Birth Order, Stage of Infancy and Infant Mortality in India

Abstract

SummaryUsing data from India's National Family Health Survey, 2005-06 (NFHS-3), this article examines the patterns of relationship between birth order and infant mortality. The analysis controls for a number of variables, including mother's characteristics such as age at the time of survey, current place of residence (urban/rural), years of schooling, religion, caste, and child's sex and birth weight. A modest J-shaped relationship between birth order of children and their risk of dying in the neonatal period is found, suggesting that although both first- and last-born children are at a significantly greater risk of dying compared with those in the middle, last-borns (i.e. fourth and higher order births) are at the worst risk. However, in the post-neonatal period first-borns are not as vulnerable, but the risk increases steadily with the addition of successive births and last-borns are at much greater risk, even worse than those in the neonatal period. Although the strength of relationship between birth order and mortality is attenuated after the potential confounders are taken into account, the relationship between the two variables remains curvilinear in the neonatal period and direct in the post-neonatal period. There are marked differences in these patterns by the child's sex. While female children are less prone to the risk of dying in the neonatal period in comparison with male children, the converse is true in the post-neonatal period. Female children not only run higher risks of dying in the post-neonatal period, but also become progressively more vulnerable with an increase in birth order.

Gender Discrimination and Excess Female Under-5 Mortality in India: A New Perspective Using Mixed-Sex Twins

“…The implication of this form of selection for mortality is a priori ambiguous. Whereas some studies found a J-shaped relationship between infant mortality and birth order (e.g., Hobcraft et al 1985;Pandey et al 1998), with firstborns showing the elevated risks, others found a linearly increasing risk from earlier-born to later-born children, which could protect earlier-born girls (e.g., Mishra et al 2018). Basu and De Jong (2010) hypothesized that in a context with son preference, earlier-born daughters may experience negative consequences for their well-being as a result of having to assist in the care of laterborn children within their families.…”

Associations Between Sex Composition of Older Siblings and Infant Mortality in India from 1992 to 2016

“…Eldest boys appear to be in the strongest position of parental investment, with the least risk of stunting [8]. Studies on sibling composition and infant mortality in India found that having older sisters increases risk of female infant mortality regardless of wealth; no sibling effects on male infant mortality were observed [6], [12], [13]. Last born children were also most vulnerable to infant mortality [6].…”

“…Analysis of nationally representative 2005–06 data and 2015–16 data from India found that boys were more likely than girls to die in the neonatal period (0–1 month) [5], [6], as would biologically be expected [7]. However, girls were more likely than boys to die in the postnatal period (1–12 months) in 2005–06, contrary to biologic expectation, though no sex difference in postnatal mortality was seen in 2015–16 [5], [6]. These findings suggest the social norm of son preference, which contributes to excess female infant mortality, may be declining [5].…”

“…Studies on sibling composition and infant mortality in India found that having older sisters increases risk of female infant mortality regardless of wealth; no sibling effects on male infant mortality were observed [6], [12], [13]. Last born children were also most vulnerable to infant mortality [6]. These studies were all limited to data from 10 + years ago, and the infant mortality focused study aggregated all births, impeding recent cohort considerations in analysis.…”

Association between Maternal High-Risk Fertility Behavior and Childhood Morbidity in Bangladesh: A Nationally Representative Cross-Sectional Survey

“…[17][18][19][20][21][22][23][24][25][26][27] Women who begin childbearing at an early age often have a greater number of children, 28 and this, in turn, is linked to adverse maternal, infant, and child health outcomes. 29 Short birth intervals (< 24 months) 30,31 and higher birth order 32 are also associated with infant and child mortality.…”