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Education, Health, and Gender Linkages to Improve Learning Outcomes for Women and Girls

by Anna Vanderkooy

Published: May 30, 2018

There is enormous potential for Canada to fund educational interventions and targets that are highly cost-effective and could have a considerable impact on women, girls, and developing country societies as a whole.

This article makes the case for building strategic linkages between health, education and gender interventions, as well as targeted improvements in the learning environment and pedagogical approaches.

Education, Health, and Gender

Education, health, and gender intersect in a variety of ways. Schools can be used as places where health and gender outcomes are strengthened; similarly, health and gender interventions can be used to narrow gender gaps by promoting positive educational outcomes specifically for girls.

According to the World Health Organization, 11% more girls attend school when sanitation is available. A pilot study in Ghana found that providing pads with puberty education/puberty education alone had significant positive effects on girls’ school attendance (for example, a 9% increase in attendance after 5 months of pads with education), while one in Kenya found that water treatment and hygiene promotion resulted in a 58% decrease in absenteeism among girls. Systematic reviews on menstrual hygiene management and providing separate toilets for girls at schools both conclude that, although current results are promising, there is insufficient evidence to establish a positive impact of interventions in these areas on education; further research is needed.

Education, health, and gender also intersect through nutrition. Reducing child malnutrition is estimated to have very high returns (approximately $45 for every $1 spent). School feeding programs have shown promise in terms of improving school attendance and learning outcomes in places where food insecurity is high and school participation is low. School feeding coupled with take-home rations also seems to have a greater impact on girls’ enrolment compared with that of boys. An evaluation of a school feeding program in Cambodia found school feeding to be a very cost-effective intervention, especially when combined with deworming medicines. However, the evaluation found that home rations for girls in grades 4-6 were less cost-effective than scholarships of $45 USD for girls, which increased enrolment and attendance of female recipients by about 30%.

Other interventions at the intersection of education, health, and gender that are highly cost-effective menu items include: eliminating violence against girls (estimated high returns); eliminating violence in child discipline (approximately $11 return for every $1 spent); and achieving universal access to sexual and reproductive health services and modern contraception (approximately $120 return for every $1 spent). For example, delaying child and adolescent marriage is almost always associated with girls staying in school for longer, as well as numerous health and gender benefits including improved economic opportunities for women and lower maternal mortality. Information regarding violence against girls and violence in child discipline, as well as regarding sexual and reproductive health, could be integrated into educational curricula at all levels of education, capitalizing on synergies between education, health, and gender to improve development outcomes.

Key Takeaway

Synergies between education, health, and gender could enable Canadian funding to have positive impacts on outcomes in all these areas. For example, school feeding programs in food insecure areas with low school attendance could help reduce child malnutrition, increase girls’ (and boys) enrolment, and improve educational outcomes.

Quality and Learning Outcomes

Donor countries tend to focus more on school enrolment and attainment than education quality, which is harder to measure yet of considerable importance. Research finds that more money invested in education does not necessarily lead to improved test scores; out of almost 400 education production functions, most report negative or insignificant effects of expenditure per student, teacher salaries, or class size on student achievement. Likewise, systematic reviews have found that health interventions (e.g., deworming) and cost-reducing interventions (e.g., fee reductions or grants) have little-to-no impact on improving students’ test scores (although they can increase school enrolment and attendance).

There are a number of interventions that do however appear to have positive impacts on student achievement. Structured pedagogy programs seek to address barriers to learning, generally using evidence-based curricula and instructional approaches along with lesson plans and training for teachers in delivering new content and material for students. A systematic review of primary education interventions found that structured pedagogy programs have the largest and most consistent positive effects on learning outcomes within interventions focusing on schools and teachers. Other reviews have also consistently found positive impacts for structured pedagogy programs/pedagogical interventions, as well as repeated teacher training and improved accountability through contracts or performance incentives. For example, assigning Kenyan students to classes on the basis of initial preparedness, so that teachers could instruct at students’ learning levels, was found to increase test scores for both low and high achieving students. A computer-assisted learning program in India which used math software so that children could learn at their own pace significantly increased math scores in a very cost-effective manner.

Pedagogical interventions are found to be of limited or no effectiveness when they fail to change children’s daily experiences at school (e.g., when computers substitute away from other useful school instruction or home study or when interventions are not linked to curriculum or classroom instruction).

Key Takeaway

Improvements in educational quality and learning outcomes seem to result not from increased spending but strategic interventions, such as structured pedagogy programs, repeated teacher training, and improved teacher/system accountability through contracts or performance incentives.


Interventions that target the learning environment, such as improved hygiene infrastructure and school feeding programs, have demonstrated some effectiveness in increasing the quantity of education (enrolment rate, attendance) of girls, although financial incentives appear to be better ‘bang for the buck’. Further, pedagogical interventions that use evidence-based curricula and instructional approaches along with lesson plans and teacher training in delivering new content and material for students have also shown to be effective.

When seeking to improve education – from pre-primary to tertiary, from quantity to quality, and at intersections with health and gender – the options on the menu should be tailored to the specificities of each country/context and creative, strategic combinations of menu options should be considered. For example, online learning programs may enable vast numbers of students to access education across the world but are likely to be of reduced efficacy in countries where computer and internet access are limited for some/many students or where there are perceptions that online education is of inferior quality.

Gender, poverty, ethnicity, and class intersect in various ways; the most effective interventions will need to strategically combine approaches in order to address the multitude of reasons why girls tend to complete education at all levels at lower rates than boys.

This article is part of a series exploring critical sectors for moving Canada’s feminist international assistance policy forward in light of opportunities to lead at the G7 Summit in Charlevoix, QC (June 8-9). The rest of the series is available here:

Part I – A Feminist G7 Agenda 

Part II – Ensuring Benefits for Women and Girls at All Education Levels

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