Effect of Schooling on Anemia and Nutritional Status Among Women: A Natural Experiment in Ethiopia

Abstract

AbstractThis study estimates the effect of length of schooling on anemia and nutritional status and evaluates the cost-effectiveness of primary schooling as an anemia intervention for women of childbearing age in Ethiopia. In 1994–1995, Ethiopia abolished primary school tuition fees and embarked on a large-scale educational investment program, which increased primary school enrollment and retention. An instrumented regression-discontinuity design was used to examine the effect on anemia risk and body mass index (BMI) of an increase in length of schooling resulting from the reforms, as a natural experiment. Anemia and BMI biomarkers and demographic data for 13,984 women were obtained from the 2011 and 2016 Ethiopia Demographic and Health Surveys, with the 2019 Mini Demographic and Health Survey used for robustness checks. Results indicate that each additional year of schooling reduced anemia risk by 3 percentage points (9.2%–11.2% reduction) and increased BMI (weight (kg)/height (m)2) by 0.26–0.42. Primary education was cost-effective—based on World Health Organization cost-effectiveness thresholds—as an anemia intervention, with a cost per anemia case averted of US$1,654. The findings suggest that investment in education reduces anemia risk later in life.