Maternal and Child Health Journal

, Volume 21, Issue 11, pp 2122–2131 | Cite as

Maternal Education Gradients in Infant Health in Four South American Countries

  • George L. WehbyEmail author
  • Jorge S. López-Camelo


Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father’s education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father’s education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more consistent across examined countries.


Child health Maternal education Health inequalities Socioeconomic status Health disparities 



The study was supported by grant 1R03TW008110A2 from the National Institutes of Health/Fogarty International Center, USA. The authors thank all health professionals and coordinators of the Latin American Collaborative Study of Congenital Anomalies (ECLAMC) for their efforts in data collection.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest with this work.

Supplementary material

10995_2017_2327_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 47 KB)


  1. Acevedo-Garcia, D., Soobader, M. J., & Berkman, L. F. (2007). Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education. Social Science & Medicine (1982), 65(12), 2503–2516.CrossRefGoogle Scholar
  2. Castilla, E. E., & Orioli, I. M. (2004). ECLAMC: The Latin-American collaborative study of congenital malformations. Community Genetics, 7(2–3), 76–94.Google Scholar
  3. Cawley, J., & Choi, A. (2015). Health disparities across education: The role of differential reporting error (No. w21317). Cambridge: National Bureau of Economic Research.CrossRefGoogle Scholar
  4. Desai, S., & Alva, S. (1998). Maternal education and child health: Is there a strong causal relationship? Demography, 35(1), 71–81.CrossRefPubMedGoogle Scholar
  5. Hanushek, E. A., & Woessmann, L. (2012). Schooling, educational achievement, and the Latin American growth puzzle. Journal of Development Economics, 99(2), 497–512.CrossRefGoogle Scholar
  6. Nyarko, K. A., Lopez-Camelo, J., Castilla, E. E., & Wehby, G. L. (2013). Explaining racial disparities in infant health in Brazil. American Journal of Public Health, 103(9), 1675–1684.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Phelan, A. L., DiBenedetto, M. R., Paul, I. M., Zhu, J., & Kjerulff, K. H. (2015). Psychosocial stress during first pregnancy predicts infant health outcomes in the first postnatal year. Maternal and Child Health Journal, 19(12), 2587–2597.CrossRefPubMedGoogle Scholar
  8. Urquia, M. L., Frank, J. W., Alazraqui, M., Guevel, C., & Spinelli, H. G. (2013). Contrasting socioeconomic gradients in small for gestational age and preterm birth in Argentina, 2003–2007. International Journal of Public Health, 58(4), 529–536.CrossRefPubMedGoogle Scholar
  9. Wehby, G. L. (2014). Child health insurance coverage and household activity toward child development in four South American countries. Maternal and Child Health Journal, 18(4), 939–949.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Wehby, G. L., Castilla, E. E., Lopez-Camelo, J. S., & Murray, J. C. (2009b). Predictors of Multivitamin Use during Pregnancy in Brazil. International Journal of Public Health, 54(2), 78–87.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Wehby, G. L., Gili, J. A., Pawluk, M., Castilla, E. E., & Lopez-Camelo, J. S. (2015). Disparities in birth weight and gestational age by ethnic ancestry in South American countries. International Journal of Public Health, 60(3), 343–351.CrossRefPubMedGoogle Scholar
  12. Wehby, G. L., Gimenez, L. G., & López-Camelo, J. S. (2017). The impact of unemployment cycles on child and maternal health in Argentina. International Journal of Public Health, 62(2), 197–207.CrossRefPubMedGoogle Scholar
  13. Wehby, G. L., Lopez-Camelo, J., & Castilla, E. E. (2010). The impact of altitude on infant health in South America. Economics & Human Biology, 8(2), 197–211.CrossRefGoogle Scholar
  14. Wehby, G. L., Lopez-Camelo, J., & Castilla, E. E. (2012). Hospital volume and mortality of very low-birthweight infants in South America. Health Services Research, 47, 1502–1521.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Wehby, G. L., & McCarthy, A. M. (2013). Economic gradients in early child neurodevelopment: a multi-country study. Social Science and Medicine, 78, 86–95.CrossRefPubMedGoogle Scholar
  16. Wehby, G. L., Murray, J. C., Castilla, E. E., Lopez-Camelo, J. S., & Ohsfeldt, R. L. (2009a). Prenatal care effectiveness and utilization in Brazil. Health Policy and Planning, 24(3), 175–188.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Wehby, G. L., Nyarko, K. A., & Lopez-Camelo, J. S. (2014). Fetal health shocks and early inequalities in health capital accumulation. Health Economics, 23(1), 69–92.CrossRefPubMedGoogle Scholar
  18. Wehby, G. L., Pawluk, M., Nyarko, K. A., & López-Camelo, J. S. (2016). Explaining ethnic disparities in preterm birth in Argentina and Ecuador. Global Public Health, 1–18. doi: 10.1080/17441692.2016.1251603.
  19. Woodhouse, C., Lopez Camelo, J., & Wehby, G. L. (2014). A comparative analysis of prenatal care and fetal growth in eight South American countries. PLoS One, 9(3), e91292.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Departments of Health Management and Policy, Economics, and Preventive & Community Dentistry, and Public Policy CenterUniversity of IowaIowa CityUSA
  2. 2.National Bureau of Economic ResearchCambridgeUSA
  3. 3.Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC)Buenos AiresArgentina

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