According to a study by Moynihan (2015), the REALM health literacy assessment tool was used in a sample

of 169 women with 56 cases and 113 control. The goal of the study was to examine the association between
maternal health literacy levels and preterm birth with the hypothesis that reproductive-age women with low
levels of maternal health literacy would be more likely to experience a preterm birth. When comparing
mothers who delivered preterm to mothers that delivered term, there was no significance difference (p =
0.112) with respect to maternal health literacy. There was no association between low maternal health
literacy levels, as assessed by the REALM instrument, and preterm birth for English-speaking women
between the ages of 18 and 35 within the metropolitan Atlanta area. In contrast to this, the study of Kohan
et. al (2007) indicated that women with adequate health literacy had significant difference in starting earli- er
and frequency of antenatal care, neonatal birth weight, mother hematocrit (HCT), ferrous and folic acid
tablet con- sumption, pregnancy weight gain, gestational age at birth, method of delivery and breastfeeding.
Their findings suggest that good health literacy among pregnant women is associated with good pregnancy
outcome and the fact that poor health literacy causes poor chance to gain a positive pregnancy outcome.

Furthermore, maternal health literacy also affects the different aspects of the child after delivery.
DeWalt et. al (2009) summarized the pertinent literature regarding literacy and child outcomes from
1980 through 2008 and found that lower literacy was associated with a lack of basic knowledge
regarding a known medical condition, dif culty utilizing consent forms, non-comprehension of the
concepts behind prenatal screening, and non- understanding of educational brochures resulting in
poorer health outcomes. In a study by Connelly and Turner (2017), they mentioned that: low
parental literacy affects almost every aspect of newborn and infant care, including breastfeeding, use
of the emergency room, medication administration, and participation in social welfare programs.
Kaufman and co-workers found that only 23% of rst-time mothers with poor health literacy breast-
fed exclusively for 2 months, compared to 54% of women who had higher levels of literacy skills.