A very important social determinant of health in the world is education. Through education, people are able to improve their socio-economic status, employment opportunities, health, and overall well being. One of the major problems in Chadian society is a lack of overall education. According to the UNICEF statistics, the overall adult literacy rate (percentage of the population, 15 years and older, who can read and write) in the country was 35.4% from 2008-2012. A lack of proper education is an even larger problem for the women of Chad. In 2012, the net attendance ratio for secondary school participation for males was 22%, while the net attendance ratio for females was only slightly over half that of the males at 11.6%. Not only does receiving a proper education benefit women by providing more opportunities for them, but staying in school also reduces their chances of having children at a very young age.
One of the biggest health problems in the country of Chad is their extremely high Maternal Mortality Rate. One in fifteen Chadian women will die due to a complication with pregnancy or child birth. (UNICEF) It is common for women in Chad to be married very young, and in turn, start having children at a very young age. Because their bodies are not fully developed and ready to carry and deliver children so young, pregnancy is one of the leading causes of death in the world for girls ages 15-19. If young girls were able to stay in primary school and continue on to receive their full secondary school education before they married and began having children, then their bodies would have the time they need to mature and develop in order to effectively carry and deliver children. They also would be able to develop and mature emotionally in order to ready themselves to become wives and mothers. Many child brides feel very isolated and excluded when they are taken away from their family and school friends to be married, often times, to an older man with whom they do not have much in common. Social exclusion is another important social determinant of health, and could influence women’s health in general as well as the way they handle their pregnancy, childbirth, and motherhood. If given the time to mature emotionally, they may find it easier to adjust to being a wife, partner, and mother. Also, allowing women to stay in school longer before getting married may also give them the time to receive education about their bodies, pregnancy, childbirth, and contraception. Because sex is a taboo topic in Chadian society, there is almost no information given to young girls about these “forbidden” topics. Premarital sex/pregnancy bring much shame upon a girl’s family, so there is little discussion of the options they have available to them. Girls are married off at a young age to prevent them from shaming their families through premarital sexual activity; most consider it unnecessary to give them information about safe sex. This lack of sex education is evidenced by the very high fertility rate and low prevalence of contraceptives used in the country. In Chad the fertility rate in 2012 was 6.4 and the contraceptive prevalence was only 4.8%. It is no wonder that girls begin having children as soon as they are married with a contraceptive rate that low. If women, as well as the entire community, were educated on the different contraceptive methods available, and the dangers of bearing children at such young ages, they may begin to change their culture and practice safe sex or strive to remain unwed or abstinent longer. Another benefit of women staying in school to receive further education would be the opportunity for some of them to be trained to become midwives or obstetricians. The prevalence of trained medical professionals in Chad is very low, and contributes to the extremely low percentage of women who receive antenatal care and deliver in the presence of a trained professional, both of which would help combat the high Maternal Mortality. “The availability of skilled delivery personnel, life expectancy, national economic wealth, and health expenditure per capita predict the maternal mortality rate of a country.” (Buor et. al, 2004) According to UNICEF statistics, only 53.2% of women in Chad received at least one antenatal care visit and only 23.1% received at least four visits. Sadly, only 22.7% of women had a skilled attendant present at the time of birth, and only 15.8% of births occurred in an institutional setting. If more women were trained to assist with births, the process would become safer for many. Further education for both men and women in the country of Chad may help to change ideas on female genital mutilation/cutting, which is still a fairly common practice in the country. Support for FGM/C was at 37.7% in 2012. Because FGM/C is a cultural norm, both men and women fail to see any problem with continuing the practice. If, through education, they could see that FGM/C may have adverse effects on women’s ability to carry and deliver children, the prevalence of this cultural practice may decline, as long as the cultural ideology is targeted in the right way.
Daniel Buor and Kent Bream. Journal of Women’s Health. October 2004, 13(8): 926-938. doi:10.1089/jwh.2004.13.926
Marmot, M., & Allen, J. J. (2014). Social Determinants of Health Equity. Am J Public Health American Journal of Public Health, 104(S4). doi:10.2105/ajph.2014.302200
Statistics. (n.d.). Retrieved August 10, 2016, from http://www.unicef.org/infobycountry/chad_statistics.html
Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. doi:10.1016/s0140-6736(05)74234-3
Mackenbach, J. P. (2014). Political determinants of health. The European Journal of Public Health, 24(1), 2-2. doi:10.1093/eurpub/ckt183
Wilkinson, R., & Marmot, M. (2003). Social Determinants of Health: The Solid Facts. WHO: Social Determinants of Health.