Lower maternal education linked to child stunting

Children born to mothers with lower educational levels appear to be at a higher risk of having compromised growth, according to a recent Indonesia study.

“Based on the results, the authors recommended that the government conduct interventions focusing on mothers of children under two with poor education to reduce the proportion of stunting under 2 years,” the researchers said. “A more specific target is mothers of children under five who live in rural areas, are never married, and are employed.”

Drawing from the 2017 Indonesia Nutritional Status Monitoring Survey, the analysis included 70,293 children under 2 years of age. Independent variables assessed in the study included maternal education, place of residence, and maternal employment. The outcome of interest was child stunting, defined as being –2.0 to <–3.0 standard deviations from the average height for their age.

One in five (20.1 percent) children under 2 years of age in Indonesia were stunted, a subpopulation that was comprised mostly of children living in rural areas (77.4 percent). Co-linearity tests found no correlations among the independent variables. [PLoS One 2022;doi:10.1371/journal.pone.0271509]

Basic descriptive statistics stratified according to maternal characteristics found that stunting was lowest among children born to mothers with college-level education (6.6 percent), and highest among those who had finished only senior high school (34.1 percent) or primary school (30.6 percent). These differences were statistically significant (p<0.001).

Multivariable logistic regression analysis confirmed that maternal education was an important indicator of their offspring’s growth and nutritional status. Those who had finished only until primary education at most were nearly 60 percent more likely to have stunted children (adjusted odds ratio [OR], 1.587, 95 percent confidence interval [CI], 1.576–1.598) as compared with their college-educated counterparts.

Similarly, finishing only junior or senior high school significantly increased the likelihood of child stunting by more than 40 percent and 20 percent, respectively (adjusted OR, 1.430, 95 percent CI, 1.420–1.440 and adjusted OR, 1.230, 95 percent CI, 1.222–1.238, respectively).

Other independent correlates of child stunting included being unmarried (adjusted OR, 1.348, 95 percent CI, 1.308–1.389), being unemployed (adjusted OR, 0.972, 95 percent CI, 0.968–0.975), and living in an urban area (adjusted OR, 0.828, 95 percent CI, 0.825–0.31). Moreover, boys were around 30 percent more likely to be stunted than girls (adjusted OR, 1.352, 95 percent CI, 1.347–1.356).

The present findings confirm that education in parents is an important determinant of child health, as detailed by prior systematic reviews and meta-analyses. In fact, even paternal education has been found to lead to better health outcomes in their offspring. [Enferm Clin 2020;30:241-245; Int J Environ Res Public Health 2016;14:863; Lancet 2008;371:322-328]

These effects could be attributed to the parents’ role as primary caregivers and decision-makers regarding their child’s nutrition. Mothers, in particular, have been shown to have a strong impact on their child’s feeding behaviours, while better-educated fathers tend to be more protective of their child and lead to better immunization rates. [PLoS One 2016;11: e0154756]

Due to its cross-sectional design, however, the current study was unable to rule out the possibility of reverse-causation. Future studies are needed to better understand the links between maternal education, as well as other maternal factors, and child stunting.