Literacy and Childbearing Across Organisation for Economic Co-operation and Development and Partner Nations

• In Event: Moscone Center North Roundtable Session 11
  In Roundtable Session: Impact of Family Literacy and Parental Characteristics on Adult Outcomes Using Program for the International Assessment of Adult Competencies Data

Abstract

Objectives and Theoretical Framework
Literacy is associated with a range of health behaviors and outcomes, however, the relationship between literacy and reproductive health remains understudied. Literacy level is related to but distinct from educational attainment, a social determinant of health, which is strongly associated with health inequities. Given policy makers’ interest in factors that influence childbearing and interventions that would impact them, further investigation of literacy skills and their relationship with reproduction and associated variables is warranted. Social determinants of population health such as literacy are a lens through which to view the health of communities and nations (Kindig & Stoddard, 2003; Norman, Kennedy & Kawachi, 1999). Social determinants provide an opportunity to understand disparities or inequities in health across communities and to identify interventions to reduce such disparities (Marmot, 2007). Health inequities are often most stark between low- and high-income regions and nations, however a health inequality lens is also relevant when examining disparities in health outcomes across high income nations (Braveman, 2006; Healthy People, n.d.; Solar & Irwin, 2007).

Methods
The Program for the International Assessment of Adult Competencies (PIAAC) uses a robust and valid measure of literacy skill, and such offers an opportunity to deepen understandings of the relationship between literacy and health outcomes across a range of nations. PIAAC’s measure of literacy is far superior to those used in most investigations of literacy and health (Berkman et al., 2011; Dewalt et al., 2004).

We sought to address the following questions: 1) Are self-reported health and literacy related to childbearing in OECD and partner nations, and 2) If so, is there evidence that literacy acts as a mediator, moderator, or both in the relationship between self-reported health and childbearing across these developed countries?

Data Sources
Data from the PIAAC Round 1 were used. We included all women without missing data on PIAAC literacy score, childbearing, and other covariates from 18 OECD and two partner countries. The final study population included 52,300 women.

Results
Consistent with previous work, higher literacy skill was associated with lower childbearing and better self-reported health was associated with higher childbearing in all OECD countries, however these associations were not observed among partner countries. After controlling for education and age, we found evidence of moderation between self-reported health and childbearing in the excellent/very good and good self-reported health groups or in the fair/poor and good self-reported health groups in three countries; however, the magnitude of these moderating effects were small and may not be meaningful. Controlling for education and age, we found some evidence that literacy operated as a mediator of the relationship between self-reported health and childbearing in nine countries, including the United States.
Significance
These results extend our understanding of the role of literacy skills as a social determinant of health for a key reproductive health outcome, childbearing. The independence of literacy from the educational attainment is a basis for supporting the health benefits of interventions targeting literacy development in primary and adult education in high income nations.

Author

• Ian Bennett, University of Washington