% and 73.9%, respectively, while the same rates for Uttar Pradesh and Bihar are about half, at 42.2% and 33.1%, respectively. Average age at marriage for women in these states is 21.4 for Kerala and 21.2 for Tamil Nadu, above the national average of 20.7 years. The same figures for Uttar Pradesh and Bihar are significantly lower at 19.4 and 19.5, respectively. I’ve observed, working in northern states, that women are routinely forced into early marriages. At the same time, there are enough cases I encounter of girls whose families place greater priority on having their daughters finish school and perhaps college. These parents say they see a better overall future for their daughters, if they are educated.

Female literacy + delayed marriage = Fewer babies per woman

In many parts of rural India there is immense pressure on women to produce boys, who will supposedly be the “breadwinners". The sex ratio at birth (girls born per 1,000 boys) has fallen and is only around 800 in some North Indian states. Multiple pregnancies with inadequate spacing adversely affect the health of mother and child.

The good news is that where there has been an improvement in literacy and delayed marriage, the fertility rate (average number of children per woman) has reduced. Kerala (1.7) and Tamil Nadu (1.6) perform better than the national average of 2.3, while Uttar Pradesh and Bihar are significantly worse at 3.1 and 3.3, respectively, though these figures are improving.

Female literacy + delayed marriage + fewer babies per woman = Higher child survival

A woman who is educated, older when she gets married and plans fewer babies will proactively seek out good antenatal care. The percentage of women receiving full antenatal care is 61.2 and 45 in Kerala and Tamil Nadu, respectively. These figures are only 5.9 and 3.3 in Uttar Pradesh and Bihar, respectively, though improving. Fewer babies receiving better care mean that fewer children die in their first four weeks. The neonatal mortality rate in all states is improving, but Kerala and Tamil Nadu are way ahead of the national average (28), with figures of 6 and 15, respectively. The Kerala figure is the same as that in the US.

All of the above add up to lower poverty in the long run

As families become smaller and children survive and thrive, they can spend more productively, and improve their economic situation. Between 2004 and 2011, the percentage of population below the poverty line in Uttar Pradesh and Bihar registered slight improvements from 32.8 to 29.4, and 41.4 to 33.7, respectively. The percentage of population below the poverty line for Kerala and Tamil Nadu halved from 15 to 7.1 and 22.5 to 11.3, respectively. States that invested in education and health earlier are alleviating poverty faster now. China is a global benchmark for how these social investments, made decades ago, formed the foundation for that country’s rapid economic growth.

The message should be clear: greater female literacy translates into better health outcomes in the short run and poverty alleviation in the long run. Beti padhao makes a lot of sense.

Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok. 

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Updated: 17 Jul 2018, 11:14 PM IST
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