Current Issue

The socio-contextual characteristics of parents are known to have a wide range of influences not only on biological indicators such as height and weight of children, but also on the possibility of their child’s acquired disease, future educational attainment and income (Marmot, 2007). Through this intergenerational transfer mechanism, social inequality also tends to be passed on from parent to child (Marmot, 2015). However, it is not yet known whether health inequality has a long-term impact over generations. It has been reported that certain socio-economic characteristics of parents, such as their education level (Calhoun et al., 2014; Ueda, Kondo, Takada, & Hashimoto, 2014), poverty (Galarce, Minsky, & Viswanath, 2011), and age (Danis, Georgakopoulou, Stavrou, Laggas, & Panagiotopoulos, 2010) may be associated with their child’s health status. However, more studies are needed to determine which mechanisms affect parental characteristics and children’s health. In addition, little is known about how the social characteristics of the father and mother contribute to determining their children’s health when genetic and predisposition factors are held constant.

One hypothesis it that inequality in maternal use of health care services regarding their children is related to individual economic, educational, and empowerment status (3Es) (Ahmed, Creanga, Gillespie, & Tsui, 2010). These 3Es are indispensable for realizing the MDGs (Millennium Development Goals), because undesirable social environments can weaken the effects of public health interventions and consolidate inequality (Gillespie, Ahmed, Tsui, & Radloff, 2007). In developing countries, a diverse set of delays (e.g., obtaining medical services, arriving at medical institutions, and providing medical services) can adversely affect child’ health (Thaddeus & Maine, 1994). Delays related to health and medical care directly contribute to maternal and child mortality, which is related to the level of 3Es.

The other hypothesis is that maternal capacity affects children’s health through health communication (Jung, Lin, & Viswanath, 2013; Jung, Lin, & Viswanath, 2015). Because mothers are often more involved in raising the children compared to fathers, if mothers have strong ability to control themselves, the result may be a positive impact on their children’s health. In other words, even if parents in different households have similar socio-economic statuses, if certain maternal capacities, such as empowerment, self-efficacy, and health literacy, are high, the health of the children in such households is more likely to be protected from health risk factors (Prata, Tavrow, & Upadhyay, 2017). Conversely, if these maternal capacities are low, the children may be exposed to the health risks caused by their parent’s poor socioeconomic status.

Maternal capacity, consisting of the aspects of self-efficacy, empowerment, and e-health literacy, may be a potential maternal predictor that had a significant effect on the general health of children (Kotch, 2012). In particular, empowerment of women is a process of providing power to woman to become free from control by others, that is, to assume the power to control their own lives and determine their own conditions (Ehrhardt, Sawires, McGovern, Peacock, & Weston, 2009). Women’s empowerment may also be understood as a process of providing equal rights, opportunities, responsibilities and power positions to women so that they can play a role in society on par with men (Allendorf, 2007). However, although maternal empowerment and proper health communication are important predictors in studies of population-based health promotion, these factors have not been fully identified in many countries and cultures (Kusuma, Kumari, Pandav, & Gupta, 2010; Thorpe, VanderEnde, Peters, Bardin, & Yount, 2016). In particular, there is a lack of research in the East Asian region, where patriarchal and Confucian characteristics remain. This study explores the effects of maternal empowerment and health communication behaviors on children’s health status in Korea, China and Japan.

It has been reported that maternal empowerment has a positive impact on children’s health in national-level data in developing countries (Abuya, Onsomu, Kimani, & Moore, 2011; Vikram, Vanneman, & Desai, 2012; Mahapatro, 2012). Nevertheless, there is still little research on what maternal empowerment is specifically and how it can help with health problems. In addition, there is a lack of understanding of the social context of mothers in various countries and cultures. Therefore, this study explored the effects of maternal empowerment and health communication behavior on the health status of underage children in their 20s through their 40s living in East Asia. The three main findings of this study are given below.

First, maternal capacity, consisting of the aspects of self-efficacy, empowerment, and e-health literacy, was an important maternal predictor that had a significant effect on the general health status of children. With proper control of potential confounders, the higher these three factors are, the lower the likelihood becomes that the child’s health status will be poor. Maternal empowerment has been shown to be a preventive factor to reduce the health inequality effect on children when controlling for the socio-economic status of the parents.

Second, factors constituting maternity empowerment differentially influenced children’s health status according to the social context of East Asian countries. In Korea, self-efficacy was important, while in Japan, empowerment was an important predictor. However, in China, maternal health behaviors such as smoking and drinking alcohol were much more important. These results may stem from the problem of sample size. However, the differences seen in these countries with similar patriarchal cultures provide us with the lessons needed to promote maternity empowerment for each country.

Third, although the impact of maternal health communication as measured by HISB was significantly related to the child’s health status, it is difficult to conclude a causal relationship. In other words, the result appeared to be an instance of reverse causality. It is difficult to assume that the more mothers find health information, the sicker their children will become. On the other hand, maternal HISBs are more likely to be active when children are often sick or have congenital diseases. In particular, when analyzed by country, this tendency found only in Japanese women shows that this result can be contingent. This is also supported by the fact that all other variables in Model 4, shown in Table 3, were consistent with the hypothesis here or with the findings of previous studies (Ahmed et al., 2010; Jung et al., 2015; Sohn & Jung, 2020). Therefore, we need to think about how to prevent reverse causality when using health communication variables such as HISB. In addition, differences between countries need to be clarified through follow-up studies.

This study has several limitations. First, it is difficult to determine the causal direction due to the use of cross-section data. Second, for comparison with DHS data, the questionnaire was composed of questions based on DHS, and information on children was limited. Third, qualitative heterogeneity exists in each country, which may lead to bias when estimating the regression coefficient of the statistical model. Nevertheless, the findings here can help to derive local intervention strategies ultimately to improving maternal empowerment in East Asia.

In terms of maternal and child health, the health status of children is an important research concern. This study surveyed married women from three countries in East Asia to determine how maternal predictors affect their children’s subjective health status. The results of the study show that maternal capacity, consisting of self-efficacy, empowerment, and e-health literacy, is a significant protective factor with regard to children’s health status. However, the meaning can vary depending on the social context of the East Asian country in question. Compared to the risk factors affecting children’s health status, there have been few studies on preventive factors, so we need to develop a multidimensional measures related to women’s capacity according to social context. In addition, the health communication behavior of seeking health information can be confirmed only by associations, and uncertainty exists with regard to causality. Also, referring to the findings of this study when establishing intervention strategies for maternal and child health by country can be very beneficial. In particular, it is time to consider a strategy based on human capital to increase maternal capacity from the existing media campaign strategy.