Can sending girls to school help reduce maternal mortality?

Highlights of Bixby Center research in Zaria, Northern Nigeria

In the Northern Nigerian communities where the Bixby Center conducts research, maternal mortality is extremely high and morbidity from childbearing is a too common occurrence.   Women in these communities marry and become mothers at a young age.  Married adolescents are a particularly vulnerable population due to large age gaps between spouses, little to no educational attainment, social separation, restricted movement outside of the home, little knowledge of reproductive health, and extreme social pressure to become pregnant. These social norms, combined with poor nutritional status, lack of physical maturity of girls at first pregnancy, and poor access to family planning and emergency obstetric care, greatly increase the risks to young women in the region.

Since 2006 the Bixby Center has been working with Ahmadu Bello University (ABU), the premier university in northern Nigeria, to conduct community-based research leading to innovative approaches to the prevention of maternal mortality and morbidity.  The baseline ethnographic field work and surveys carried out by Bixby’s Nigerian postdoctoral fellows found that while most fathers and mothers in the collaborating villages plan to have their daughters marry at the age of 14 or 15, school attendance is seen by many in these communities as an acceptable reason to delay marriage.  Many parents are open to the possibility of leaving their daughters in school and delaying their marriages if offered help with school fees, books, and related expenses. These findings offered the Bixby Center an opportunity for intervention.

Could keeping girls in school help reduce maternal mortality?
Girls’ education has other important benefits for women, health and communities; education can increase women’s livelihoods and can improve health.  With these goals in mind the Bixby Center, with funding from the Packard Foundation, is working to keep girls in school.

Building Community Consensus to Keep Girls in School:
The Bixby Center and its partners at ABU conducted a lengthy community consultation process to deepen their understanding of the barriers to school attendance. Both men and women cited the lack of household funds for school fees, the poorly functioning educational system, and the need for girls to work with their mothers as major impediments to girls’ education. The community also pointed out that it is difficult for those parents who have not had the opportunity to go to school to understand the value of education.

After inquiring about barriers to girl child education, the postdoctoral fellows and staff asked what the communities and our program can do together to overcome these obstacles. “We knew educating girls can change the course of their lives for the better and reduce their risk of maternal mortality, but we didn’t know the most effective way of promoting girls education in this context.  We needed these community dialogues to come-up with the best approach,” explains Daniel Perlman, Ph.D., the co-director of the Bixby-ABU research center in Zaria, Nigeria.

A consensus developed that the girl-child education program should provide school fees and books for the girls entering junior secondary school from nine communities. In turn, the parents agreed to provide daily lunch money, and the mothers consented to accept the opportunity costs of not having their daughters market goods for them during school hours.  The teachers are monitoring attendance and the community PTAs are meeting with parents whose daughters start missing classes. According to Dr. Perlman, “We originally intended to provide greater incentives for school attendance.  However, the strength of the community response has shown that we can provide less costly incentives and rely on the PTAs and community leaders to encourage regular school attendance.”  This reduced expenditure will make the program far easier to scale-up in the future.

A basic premise of the Bixby  program is that the healthy development of each individual girl is promoted by the social support generated in girls’ clubs and reinforced by the collective engagement of the community as a whole.  The program has organized fifteen active “Safe Space Girls Clubs” and is in the process of opening eight more. The clubs—which meet in rooms provided by trusted religious and community leaders—provide an opportunity for girls to acquire valuable life skills, improve their reading and writing, openly discuss their reproductive health questions and concerns, and become familiar with services offered at nearby health centers and hospitals. Importantly, few of the girls in the girls clubs have been withdrawn from school this year for marriage. Girls participating in the girls’ education program have also had tremendous increases in academic achievement.  In the first year there was a 400 percent increase in girls’ functional literacy and 120 percent increase in girls’ functional numeracy.

Along with success came resistance.  “One father told our community coordinator that if his daughters brought home books and uniforms he would beat them and destroys the materials” explains Dr. Perlman.  In another case one little girl waited for an hour outside the registration room.  She asked the program staff repeatedly for her books and uniform but refused to come into the room to be registered because her father didn’t want her to enroll.  Such cases of resistance are disheartening, but rare.  Most parents are excited to have this support and to give their daughters this opportunity.  During the first year of the program, one participating community saw a 48% increase in girls enrollment. Another saw at least a 38% increase in girls registration..

The Challenge of Junior Secondary School
There is a large drop in girls’ enrollment in 5^th and 6^th grade, as visible signs of puberty coincides with the age parents perceive to be appropriate for marriage. Currently the program is creating a bridge between primary and junior secondary school by providing 240 scholarships that will cover school fees and books for each of the girls until she graduates from senior secondary school. A new cohort of 200 girls will receive the scholarships and join groups in October 2010.

It will be many years before the Bixby Center will have the data necessary to determine if staying in school does reduce maternal mortality, but in the short term the girls in the participating communities are gaining valuable life and academic skills that will serve them well throughout their lives.