Elementary education and its impact on healthBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7177.141 (Published 16 January 1999) Cite this as: BMJ 1999;318:141
Empowers women and improves the health of them and their children
Fifty years after independence India is about to enact the provision for compulsory primary education enshrined in its constitution. When it does it will not only be a step forward in human rights in India; it should have a large impact on health as well.
Article 45of India's constitution requires the state to provide free compulsory education for children up to the age of 14 years within 10years of the start of our constitution.1 The national policy on education has similar sentiments. However, even after 50years of independence, compulsory elementary education eludes us. Recently the supreme court upheld the fundamental right to compulsory elementary education,2 and the government has therefore drawn up a bill to implement this right.
According to the World Development Report for 1993adult literacy stood at 52% in India; 24million children are estimated to be outside the primary school system. Furthermore, girls and women lag behind boys and men: 73% of rural women of childbearing age are illiterate.3 When India became independent government spending on education was 1.2% of gross national product, and this has recently increased to 3.7%. This spending is, however, distorted in favour of higher education. The central government spends barely 20% of it on primary and secondary education.
Yet basic education affects the health status of a population. The world map of illiteracy coincides with maps of poverty, malnutrition, ill health, and high infant and child mortality. To some extent education compensates for the effects of poverty on health, irrespective of the availability of health facilities.
The impact of education is even greater in the case of women. The National Family Health Survey in India has shown that the education of women can play a major role in shaping their attitudes and behaviour. Educational attainments showed a strong associations with every important variable considered, including age at marriage, fertility behaviour, the use of and demand for family planning, number of children desired, use of antenatal care, delivery in a health facility, vaccination and nutritional status of children, use of oral rehydration solution, and infant and child mortality. Furthermore, the more years spent in schooling the better the outcome on these variables.3
Education is a prerequisite for empowering women. There is a robust link between the economic status of women, the degree to which they are literate, in good health, and in jobs which pay a living wage, and the fertility rate—as the examples of Kerala, Goa, and Tamil Nadu have shown. The “Kerala model” has become a cliche in development jargon. With the adoption of a reproductive health approach in India's family planning programme, literacy assumes even greater importance.
Quite clearly our national leaders, even those of the stature of Jawaharlal Nehru, have not fully comprehended the importance of social development. Even after 50years of independence, eight planning commissions, and tens of millions of rupees of expenditure, our nation is still unclear about how best to give priority to elementary teaching. Several programmes, from “operation blackboard” to midday meals, have been initiated in vain to woo and retain children in the education system. To succeed education needs to be an attractive and joyful experience, relevant to daily life, and we need to introduce incentives for children and their parents that will create a norm of schooling. Budgetary allocations should favour elementary education.
The government's current proposal to make primary education a fundamental right will no doubt be hailed as a necessary basis for emancipation, empowerment, and success. Total literacy is apparently to be achieved as part of the “second liberation struggle” initiated in the 50th year of India's independence. It is essential, however, that the proposed constitutional bill should be passed by the Rajya Sabha (India's lower chamber of parliament) and not be overshadowed by political chimera such as nuclear empowerment.