The impact of education and globalization on sexual and reproductive health: Retrospective evidence from eastern and southern Africa

Abstract

The objective of this study is to qualify the relationship between sexual and reproductive health (SRH) and educational attainment in eastern and southern Africa (ESA). We hypothesize that the regional level of globalization is a moderating factor in the relationship between SRH and educational attainment. Using retrospective data from Kenya, Malawi, Tanzania, and Zambia, the associations between SRH (eight indicators), educational attainment, and globalization were examined using multilevel logistic regression analysis. It was found that the model fit for every SRH outcome indicator increased significantly after including the interaction between globalization and educational attainment, supporting the hypothesis. Depending on the level of globalization, three types of relationships between education and SRH were found: (1) for the indicators “more than four children,” “intercourse before 17 years,” “first child before 20 years,” and “one or more child died” education is risk-decreasing, and the reduction is stronger in more globalized regions; (2) for the indicators “condom use at last intercourse” and “current contraceptive use” education is risk-decreasing, and the reduction is stronger in less globalized regions; (3) for the indicators “HIV positive” and “more than four lifetime sexual partners” education is risk increasing, but only in less globalized regions. In conclusion, these effects are related to three types of access: (1) access to services, (2) access to information, and (3) access to sexual networks. The findings highlight the relevance of globalization when analyzing the association between SRH and education, and the importance of structural factors in the development of effective SRH promotion interventions.

Keywords:

• sexual and reproductive health
• HIV
• educational attainment
• globalization
• eastern and southern Africa

Acknowledgments

We gratefully acknowledge MEASURE DHS (ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA) for granting access to the original data-sets of their country databases. The corresponding author should list the principal contributions made by each of the authors to the article. M.V.S. wrote the framework of the paper and conducted statistical analysis supported by supervisors. K.M. supervised and assisted in data management and analysis and contributed to writing the paper. K.S. developed the research question, supervised data management and analysis, and contributed to writing the paper. B.Z. supervised and assisted in data analysis and report of the method and result section in the paper.