Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings

Abstract

This article examines the role of the sex composition of surviving older siblings on gender differences in childhood nutrition and immunization, using data from the National Family Health Survey, India (1992–1993). Logit and ordered logit models were used for severe stunting and immunization, respectively. The results show selective neglect of children with certain sex and birth-order combinations that operate differentially for girls and boys. Both girls and boys who were born after multiple same-sex siblings experience poor outcomes, suggesting that parents want some balance in sex composition. However, the preference for sons persists, and boys who were born after multiple daughters have the best possible outcomes.

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References

  1. Agarwal, B. 1994. A Field of One’s Own: Gender and Land Rights in South Asia. New York: Cambridge University Press.

    Google Scholar 

  2. Amin, S. 1990. “The Effect of Women’s Status on Sex Differentials in Infant and Child Mortality in South Asia.” Genus 46(3–4):55–69.

    Google Scholar 

  3. Arnold, F. 1992. “Sex Preference and Its Demographic and Health Implications.” International Family Planning Perspectives 18:93–101.

    Article  Google Scholar 

  4. — 1997. Gender Preferences for Children. DHS Comparative Studies No. 23. Calverton, MD: Macro International.

    Google Scholar 

  5. Arnold, F., M.K. Choe, and T.K. Roy. 1998. “Son Preference, the Family-Building Process and Child Mortality in India.” Population Studies 52:301–15.

    Article  Google Scholar 

  6. Bairagi, R. 1986. “Food Crisis, Nutrition, and Female Children in Rural Bangladesh.” Population and Development Review 12:307–15.

    Article  Google Scholar 

  7. Banthia, J.K. 2001. Provisional Population Totals: India. Census of India 2001, Series 1, India, Paper 1 of 2001. New Delhi: Office of the Registrar General, India.

    Google Scholar 

  8. Baqui, A.H., R.E. Black, S.E. Arifeen, K. Hill, S.N. Mitra, and A. Al Sabir. 1998. “Causes of Childhood Deaths in Bangladesh: Results of a Nationwide Verbal Autopsy Study.” Bulletin of the World Health Organization 76:161–71.

    Google Scholar 

  9. Bardhan, P.K. 1974. “On Life and Death Questions.” Economic and Political Weekly August, Special Number:1293–304.

    Google Scholar 

  10. Bardhan, P.K. 1982. “Little Girls and Death in India.” Economic and Political Weekly September 4: 1448–50.

  11. Basu, A.M. 1989. “Is Discrimination in Food Really Necessary for Explaining Sex Differentials in Childhood Mortality?” Population Studies 43:193–210.

    Article  Google Scholar 

  12. Basu, A. M. and K. Basu. 1991. “Women’s Economic Roles and Child Survival: The Case of India.” Health Transition Review 1(1):83–103.

    Google Scholar 

  13. Bhat, P.N.M. 1989. “Mortality and Fertility in India, 1881–1961: A Reassessment.” Pp. 73–118 in India’s Historical Demography: Studies in Famine, Disease and Society, edited by T. Dyson. London: Curzon.

    Google Scholar 

  14. Bhuiya, A. and K. Streatfield. 1992. “A Hazard Logit Model Analysis of Covariates of Childhood Mortality in Matlab, Bangladesh.” Journal of Biosocial Science 24:447–62.

    Article  Google Scholar 

  15. Bhuiya, A., B. Wojtyniak, and R. Karim. 1989. “Malnutrition and Child Mortality: Are Socioeconomic Factors Important?” Journal of Biosocial Science 21:357–64.

    Article  Google Scholar 

  16. Bhuiya, A., S. Zimicki, and S. D’Souza. 1986. “Socioeconomic Differentials in Child Nutrition and Morbidity in a Rural Area of Bangladesh.” Journal of Tropical Pediatrics 32:17–23.

    Google Scholar 

  17. Cain, M.T. 1988. “The Material Consequences of Reproductive Failure in Rural South Asia.” Pp. 20–38 in A Home Divided: Women and Income in the Third World, edited by D. Dwyer and J. Bruce. Stanford, CA: Stanford University Press.

    Google Scholar 

  18. — 1993. “Patriarchal Structure and Demographic Change.” Pp. 19–41 in Women’s Position and Demographic Change, edited by N. Federici, K. Oppenheim Mason, and S. Sogner. Oxford, England: Clarendon Press.

    Google Scholar 

  19. Cain, M.T., S.R. Khanam, and S. Nahar. 1979. “Class, Patriarchy, and Women’s Work in Bangladesh.” Population and Development Review 5:405–38.

    Article  Google Scholar 

  20. Caldwell, J.C. 1979. “Education as a Factor in Mortality Decline: An Examination of Nigerian Data.” Population Studies 33:395–413.

    Article  Google Scholar 

  21. Caldwell, J.C., P.H. Reddy, and P. Caldwell. 1982. “The Causes of Demographic Change in Rural South India: A Micro Approach.” Population and Development Review 8:689–727.

    Article  Google Scholar 

  22. Caldwell, P. and J.C. Caldwell. 1990. Gender Implications for Survival in South Asia. Health Transition Working Paper No. 7. Canberra: National Centre for Epidemiology and Population Health, Australian National University.

    Google Scholar 

  23. Chen, L.C., E. Huq, and S. D’Souza. 1981. “Sex Bias in the Family Allocation of Food and Health Care in Rural Bangladesh.” Population and Development Review 7:55–70.

    Article  Google Scholar 

  24. Choe, M.K., H. Hongsheng, and W. Feng. 1995. “Effects of Gender, Birth Order, and Other Correlates on Childhood Mortality in China.” Social Biology 42(1–2):50–64.

    Google Scholar 

  25. Cleland, J.G. and J.K. van Ginneken. 1988. “Maternal Education and Child Survival in Developing Countries: The Search for Pathways of Influence.” Social Science and Medicine 27: 1357–68.

    Article  Google Scholar 

  26. Curtis, S.L., I. Diamond, and J.W. McDonald. 1993. “Birth Interval and Family Effects on Postneonatal Mortality in Brazil.” Demography 30:33–43.

    Article  Google Scholar 

  27. Das Gupta, M. 1987. “Selective Discrimination Against Female Children in Rural Punjab, India.” Population and Development Review 13:377–400.

    Article  Google Scholar 

  28. — 1989. “The Effects of Discrimination on Health and Mortality.” Pp. 349–65 in International Union for the Scientific Study of Population (IUSSP), International Population Conference, Montreal, Vol. 3. Paris: IUSSP.

    Google Scholar 

  29. Das Gupta, M. and P.N.M. Bhat. 1997. “Fertility Decline and Increased Manifestation of Sex Bias in India.” Population Studies 51:307–15.

    Article  Google Scholar 

  30. Desai, S. 1994. Gender Inequalities and Demographic Behavior: India. New York: Population Council.

    Google Scholar 

  31. Desai, S. and S. Alva. 1998. “Maternal Education and Child Health: Is There a Strong Causal Relationship?” Demography 35:71–81.

    Article  Google Scholar 

  32. Desai, S. and D. Jain. 1994. “Maternal Employment and Changes in Family Dynamics: The Social Context of Women’s Work in Rural South India.” Population and Development Review 20: 115–36.

    Article  Google Scholar 

  33. Dharmalingam, A. 1996. “The Social Context of Family Size Preference and Fertility Behaviour in a South Indian Village.” Genus 42(1–2):83–103.

    Google Scholar 

  34. D’Souza, S. and L.C. Chen. 1980. “Sex Differentials in Mortality in Bangladesh.” Population and Development Review 6:257–70.

    Article  Google Scholar 

  35. Dyson, T. and M. Moore. 1983. “On Kinship Structure, Female Autonomy, and Demographic Behavior in India.” Population and Development Review 9:35–60.

    Article  Google Scholar 

  36. El-Badry, M.A. 1969. “Higher Female than Male Mortality in Some Countries of South Asia: A Digest.” American Statistical Association Journal 64:1234–44.

    Article  Google Scholar 

  37. Faisel, A., T. Ahmad, and Z. Kundi. 1993. “Differentials in Health-Related Variables Among Children at a Diarrhoea Training Unit in Pakistan.” Journal of Diarrheal Disease Research 11:19–24.

    Google Scholar 

  38. Filmer, D. and L. Pritchett. 2001. “Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application to Educational Enrollments in States of India.” Demography 38:115–32.

    Google Scholar 

  39. Ganatra, B. and S. Hirve. 1994. “Male Bias in Health Care Utilization for Under-Fives in a Rural Community in Western India.” Bulletin of the World Health Organization 72:101–104.

    Google Scholar 

  40. Govindaswamy, P. and B.M. Ramesh. 1996. “Maternal Education and Gender Bias in Child Care Practices in India.” Paper presented at the annual meeting of the Population Association of America, New Orleans, May 9–11.

  41. Hill, K. and D.M. Upchurch. 1995. “Gender Differences in Child Health: Evidence From the Demographic and Health Surveys.” Population and Development Review 21:127–51.

    Article  Google Scholar 

  42. Hobcraft, J. 1993. “Women’s Education, Child Welfare and Child Survival: A Review of the Evidence.” Health Transition Review 3(2):159–75.

    Google Scholar 

  43. Hosmer, D.W. and S. Lemeshow. 1989. Applied Logistic Regression. New York: John Wiley & Sons.

    Google Scholar 

  44. International Institute for Population Sciences (IIPS). 1995. National Family Health Survey (MCH and Family Planning) India 1992–93. Bombay: IIPS.

    Google Scholar 

  45. Jain, A.K. 1985. “Determinants of Regional Variations in Infant Mortality in Rural India.” Population Studies 39:407–24.

    Article  Google Scholar 

  46. Karve, I. 1965. Kinship Organization in India. Bombay: Asia Publishing House.

    Google Scholar 

  47. Kennedy, P. 1996. A Guide to Econometrics. 3rd ed. Cambridge, MA: MIT Press.

    Google Scholar 

  48. Kishor, S. 1993. “‘May God Give Sons to All’: Gender and Child Mortality in India.” American Sociological Review 58:247–65.

    Article  Google Scholar 

  49. — 1995. “Gender Differentials in Child Mortality: A Review of the Evidence.” Pp. 19–54 in Women’s Health in India: Risk and Vulnerability, edited by M. Das Gupta, L.C. Chen, and T.N. Krishnan. Bombay: Oxford University Press.

    Google Scholar 

  50. Koenig, M.A. and S. D’Souza. 1986. “Sex Differences in Childhood Mortality in Rural Bangladesh.” Social Science and Medicine 22:15–22.

    Article  Google Scholar 

  51. Kurz, K.M. and C. Johnson-Welch. 1997. Gender Differences Among Children 0–5 Years: An Opportunity for Child Survival Interventions. A Review Paper prepared for the BASICS Project. Arlington, VA: BASICS.

    Google Scholar 

  52. Langsten, R. and K. Hill. 1998. The Accuracy of Mothers’ Reports of Child Vaccination: Evidence From Rural Egypt. Social Science and Medicine 46:1205–12.

    Article  Google Scholar 

  53. Leslie, J. 1989. “Women’s Time: A Factor in the Use of Child Survival Technologies?” Health Policy and Planning 4(1):1–16.

    Article  Google Scholar 

  54. Liang, K. and S.L. Zeger. 1993. “Regression Analysis for Correlated Data.” Annual Review of Public Health 14:43–68.

    Article  Google Scholar 

  55. Makinson, C. 1994. “Discrimination Against the Female Child.” International Journal of Gynecology and Obstetrics 46:119–25.

    Article  Google Scholar 

  56. Mandelbaum, D.G. 1988. Women’s Seclusion and Men’s Honor: Sex Roles in North India, Bangladesh and Pakistan. Tucson: University of Arizona Press.

    Google Scholar 

  57. Mason, K.O. 1984. The Status of Women: A Review of Its Relationships to Fertility and Mortality. New York: Rockefeller Foundation.

    Google Scholar 

  58. — 1993. “The Impact of Women’s Position on Demographic Change During the Course of Development.” Pp. 19–42 in Women’s Position and Demographic Change, edited by N. Federici, K.O. Mason, and S. Sogner. Oxford, England: Clarendon Press.

    Google Scholar 

  59. Mason, K.O. 1994. “Conceptualizing and Measuring Women’s Status.” Paper presented at the annual meeting of the Population Association of America, Miami, May 5–7.

  60. McCullagh, P. and J.A. Nelder. 1989. Generalized Linear Models. Monographs on Statistics and Applied Probability 37. London: Chapman and Hall.

    Google Scholar 

  61. Merchant, K.M. and K.M. Kurz. 1992. “Women’s Nutrition Through the Life Cycle: Social and Biological Vulnerabilities.” Pp. 63–90 in The Health of Women: A Global Perspective, edited by M. Koblinsky, J. Timyan, and J. Gay. Boulder: Westview Press.

    Google Scholar 

  62. Miller B.D. 1981. The Endangered Sex: Neglect of Female Children in Rural North India. Ithaca, NY: Cornell University Press.

    Google Scholar 

  63. — 1989. “Changing Patterns of Juvenile Sex Ratios in Rural India, 1961 to 1971.” Economic and Political Weekly June 3:1229–36.

    Google Scholar 

  64. Mishra, V.K., S. Lahiri, and N.Y. Luther. 1999. Child Nutrition in India. National Family Health Survey Subject Reports No. 14. Honolulu: East-West Center Population and Health Studies.

    Google Scholar 

  65. Montgomery, M.R., M. Gragnolati, K.A. Burke, and E. Paredes. 2000. “Measuring Living Standards With Proxy Variables.” Demography 37:155–74.

    Article  Google Scholar 

  66. Mosley, W.H. 1985. “Biological and Socioeconomic Determinants of Child Survival. A Proximate Determinants Framework Integrating Fertility and Mortality Variables.” Pp. 189–208 in International Union for the Scientific Study of Population (IUSSP), International Population Conference,Florence, Vol. 2. Paris: IUSSP.

    Google Scholar 

  67. Mosley, W.H. and S. Becker. 1991. “Demographic Models for Child Survival and Implications for Health Intervention Programmes.” Health Policy and Planning 6:218–33.

    Article  Google Scholar 

  68. Mosley, W.H. and L.C. Chen. 1984. “An Analytical Framework for the Study of Child Survival in Developing Countries.” Population and Development Review (Suppl.) 10:25–45.

    Article  Google Scholar 

  69. Muhuri, P.K. and S.H. Preston. 1991. “Effects of Family Composition on Mortality Differentials by Sex Among Children in Matlab, Bangladesh.” Population and Development Review 17: 415–34.

    Article  Google Scholar 

  70. Murthi, M., A. Guio, and J. Dreze. 1995. “Mortality, Fertility and Gender Bias in India: A District-Level Analysis.” Population and Development Review 21:745–81.

    Article  Google Scholar 

  71. Mutharayappa, R., M.K. Choe, F. Arnold, and T.K. Roy. 1997. Son Preference and Its Effect on Fertility in India. National Family Health Survey Subject Reports No. 3. Honolulu: East-West Center Program on Population.

    Google Scholar 

  72. Obermeyer, C.M. and R. Cardenas. 1997. “Son Preference and Differential Treatment in Morocco and Tunisia.” Studies in Family Planning 28:235–44.

    Article  Google Scholar 

  73. Oldenburg, P. December 5–12, 1992. “Sex Ratio, Son Preference and Violence in India: A Research Note.” Economic and Political Weekly 27(49 & 50):2657–62.

    Google Scholar 

  74. Pande, R.P. 1999. “Grant a Girl Elsewhere, Here Grant a Boy: Gender and Health Outcomes in Rural India.” Unpublished doctoral dissertation. School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD.

    Google Scholar 

  75. Parasuraman, S. and T.K. Roy. 1991. “Some Observations of the 1991 Census Population of India.” Journal of Family Welfare 37:62–68.

    Google Scholar 

  76. Pebley, A.R. and S. Amin. 1991. “The Impact of a Public-Health Intervention on Sex Differentials in Childhood Mortality in Rural Punjab, India.” Health Transition Review 1:143–69.

    Google Scholar 

  77. Ravindran, S. 1986. Health Implications of Sex Discrimination in Childhood: A Review Paper and an Annotated Bibliography. Geneva: WHO/UNICEF.

    Google Scholar 

  78. Sastry, N. 1996. “Community Characteristics, Individual and Household Attributes, and Child Survival in Brazil.” Demography 33:211–29.

    Article  Google Scholar 

  79. Schultz, T. 1984. “Studying the Impact of Household Economic and Community Variables on Child Mortality.” Population and Development Review (Suppl.) 10:215–35.

    Article  Google Scholar 

  80. Scrimshaw, S.C.M. 1978. “Infant Mortality and Behavior in the Regulation of Family Size.” Population and Development Review 4:383–403.

    Article  Google Scholar 

  81. Sen, A. and S. Sengupta. 1983. “Malnutrition of Rural Children and the Sex Bias.” Economic and Political Weekly, May 18:855–64.

    Google Scholar 

  82. Simmons, G.B., C. Smucker, S. Bernstein, and E. Jensen. 1982. “Post-Neonatal Mortality in Rural India: Implications of an Economic Model.” Demography 19:371–89.

    Article  Google Scholar 

  83. Singh, K. 1993. “Women’s Rights and the Reform of Personal Laws.” Pp. 177–97 in Hindus and Others: The Question of Identity in India Today, edited by G. Pandey. New Delhi: Viking Penguin.

    Google Scholar 

  84. Sopher, D.E. 1980. “The Geographic Patterning of Culture in India.” Pp. 289–326 in An Exploration of India: Geographical Perspective on Society and Culture, edited by D.E. Sopher. Ithaca, NY: Cornell University Press.

    Google Scholar 

  85. StataCorp. 1997. Stata Statistical Software: Release 5. College Station, TX: Stata Corporation.

    Google Scholar 

  86. Tabutin, D. and M. Willems. 1995. “Excess Female Child Mortality in the Developing World During the 1970s and 1980s.” Population Bulletin of the United Nations 39:45–78.

    Google Scholar 

  87. Visaria, L. 1988. “Level, Trends and Determinants of Infant Mortality in India.” Pp. 67–126 in Infant Mortality in India: Differentials and Determinants, edited by A.K. Jain and P. Visaria. New Delhi: Sage.

    Google Scholar 

  88. Visaria, L. and P. Visaria. 1983. “Population (1757–1947).” Pp. 463–532 in The Cambridge Economic History of India, Vol. 2, edited by D. Kumar. Cambridge, England: Cambridge University Press.

    Google Scholar 

  89. — 1995. “India’s Population in Transition.” Population Bulletin 50(3):1–51.

    Google Scholar 

  90. Visaria, P. M. 1967. “The Sex Ratios of the Population of India and Pakistan and Regional Variations During 1901–1961.” Pp 334–71 in Patterns of Population Change in India 1951–61, edited by A. Bose. Bombay: Allied Publishers.

    Google Scholar 

  91. — 1969. The Sex Ratio of the Population of India. Census of India 1961, Vol. 1, Monograph No. 10. New Delhi: Office of the Registrar General, India, Ministry of Home Affairs.

    Google Scholar 

  92. Vlassoff, C. 1990. “The Value of Sons in an Indian Village: How Widows See It.” Population Studies 44:5–20.

    Article  Google Scholar 

  93. Wadley, S.S. 1993. “Family Composition Strategies in Rural North India.” Social Science and Medicine 37:1367–76.

    Article  Google Scholar 

  94. Waldron, I. 1987. “Patterns and Causes of Excess Female Mortality Among Children in Developing Countries.” World Health Statistics Quarterly 40:194–210.

    Google Scholar 

  95. Williamson, N.E. 1976. Sons or Daughters, A Cross-Cultural Survey of Parental Preferences. Vol. 31, Sage Library of Social Research. Beverly Hills, CA: Sage Publications.

    Google Scholar 

  96. World Bank. 1991. Gender and Poverty in India. Washington, DC: The World Bank.

    Google Scholar 

  97. World Health Organization. 1984. Immunization in Practice: A Guide for Health Workers Who Give Vaccines. Module 1: Vaccines and When to Give Them. Geneva: Department of Vaccines and Biologicals, World Health Organization.

    Google Scholar 

  98. Zenger, E. 1993. “Siblings’ Neonatal Mortality Risks and Birth Spacing in Bangladesh.” Demography 39:477–88.

    Article  Google Scholar 

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This article is part of the author’s doctoral dissertation completed at the Bloomberg School of Public Health, Johns Hopkins University, supported by the Hewlett Foundation and the Population Council. I thank Ken Hill, Nan Astone, and Michael Koenig for their comments and encouragement.

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Pande, R.P. Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings. Demography 40, 395–418 (2003). https://doi.org/10.1353/dem.2003.0029

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Keywords

  • Development Review
  • Proximate Determinant
  • Order Logit Model
  • National Family Health Survey
  • Severe Stunting