Maternal Education in Context: Reassessing the Infant Health Paradox among Latin American Immigrants

One aspect of the Hispanic Health Paradox is the longstanding observation that Latin American immigrants in the United States often experience equal or better health outcomes than U.S.-born counterparts despite greater socioeconomic disadvantage. This advantage extends to their infants and is most pronounced among mothers with the least education. Whether such patterns reflect selective migration remains unclear. This study evaluates the role of educational selectivity in explaining nativity disparities in infant health. Using U.S. natality data among immigrants from Mexico, Cuba, El Salvador, Guatemala, the Dominican Republic, Colombia, Honduras, and Venezuela (2012–2023), linked with internationally harmonized educational data, we assess preterm birth disparities using two measures of maternal education: absolute and relative attainment. Immigrants at the bottom of the U.S. education distribution often rank much higher in their origin countries, consistent with positive selection. For most births to Latin American mothers (except Colombian and Venezuelan), measuring education relative to origin-country distributions reverses immigrant advantages. At equivalent relative education ranks, immigrant mothers face comparable or higher risks of preterm birth than U.S.-born Hispanic mothers. These findings offer a new perspective on the Hispanic Health Paradox, highlighting the importance of relative education in understanding the association between maternal education and infant health.