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

Abstract

Son preference has been linked to excess female under-5 mortality in India, and considerable literature has explored whether parents invest more resources in sons relative to daughters—which we refer to as explicit discrimination—leading to girls’ poorer health status and, consequently, higher mortality. However, this literature has not adequately controlled for the implicit discrimination processes that sort girls into different types of families (e.g., larger) and at earlier parities. To better address the endogeneity associated with implicit discrimination processes, we explore the association between child sex and postneonatal under-5 mortality using a sample of mixed-sex twins from four waves of the Indian National Family Health Survey. Mixed-sex twins provide a natural experiment that exogenously assigns a boy and a girl to families at the same time, thus controlling for selectivity into having an unwanted female child. We document a sizable impact of explicit discrimination on girls’ excess mortality in India, particularly compared with a placebo analysis in sub-Saharan Africa, where girls have a survival advantage. We also show that explicit discrimination weakened for birth cohorts after the mid-1990s, especially in northern India, but further weakening has stalled since the mid-2000s, thus contributing to understandings of how the micro-processes underlying the female mortality disadvantage have changed over time.

A Comparison of Non-verbal Maternal Care of Male and Female Infants in India and the United Kingdom: The Parent-Infant Caregiving Touch Scale in Two Cultures

“…Our findings were very clear, with higher rates of early stroking being reported for the United Kingdom than India, but no sex differences in rates in either country and no differential gender difference by culture. This is consistent with recent findings of a decline in intra-household sex discrimination found for the under-5 mortality of opposite-sex twins in southern India ( Kashyap and Behrman, 2020 ).…”

Integrating time into stigma and health research

“…Stigma plays a role in the risk for, development of and/or worsening of many diseases including mental health conditions (such as depression 36 , 62 , 63 and anxiety 36 ), behavioural health conditions (such as substance use disorders (SUDs) 63 , 64 ), infectious diseases (such as HIV 63 , 65 and tuberculosis 63 ) and non-communicable diseases (such as cardiovascular disease 66 , 67 and epilepsy 63 ). Longitudinal and population-based studies further suggest that greater stigma is associated with greater risk of mortality 68 – 71 .…”

Do precarious female employment and political autonomy affect the under-5 mortality rate? Evidence from 166 countries

“…It may be accomplished by establishing universal healthcare coverage, establishing a social safety net, and implementing social labour market adjustments through the decent programme. Kashyap and Behrman [ 6 ] examined the various causes of India’s high female under-5 death rate, concluding that the primary cause is a lack of parental healthcare investment in the female child, resulting in poor health. If a country wants to minimize female under-5 mortality rates, it must shift the traditional parental perspective toward giving equal importance to their children.…”