The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment

Abstract

This paper explores the causal relationship between primary schooling and adult HIV status in Malawi and Uganda, two East African countries with some of the highest HIV infection rates in the world. Using data from the 2010 Malawi Demographic Health Survey and the 2011 Uganda AIDS Indicator Survey, the paper takes advantage of a natural experiment, the implementation of Universal Primary Education policies in the mid 1990s. An instrumented regression discontinuity approach is used to model the relationship between increased primary schooling and adult women's HIV status. Results indicate that a one-year increase in schooling decreases the probability of an adult woman testing positive for HIV by 0.06 (p < 0.01) in Malawi and by 0.03 (p < 0.05) in Uganda. These results are robust to a variety of model specifications. In a series of supplementary analyses a number of potential pathways through which such effects may occur are explored. Findings indicate increased primary schooling positively affects women's literacy and spousal schooling attainment in Malawi and age of marriage and current household wealth in Uganda. However primary schooling has no effect on recent (adult) sexual behavior.

Educational attainment and adult health: Under what conditions is the association causal?

“…Results for other health outcomes were not as strong, which the author suggests may require even larger sample sizes. Behrman (2015) examines the effects of increases in primary schooling on women's HIV status in Malawi and Uganda. This interesting study takes advantage of the implementation of Universal Primary Education Policies aimed at increasing primary school enrollment.…”

Education Policy and Under-Five Survival in Uganda: Evidence from the Demographic and Health Surveys

“…Following van der Klaauw [53]; Hahn et al [54]; Grépin and Bharadwaj [14]; Tsai and Venkataramani [52] and Behrman [55], the dummy variable for susceptibility to the 1997 UPE policy (i.e., age 13 years or under in 1997) is used as the instrumental variable in the IV model [53,54]. Though other non-tuition fees might have played a role in influencing whether the woman enrolled into primary school or not, the age of the woman at UPE implementation had the biggest influence on enrollment.…”

Cross-sectional schooling-health associations misrepresented causal schooling effects on adult health and health-related behaviors: Evidence from the Chinese Adults Twins Survey

“…Alsan and Cutler (2013), using distance from school as an IV, find that more secondary schooling for adolescent Ugandan girls increases sexual abstinence and therefore reduces exposure to sexually transmitted diseases. Behrman (2014) finds that abolishing school fees in the mid-1990s increases schooling for girls in Malawi and Uganda; she then uses an RDD to estimate that a one-grade increase in the schooling of girls leads to a reduction of six percentage points in the probability of testing positive for HIV as an adult in Malawi and a three percentage point reduction in Uganda.…”