Do Girls Have a Nutritional Disadvantage Compared with Boys? Statistical Models of Breastfeeding and Food Consumption Inequalities among Indian Siblings

Abstract

BackgroundIndia is the only nation where girls have greater risks of under-5 mortality than boys. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality.Methods and FindingsSecondary, publicly available anonymized and de-identified data were used; no ethics committee review was required. Multivariate regression and Cox models were performed using Round 3 of India’s National Family and Health Survey (2005–2006; response rate = 93.5%). Models were disaggregated by birth order and sibling gender, and adjusted for maternal age, education, and fixed effects, urban residence, household deprivation, and other sociodemographics. Mothers’ reported practices of WHO/UNICEF recommendations for breastfeeding initiation, exclusivity, and total duration (ages 0–59 months), children’s consumption of 24 food items (6–59 months), and child survival (0–59 months) were examined for first- and secondborns (n = 20,395). Girls were breastfed on average for 0.45 months less than boys (95% CI: = 0.15 months to 0.75 months, p = 0.004). There were no gender differences in breastfeeding initiation (OR = 1.04, 95% CI: 0.97 to 1.12) or exclusivity (OR = 1.06, 95% CI: 0.99 to 1.14). Differences in breastfeeding cessation emerged between 12 and 36 months in secondborn females. Compared with boys, girls had lower consumption of fresh milk by 14% (95% CI: 79% to 94%, p = 0.001) and breast milk by 21% (95% CI: 70% to 90%, p<0.000). Each additional month of breastfeeding was associated with a 24% lower risk of mortality (OR = 0.76, 95% CI: 0.73 to 0.79, p<0.000). Girls’ shorter breastfeeding duration accounted for an 11% increased probability of dying before age 5, accounting for about 50% of their survival disadvantage compared with other low-income countries.ConclusionsIndian girls are breastfed for shorter periods than boys and consume less milk. Future research should investigate the role of additional factors driving India’s female survival disadvantage.

Energy intake from unhealthy snack food/beverage among 12‐23‐month‐old children in urban Nepal

“…Although inequitable intra‐household food allocation by sex has been noted in South Asian contexts including Nepal, (Harris‐Fry, Shrestha, Costello, & Saville, ), literature on the influence of child sex and feeding of USFB is extremely limited. Fledderjohann et al () found greater consumption of fresh milk by sons as compared with daughters among Indian children below 5 years of age; further exploration of our data showed that male children consumed a higher %TEI‐NBF from healthy snacks than female children, particularly dairy‐based snacks. No studies exploring sex differentials in feeding of USFB to infants and young children have been identified.…”

“…Ordinal logistic regression model for high consumption a of unhealthy snack foods and beverages (comparison with low/moderate consumption b ) CI: confidence interval.The greater odds of high USFB consumption among female children and lower odds among children from upper caste households has not been reported elsewhere; these results indicate that sociocultural beliefs may be influencing diets of young children in Nepal.Although inequitable intra-household food allocation by sex has been noted in South Asian contexts including Nepal,(Harris-Fry, Shrestha, Costello, & Saville, 2017), literature on the influence of child sex and feeding of USFB is extremely limited Fledderjohann et al (2014). …”

Is there a female disadvantage in child undernutrition in South India?: Exploring gender differences in height in infancy, childhood, and adolescence in Andhra Pradesh and Telangana

“…Female infant and child mortality are markedly higher than male mortality (Collaborators, 2010). Girls in India also experience lower access to health services (Khera et al, 2014), lower rates of immunization (Borooah, 2004;Singh, 2012), and worse performance on the proximal indicators of nutritional status, such as breastfeeding (Fledderjohann et al, 2014) as well as feeding practices and household allocation of resources towards children (Basu, 1993;Borooah, 2004;Haddad, Pena, Nishida, Quisumbing, & Slack, 1996). Discrimination in terms of care, access to health services, or other health inputs would influence nutritional status as these are key determinants of undernutrition (Black et al, 2013b).…”

Family, Gender, and Women's Nutritional Status: A Comparison Between Two Himalayan Communities in Nepal

“…Empirical research shows however that a pro-male bias in actual food intake is mainly located in South Asia, and that the extent of gender bias in nutritional status varies strongly within the region (Haddad et al 1996). Other studies show that women's nutritional status also lags behind because of differential care giving practices and lesser access to formal healthcare (Larme 1997;DeRose et al 2000;Marcoux 2002;Fledderjohann et al, 2014). Thus, the evidence of previous research on the negative effects of gender on nutrition is inconclusive.…”