Maternal and Child Health Journal

, Volume 19, Issue 11, pp 2501–2511 | Cite as

The Relationship Between Maternal Education and Child Health Outcomes in Urban Australian Children in the First 12 Months of Life

  • Tamzyn M. Davey
  • Cate M. Cameron
  • Shu-Kay Ng
  • Rod J. McClure



To describe the relationship between maternal education and child health outcomes at 12 months of age in a cohort of children in urban Australia, and to determine whether this relationship could be explained by the intermediate factors of maternal health behaviour and the social environmental context.


Data were derived from The Environments for Health Living Griffith Birth Cohort Study. Women attending their third trimester antenatal appointment at one of three public hospitals were recruited between 2006 and 2010 and invited to complete a 48-item, baseline self-administered questionnaire. Twelve months following the birth of their baby, a follow-up questionnaire consisting of 63 items was distributed.


Women for whom complete follow-up data were not available were different from women who did complete follow-up data. The children of women with follow-up data—whom at the time of their pregnancy had not completed school or whose highest level of education was secondary school or a trade—had respectively a 59 and 57 % increased chance of having had a respiratory/infectious disease or injury in the first year of life (according to parent proxy-reports), compared to children of women with a tertiary education. When maternal behavioural and social environmental factors during pregnancy were included in the model (n=1914), the effect of secondary education was still evident but with a reduced odds ratio of 1.35 (95 % CI 1.07–1.72) and 1.19 (95 % CI 0.87–1.64), respectively. The effect of not having completed school was no longer significant.


Results indicate that the relationship between maternal education and child outcomes may be mediated by maternal social environmental and behavioural factors. Results are likely an underestimation of the effect size, given the under representation in our cohort of participants with maternal characteristics associated with elevated risk of infant morbidity.


Child Maternal educational status Health behavior Social environment 



The research reported in this publication is part of the Griffith Study of Population Health: Environments for Healthy Living (EFHL) (Australian and New Zealand Clinical Trials Registry: ACTRN12610000931077). Core funding to support EFHL is provided by Griffith University. The EFHL project was conceived by Professor Rod McClure, Dr Cate Cameron, Professor Judy Searle, and Professor Ronan Lyons. The authors are thankful for the contributions of the Project Manager, Rani Scott, and the current and past Database Managers. The authors gratefully acknowledge the administrative staff, research staff, and the hospital antenatal and birth suite midwives of the participating hospitals for their valuable contributions to the study, in addition to the expert advice provided by Research Investigators throughout the project. Dr Cameron was supported by a Public Health Fellowship (ID 428254) from the National Health and Medical Research Council (NHMRC) Australia.


  1. 1.
    Cleland, J. G., & van Ginneken, J. K. (1988). Maternal education and child survival in developing countries: The search for pathways of influence. Social Science and Medicine, 27(12), 1357–1368.CrossRefPubMedGoogle Scholar
  2. 2.
    Bhargava, A., & Fox-Kean, M. (2003). The effects of maternal education versus cognitive test scores on child nutrition in Kenya. Economics and Human Biology, 1(3), 309–319.CrossRefPubMedGoogle Scholar
  3. 3.
    Chen, Y., & Li, H. (2009). Mother’s education and child health: Is there a nurturing effect? Journal of Health Economics, 28(2), 413–426.CrossRefPubMedGoogle Scholar
  4. 4.
    Boyle, M. H., Racine, Y., Georgiades, K., Snelling, D., Hong, S., Omariba, W., et al. (2006). The influence of economic development level, household wealth and maternal education on child health in the developing world. Social Science and Medicine, 63(8), 2242–2254.CrossRefPubMedGoogle Scholar
  5. 5.
    Sandiford, P., Cassel, J., Sanchez, G., & Coldham, C. (1997). Does intelligence account for the link between maternal literacy and child survival? Social Science and Medicine, 45(8), 1231–1239.CrossRefPubMedGoogle Scholar
  6. 6.
    Parashar, S. (2005). Moving beyond the mother-child dyad: Women’s education, child immunization, and the importance of context in rural India. Social Science and Medicine, 61(5), 989–1000.CrossRefPubMedGoogle Scholar
  7. 7.
    Belsky, J., Bell, B., Bradley, R. H., Stallard, N., & Stewart-Brown, S. L. (2007). Socioeconomic risk, parenting during the preschool years and child health age 6 years. European Journal of Public Health, 17(5), 508–513.CrossRefPubMedGoogle Scholar
  8. 8.
    Shin, H. (2007). Child health in Peru: Importance of regional variation and community effects on children’s height and weight*. Journal of Health and Social Behavior, 48(4), 418–433.CrossRefPubMedGoogle Scholar
  9. 9.
    Messer, L. C., Vinikoor, L. C., Laraia, B. A., Kaufman, J. S., Eyster, J., Holzman, C., et al. (2008). Socioeconomic domains and associations with preterm birth. Social Science and Medicine, 67(8), 1247–1257.CrossRefPubMedGoogle Scholar
  10. 10.
    Lagerberg, D., Magnusson, M., & Sundelin, C. (2011). Child health and maternal stress: Does neighbourhood status matter? International Journal of Adolescent Medicine and Health, 23, 19–25.PubMedGoogle Scholar
  11. 11.
    Renzaho, A. M. N., & Karantzas, G. (2010). Effects of parental perception of neighbourhood deprivation and family environment characteristics on pro-social behaviours among 4–12 year old children Australian and New Zealand. Journal of Public Health, 34(4), 405–411.Google Scholar
  12. 12.
    Hornberg, C., & Pauli, A. (2007). Child poverty and environmental justice. International Journal of Hygiene and Environmental Health, 210(5), 571–580.CrossRefPubMedGoogle Scholar
  13. 13.
    Ogunlesi, T. A. (2010). Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi- urban setting. Maternal and Child Health Journal, 14(3), 459.CrossRefPubMedGoogle Scholar
  14. 14.
    Feldens, C. A., Kramer, P. F., Rodrigues, P. H., Sequeira, M. C., & Vitolo, M. R. (2012). Maternal education is an independent determinant of cariogenic feeding practices in the first year of life. European Archives of Paediatric Dentistry, 13(2), 70.CrossRefPubMedGoogle Scholar
  15. 15.
    Vikram, K., Vanneman, R., & Desai, S. (2012). Linkages between maternal education and childhood immunization in India. Social Science and Medicine, 75(2), 331–339.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Murakami, K., Miyake, Y., Sasaki, S., Tanaka, K., Ohya, Y., & Hirota, Y. (2009). Education, but not occupation or household income, is positively related to favorable dietary intake patterns in pregnant Japanese women: The Osaka Maternal and Child Health Study. Nutrition Research, 29(3), 164–172.CrossRefPubMedGoogle Scholar
  17. 17.
    Armar-Klemesu, M., Ruel, M. T., Maxwell, D. G., Levin, C. E., & Morris, S. S. (2000). Poor maternal schooling is the main constraint to good child care practices in Accra. Journal of Nutrition, 130(6), 1597–1607.PubMedGoogle Scholar
  18. 18.
    Abuya, B. A., Onsomu, E. O., Kimani, J. K., & Moore, D. (2011). Influence of maternal education on child immunization and stunting in Kenya. Maternal and Child Health Journal, 15(8), 1389.CrossRefPubMedGoogle Scholar
  19. 19.
    Huq, M. N., & Tasnim, T. (2008). Maternal education and child healthcare in Bangladesh. Maternal and Child Health Journal, 12(1), 43–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Halim, N., Bohara, A. K., & Ruan, X. (2011). Healthy mothers, healthy children: Does maternal demand for antenatal care matter for child health in Nepal? Health Policy Plan, 26(3), 242–256.CrossRefPubMedGoogle Scholar
  21. 21.
    Kahn, R. S., Wilson, K., & Wise, P. H. (2005). Intergenerational health disparities: Socioeconomic status, women’s health conditions, and child behavior problems. Public Health Reports, 120(4), 399–408.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Dowd, J. B. (2007). Early childhood origins of the income/health gradient: The role of maternal health behaviors. Social Science and Medicine, 65(6), 1202–1213.CrossRefPubMedGoogle Scholar
  23. 23.
    Rothman, K., Greenland, S., & Lash, T. L. (2008). Modern epidemiology (3rd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.Google Scholar
  24. 24.
    Lynch, J., & Smith, G. D. (2002). Commentary: Income inequality and health: The end of the story? International Journal of Epidemiology, 31(3), 549–551.CrossRefPubMedGoogle Scholar
  25. 25.
    Lynch, J. (2000). Income inequality and health: Expanding the debate. Social Science and Medicine, 51(7), 1001–1005.CrossRefPubMedGoogle Scholar
  26. 26.
    Cameron, C. M., Scuffham, P. A., Spinks, A., Scott, R., Sipe, N., Ng, S., et al. (2012). Environments for Healthy Living (EFHL) Griffith Birth Cohort Study: Background and Methods. Maternal and Child Health Journal, 16(9), 1896–1905.CrossRefPubMedGoogle Scholar
  27. 27.
    Cameron, C. M., Scuffham, P. A., Shibl, R., Ng, S., Scott, R., Spinks, A., et al. (2012). Environments For Healthy Living (EFHL) Griffith birth cohort study: Characteristics of sample and profile of antenatal exposures. BMC Public Health, 12(1), 1080.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Australian Bureau of Statistics (2006). Information paper: An introduction to socio-economic indexes for areas (SEIFA), Canberra: Australian bureau of statistics; 2008. Report No.: 2039.0.Google Scholar
  29. 29.
    Centre for Longitudinal Studies. (2003). UK Millennium Cohort Study: First Survey: CAPI Questionnaire Documentation. London: National Centre for Social Research.Google Scholar
  30. 30.
    Furukawa, T. A., Kessler, R. C., Slade, T., & Andrews, G. (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 33(02), 357–362.CrossRefPubMedGoogle Scholar
  31. 31.
    Australian Bureau of Statistics. (2011). Household Income and Income Distribution, Australia, 2009–2010. Canberra: Australian Bureau of Statistics.Google Scholar
  32. 32.
    Australian Bureau of Statistics. (2011). Consumer price index: Concepts, sources and methods. Canberra: Australian Bureau of Statistics.Google Scholar
  33. 33.
    Roberts, C. L., & Lancaster, P. A. (1999). Australian national birthweight percentiles by gestational age. Medical Journal of Australia, 170, 114–118.PubMedGoogle Scholar
  34. 34.
    Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefPubMedGoogle Scholar
  35. 35.
    SAS Institute Inc. (2010). SAS/GRAPH® 9.2 Reference. Cary, NC: SAS Institute Inc.Google Scholar
  36. 36.
    Mackinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods. Multivariate Behavioral Research, 39(1), 99.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    The Sydney Morning Herald (cited 2014 May 15).Graduates could pay up to $120,000 in debt, HECS architect warns [Internet]. Available from:
  38. 38.
  39. 39.
    Hill, A. B. (1965). The Environment and disease: Association or Causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300.PubMedCentralPubMedGoogle Scholar
  40. 40.
    Brown, S. L. (2010). Changes in risk perceptions prospectively predict changes in self-reported speeding. Risk Analysis International Journal, 30(7), 1092–1098.CrossRefGoogle Scholar
  41. 41.
    Dunn, M. S., Ilapogu, V., Taylor, L., Naney, C., Blackwell, R., Wilder, R., et al. (2008). Self-reported substance use and sexual behaviors among adolescents in a rural state. Journal of School Health, 78(11), 587–593.CrossRefPubMedGoogle Scholar
  42. 42.
    Rosenbloom, T., & Wultz, B. (2011). Thirty-day self-reported risky driving behaviors of ADHD and non-ADHD drivers. Accident Analysis and Prevention, 43(1), 128–133.CrossRefPubMedGoogle Scholar
  43. 43.
    Shariff-Marco, S., Klassen, A. C., & Bowie, J. V. (2010). Racial/Ethnic Differences in Self-Reported Racism and Its Association With Cancer-Related Health Behaviors. American Journal of Public Health, 100(2), 364–374.PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Hser, Y. I., Anglin, M. D., & Chou, C. P. (1992). Reliability of retrospective self-report by Narcotics addicts. Psychological Assessment, 4(2), 207–213.CrossRefGoogle Scholar
  45. 45.
    Sullman, M. J. M., & Taylor, J. E. (2010). Social desirability and self-reported driving behaviours: Should we be worried? Transportation Research. Part F, Traffic Psychology and Behaviour, 13(3), 215–221.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.School of Public HealthThe University of QueenslandBrisbaneAustralia
  2. 2.Centre of National Research on Disability and Rehabilitation, School of Human Services and Social WorkGriffith UniversityBrisbaneAustralia
  3. 3.Griffith Health InstituteGriffith UniversityBrisbaneAustralia
  4. 4.School of MedicineGriffith UniversityBrisbaneAustralia
  5. 5.Harvard Injury Control Research CenterHarvard School of Public HealthBostonUSA

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