UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES HO CHI MINH CITY THE HAGUE VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS THE IMPACT OF MOTHER’S EDUCATION ON CHILD HEALTH: EVIDENCE FROM MICS4 - VIETNAM A Thesis Submitted in Partial Fulfilment of the Requirement for the Degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS By TRAN TRUNG THU Academic Supervisor: Dr TRUONG DANG THUY HO CHI MINH CITY, December 2014 DECLARATION I would like to declare that this thesis, titled “THE IMPACT OF MOTHER’S EDUCATION ON CHILDREN HEALTH: EVIDENCE FROM MICS4 - VIETNAM”, is original, which is submitted in fulfilment of the requirements for the degree of Master of Art in Development Economic s to the Vietnam – The Netherlands Programme I ensure that this paper has not been submitted anywhere for the award of any degree This thesis was completed with big support from my supervisor All source s of data and information have been fully cited in the thesis TRAN TRUNG THU MDE19 ACKNOWLEGDEMENT First of all, I would like to express my greatest gratitude to my respectful supervisor, Dr Truong Dang Thuy, for his valuable knowledge in helping me complete this study I would like to express my thanks to him, who helped and supported me through interesting courses, especially his valuable advice, guidance and inspiration, which motivate me to finish this study I also want to express my thanks to all Professors of the MDE Programme during the past two years (2012 -2014), my friends from Class MDE 19, and administrative staffs of Economic Development Faculty, University of Economics HCMC (UEH), who provided me useful documents and materials Finally, I would like to express my deeply appreciation to my dear family during the time I follow this grogram for their spiritual and physical supports In particular, I dedicate this thesis to my mother, who has been helping me virtually during the process of conducting my thesis HCMC, December 2014 TRAN TRUNG THU MDE 19 ABSTRACT This study aims to examine the relationship between mother’s education and children health in Vietnam Data are taken from The Vietnam Multiple Indicator Cluster Survey (MICS) by the General Statistics Office of Vietnam, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) The main finding of this study in Vietnam is consistent with other studies in the world about mother’s education and children health The result of this study in Vietnam showed that mother’s education is an important factor of the health of children Thus, they can provide better environment such as provid ing safe water for their house and their children The result also provides new evidence to the general literature that flushing toilet does not really affect children health in Vietnam Table of Contents DECLARATION ACKNOWLEGDEMENT ABSTRACT LIST OF TABLES CHAPTER 1: INTRODUCTION 1.1 Problem statement 1.2 Research objectives 11 1.3 Research scope and data 11 1.4 The structure of this study 12 CHAPTER 2: LITERATURE REVIEW 13 2.1 The relationship between mother’s education on child health 13 2.2 The impacts of all other factors 17 2.3 Conceptual framework 20 CHAPTER 3: RESEARCH METHODOLOGY 22 3.1 Model and Data 22 3.1.1 Model 22 3.1.2 Variables 23 3.2 Data 27 3.3 28 Research hypotheses 30 CHAPTER 4: EMPIRICAL RESULTS 32 4.1 Descriptive statistics 32 33 4.2 Bivariate analysis 35 4.3 The regression results 39 CHAPTER 5: CONCLUSION 43 5.1 Conclusion remarks 43 5.2 Limitations and future research of the study 44 REFERENCES 46 APPENDIX 50 LIST OF TABLES Table 1: Variables of the study 23 Table 2: Mean, Std.dev., minimum and maximum from MICS abour HAZ z-score 32 Table 3: Percent of HAZ z-score divided five parts 33 Table 4: Percent of mother's education level 33 Table 5: Percent of wealth index quintiles 34 Table 6: Percent of households who use safe water and use flushing toilet 34 Table 7: Mother's education and HAZ 35 Table 8: Wealth index quintiles and HAZ 36 Table 9: Variables of use safe water, mother's education and HAZ 37 Table 10: Variables of use flushing toiler, mother's education and HAZ 38 Table 11: Ordinary least squares estimates of the effect of mother's education on the health of children 39 CHAPTER 1: INTRODUCTION 1.1 Problem statement Child malnutrition is not only one of the key issues in the world but also especially pervasive in almost any low income nations and Vietnam because the poorest quintile of children usually has the highest ratio of malnutrition What is malnutrition? When nutrients in meal are not enough or perhaps are too much, it can lead to malnutrition Children who suffer from malnutrition can have health problems such as a weakened immune system, infections, mental retardation, brain damage or even HIV/AIDS which lead to a high risk of developmental delay Many children even can be at this damaged risk caused their mother don’t get proper nourishment Even after recovering from this issue, they still remain stunted in their lives In reality, more than 200 million children in all developing countries under age years old were not provided with a good enough environment to reach their developmental potential (Grantham-Mc Gregor et al., 2007) There have been many efforts in many countries to bring out solutions which can reduce the number of malnourished children It is very important for national security issues in the long time for any nations about human resources and economics In particular, this serious problem is occurring in developing countries However, it varies from region to region and from country in order to country such as in South/Southeast Asia, Latin America or perhaps Sub-Saharan Africa Therefore, many countries try to estimate which factors affect child health, particularly health and nutritional inputs, medicines, medical care or perhaps the quality of household drinking water sources, toilet facilities, and other hygienic conditions or household assets, parental schooling, community economic and health-related characteristics (Glewwe, 1999) From many factors above, there are numerous studies found out the important role of parental schooling, especially mother’s education It is believed that increased education of mothers may be an important means for improvement of child health or perhaps their nutrition As a result, they can provide safer environment from their earnings or beneficial food as well as health habits; thus, mothers are given chances in order to improve the nutrition of their children However, the results of the relationship of mother’s educ ation and child health were not the same from country to country Hobcraft et al (1984) suggested that because of large socio-economic differentials among countries, the relationship between mother’s education and child survival were different amount countries This result is covered 28 World Fertility Surveys by Hobcraft et al (1984) In detail, increased education of mothers was an important factor in order to improve opportunities of child survival in larg e area of developing countries They pointe d out that because of l arge socio economic differentials from country to country in child survival (from age one and five), increased age of the child were widened Both mother’s and father’s levels of education also play an important role in de termining child survival The father’s occupation also related to this variable In detail, the father’s education variable increased opportunities of child survival This result improved even with a small increasing levels of education Mensch et al (1985) also covered from 15 countries and had the same result as Hobcraft et al (1984) They both pointed out that because of large socio- economic differentials, the above association was weaker in sub-Saharan Africa than in Asia or particularly Latin America Furthermore, Mensch et al (1985) also suggested that the relationship between maternal education and child survival was the same in any regions (include in rural and urban areas) In Bangladesh, Lindenbaum (1990) suggested that educated women can keep greater cleanliness which explained differentials in child mortality or incidence of diarrhoeal episodes While Cleland (1990) combined the international evidence between diarrhoean episodes and maternal education The author believed that education maybe play an important role in determining health knowledge, which leads to a more innovative attitude for women who can have more opportunities in order to have some experience of school When comparing Bolivia, Egypt and Kenya, Stewart and Sommerfelt (1991) covered from 25 Demographic and Health Surveys They showed out that the woman’s own educational level can effect on prenatal care and mother’s education in urban was more powerful than in rural in Bolivia and Egypt while Kenya has weakly significant in this relationship after controlling urban-rural residence, a possessions index, father’s education, age, births, mother’s education, family-planning use In Kenya, at least, the urban-rural residence variable appeared to have strong significant Malnutrition of children under five is also the key issue in Vietnam, as many low-income countries (WHO, 2007) UNICEF reported that 50 percent of Vietnamese children under were stunted (abnormally low height for age) in 1993 In 2005, this figure has been improved with 25 percent of children (UNICEF, 2006) because of economic growth and sustained investment in primary healthcare Haughton et al (1997) also showed large differences across regions and ethnic groups in malnutrition of children in Vietnam That means the greater levels of malnutrition is concentrated on families in the northern regions, rural households and ethnic families more than the rest National institute of nutrition and UNICEF (2011) mentioned that stunting of children under was about 29.3 percent and the average rate reduced at 1.3 percent points per year in years from 1995 to 2010 It is reported that around 60% of all under dead who suffer neonatal mortality; a third of children under are affected by stunting malnutrition, anaemia Moreover, the rate of overweight children is increasing year by year; and children older than year old often die because of drowning and traffic accidents There are still many problems regarding children health in Vietnam remain to be settled due to the limited quality of healthcare services in mountainous areas; 10 reliability of data is high All of the coefficients of the regression are significant at 0.001 - The first hypothesis is rejected, because P-values of upper secondary and teriarty are 0.000 (< 0.01) and the coefficient of the dummy variables are positive and statistically significant Thus, mother’s education has a positive impact on children health - The second hypothesis is rejected because P-values of second, middle, fourth and richest are 0.000 (< 0.01) That means that richer family can care their children better than the poorer - The third hypothesis is rejected because P-value of use safe water is 0.001 (< 0.01) That means that child health is better when their parents care more about domestic water supplies - The fourth hypothesis is not rejected because P-value of use flushing toilet (0.395) is greater than the alpha level of 0.01 which indicates that it is not statistically significant Thus, child health is not better when their parents care more about flushing toilet in their house 42 CHAPTER 5: CONCLUSION This chapter will summarize the main findings of the study from the empirical results It also present the limitations as well as suggests the directions for future research 5.1 Conclusion remarks The purpose of this study is to examine the association of education of mother and other factors on child health based on datasets of MICS (2011) of UNICEF These databases are taken from the Vietnam Multiple Indicator Cluster Survey (MICS) by the General Statistics Office of Vietnam, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) Because data of MICS4 in Vietnam is collected by the 30 fieldwork teams traveling nation-wide to complete in a timely and professional manner, the reliability of data is high This good data helps to provide the best result after running the regression, especially in this study However, there have four surveys which is difficult to collect enough data for this research and more data for other variables Thus, this leads to some limitation in the research By applying OLS, the study showed evidences that the positive impact of mother’s education, environment, wealth index quintiles on child health at significant level is at 1% From the result, level of mother’s education and wealth index quintiles appear to have strong positive effects on HAZ z-score This result agreed with other empirical research in literature review In detail, when the β of mothers whom study in upper secondary is lower than in tertiarty The impact of household whom are richest that also are highest, and these β are reduced from the variable fourth to the variable second However, it still has some especially situations when child malnutrition has been happening in households which have more educated mother, or perhaps in rich families 43 This conclusion is based on a positive coefficient of the mother’s education and child health This study finds that the mother’s education is an important factor of the health of children in Vietnam even after controlling for these variables: use safe water and the wealth index quintiles The new finding of this study is that flushing toilet does not have effect on child health in Vietnam This finding can lead to a new research to find out answers to a question why these kinds of flushing toilet does not have effect on child health, maybe because the efforts of Vietnamese government achieve results after many years to provide information and help aids for poor people in all provinces to build the standard toilet These efforts lead to provide a better environment as well as a better health for population 5.2 Limitations and future research of the study This study has several limitations which may provide more ideas to analyze more for future research Firstly, this study didn’t have data of the number of siblings in MICS4 to analyze the effect of this variable on HAZ z-score Because this research needs information of own birth children of each mother HAZ may be considered to be determined by the number of siblings Families have more children which lead them to be more difficult to take care each child This variable which can has significant impact on children health because the size of families are smaller, parents can have more time as well as earnings to raise up their children as a result Secondly, further studies should consider more variables such as whether father’s schooling affect children health in Vietnam It is believed the role of father is very important in Asian countries, this factor should be consider ed to have the relationship with child health Father in Asia can have opportunities to study higher in their life However, they don’t have time to take care their children and even their wife They may use most of them time to work and go out for their 44 works Therefore, the responsibility of mothers is always related to their house and children However, this result can use to compare with the results of other studies in other countries in the same regions or perhaps in over the world Thirdly, one factor can be consider that is mother’s health knowledge It can be believed that mother’s education is too general and as a result, their health knowledge are not the same level What will happen when mother health knowledge can lead to the difference result with the above regression result of this research Fourthly, the difference between adopted children and own birth children or even the difference between boys and girls can provide useful studies in Vietnam Their results may be provided useful evidence for policy makers in order to issue policies However, this kind of data is difficult to collect In conclusion, these limitations of data can be improve with more surveys This study is expected that it can contribute useful information for policy makers and may be in an early stage of future research 45 REFERENCES Becker, G., & Lewis, G (1973) ON the interaction between the quantity and quality of children Journal of Political Economy 81(2), S279-288 Behrman, J & Deolalikar, A (1988) Health and 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Health through safe drinking water and basic sanitation Retrieved from World Health Organization: http://www.who.int/water_sanitation_health/mdg1/en/ Wolfe, Barbara, & Behrman, J (1987) Women's schooling and children's health: Are the effects robust with adult sibling control for the women's childhood background? Journal of Health Economics 6, 239-254 Willis J Robert (1973) A New Approach to the Economic Theory of Fertility Behavior Journal of Political Economy 81(2), S14-S64 Y.Chen, & Li, H (2009) Mother's education and child health: Is there a nurturing effect? Journal of health economics 49 APPENDIX There are length/height-for age tables of boy and girl, according to (Z Scores, n.d.) Following the agreed global standards, it is formed as the following categories: -1 < HAZ < Normal -2 < HAZ < -1 Marginally stunted -3 < HAZ < -2 Moderately stunted HAZ < -3 Severely Stunted 50 (Source: WHO) 51 (Source: WHO) 52 (Source: WHO) 53 (Source: WHO) 54 (Source: WHO) 55 (Source: WHO) 56 ... evidence from the regression results on the findings of the association mother’s education and children health Chapter 5: Conclusion This chapter will summarize the main findings of the study from the. .. education of parents is considered: mother’s education or father’s education? The next question is that the association of father’s education or perhaps mother’s education and child health Whether... as health habits; thus, mothers are given chances in order to improve the nutrition of their children However, the results of the relationship of mother’s educ ation and child health were not the