"Green famine" : mothers' education and children's nutritional outcomes in the Democratic Republic of the Congo
Undernourishment is considered the underlying cause for more than one-half of all child deaths in Sub-Saharan Africa. Undernourishment not only increases children’s risk of mortality, but also has negative long lasting health effects including developmental deficits, increased levels of hunger-related and chronic illnesses in adulthood, and adverse pregnancy outcomes for women. Studies analyzing determinants of child undernourishment have shown women’s individual-level educational attainment to be a key predictor of children’s nutritional outcomes, but have fallen short of fully considering community-level socioeconomic characteristics as determinants. Accounting for community-level characteristics points to the role that children’s external household factors and surroundings play in shaping their early-life health and nutrition outcomes. Additionally, substantial health and nutrition variation across urban and rural areas in Sub-Saharan Africa raises the need for researchers to not only study how the combination of individual-level and community-level factors affect children’s nutritional outcomes, but also how this relationship differs by urban-rural residential location. Therefore, this dissertation examines the relationship between individual-level and community-levels of women’s educational attainment and urban and rural children’s nutritional outcomes in the Democratic Republic of the Congo using a nationally-representative dataset: the 2007 Democratic Republic of the Congo Demographic and Health Survey. In sum, the findings reveal that: (a) rural Congolese children are more likely to be nutritionally deficient compared to urban Congolese children, yet the highest percentage of nutritionally deficient Congolese children reside in low educated urban communities; (b) whereas urban Congolese communities exhibit substantial variation in child nutritional outcomes by maternal education, rural Congolese communities show little variation in children’s nutritional status; (c) individual-level and community-level women’s education are associated with urban children’s nutritional outcomes, though this association narrows after taking into account women’s socioeconomic status; and (d) individual-level and community-level education are not associated with rural Congolese children’s nutritional outcomes. Overall, the results underscore the importance of a community-context perspective in understanding educational and urban-rural disparities in children’s nutritional outcomes.