The long‐term impact of education on dietary diversity among women in Zimbabwe

• Published date: 01 May 2023
• Author: Marshall Makate,Chamunorwa Nyamuranga
• Date: 01 May 2023
• DOI: http://doi.org/10.1111/rode.12980

REGULAR ARTICLE

The long-term impact of education on dietary

diversity among women in Zimbabwe

Marshall Makate

1

| Chamunorwa Nyamuranga

2

1

Health Economics and Data Analytics,

School of Population Health, Curtin

University, Perth, Australia

2

KDI School of Public Policy and

Management, KDI School, Sejong,

Republic of Korea

Correspondence

Marshall Makate, Health Economics and

Data Analytics, School of Population

Health, Curtin University, GPO Box

U1987, Perth, WA 6845, Australia.

Email: marshall.makate@curtin.edu.au

Abstract

Education is perceived to have a positive impact on a

variety of health outcomes. However, it is unclear how

causal this association is or what could account for the

observed relationship, especially in low-income countries.

This study examined the educational gradient in dietary

diversity among young women using individual-level sur-

vey data from Zimbabwe. A parametric fuzzy regression

discontinuity design was used in the empirical analysis,

with school reform exposure serving as an instrumental

variable for educational attainment. The results show that

increased schooling improves dietary diversity among

women and that this effect is large and statistically signifi-

cant. An examination of the potential mechanisms by

which education improves dietary diversity revealed that

womenwithmoreeducationaremorelikelytoengage

with print media by reading newspapers or magazines, to

be literate, to access prenatal care when pregnant, to be

wealthier, to have fewer children, and to live in metropol-

itan areas. These findings suggest that expanding educa-

tional opportunities, particularly for young girls in

developing countries like Zimbabwe, could be a useful

policystrategytopromotehealthyeatingamongyoung

women and, as a result, could enhance population health

and nutrition outcomes.

Received: 31 August 2020 Revised: 26 January 2023 Accepted: 3 February 2023

DOI: 10.1111/rode.12980

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distrib ution and

reproduction in any medium, provided the original work is properly cited.

© 2023 The Authors. Review of Development Economics published by John Wiley & Sons Ltd.

Rev Dev Econ. 2023;27:897–923. wileyonlinelibrary.com/journal/rode 897

KEYWORDS

causal mediation analysis, dietary diversity, education, quasi-

experiment, regression discontinuity design, young women,

Zimbabwe

JEL CLASSIFICATION

C36, D13, I26

1|INTRODUCTION

The physiological requirements for pregnancy and breastfeeding expose women of reproductive

age to nutrition-related problems (Black et al., 2013). Pregnant or breastfeeding women have

more significant nutritional needs than other adults. Inadequate micronutrient intake before

and during pregnancy can negatively affect women and their infant's development, especially

during the critical first two years of life (Cusick & Georgieff, 2016). A diverse and high-quality

diet for the mother is strongly associated with improved health outcomes for her children,

including a lower risk of low birth weight, preterm delivery, and developmental delays in later

life (Huang et al., 2018; Madzorera et al., 2020; Rammohan, Goli, Singh, Ganguly, &

Singh, 2019; Zhao et al., 2021). However, in many low-income countries, like Zimbabwe,

women of reproductive age eat bland, starchy staple foods deficient in essential micronutrients

(Arimond et al., 2010; Martin-Prevel et al., 2017). Improving access to education, particularly

for girls, has been at the forefront of many governments’developmental agendas in low-income

countries due to its well-documented positive effects on several health outcomes

(Grossman, 2006). Given the disproportionate share of the burden of diet-related non-

communicable diseases in low-income countries (Global Nutrition Report, 2022), there is a

greater need to understand better what role education might play in improving nutrition-

related outcomes today.

While previous research has found strong, positive correlations between education and vari-

ous outcomes, evidence on the causal effects of education, including the mechanisms through

which it influences outcomes, is limited and primarily concentrated in developed countries.

Only a few studies have been conducted in low-income countries, particularly in sub-Saharan

Africa (SSA) (Mensch, Chuang, Melnikas, & Psaki, 2019). The evidence in SSA has been limited

partly due to data unavailability and the difficulty associated with establishing a causal interpre-

tation of schooling (Agüero & Bharadwaj, 2014; Makate & Makate, 2018a). Health outcomes in

the SSA region remain unsatisfactory, with several countries less likely to meet their Sustain-

able Development Goals (SDGs) obligations (Mejía-Guevara, Zuo, Bendavid, Li, &

Tuljapurkar, 2019). For instance, several countries in the continent continue to experience

higher levels of undernutrition among children under age 5, with others less likely to meet the

second goal of the SDG, which calls for a global end to hunger through improved food security

and better feeding practices (World Health Organisation, 2018). Expanding education opportu-

nities, especially for young girls in low-income countries, remains among several policy options

available to address salient health inequalities in the region.

This paper studies how education affects dietary diversity among women in Zimbabwe. To

do so, we exploit a powerful quasi-experiment that increased schooling opportunities for

Zimbabwean children following the country's independence from Britain in 1980. Compared to

898 MAKATE and NYAMURANGA