Prenatal sex selection and female infant mortality are more common in India after firstborn and second-born daughters

Abstract

PSS and female infant mortality increase with the presence of older female siblings, yet we find no evidence that increasing use of PSS prevents female infant mortality, because PSS and the proportion of female infant mortality attributable to having older sisters increased over the study period. Increased pressure on higher birth order females caused by the trend towards smaller family sizes may explain this.

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

“…For example, studies suggesting that physiologic traits or toxicity exposure affect likelihood of male births were published but eventually disproven [27]. We feel more confident regarding the validity of our findings because they are consistent with prior research indicating differential risk for infant mortality by sex in India, based on older data [6], [12], [13]. Hence, these findings highlight continuation of an ongoing and recognized concern.…”

“…Findings from this study reinforce prior research documenting that sex differences in infant mortality persist in India in ways that suggest persistence of son preference as a social norm affecting infant survival in India [2], [3], [4], [5], [6], [12]. Findings extend prior research by documenting that sex differences have not declined significantly over the past 25 years, and are most clearly seen for infants born following two sisters and no brothers.…”

“…This lower mortality risk may be attributable to greater nutritional and health care investments in these male children, a theory supported by prior research showing that parents in India are more likely to breastfeed and seek required health care for male relative to female children [8], [9], [10], [11], [18], [19]; such behaviors may be even greater for boys born subsequent to only daughters. There is extensive evidence from India regarding prenatal fertility practices in families with only girls to achieve a more highly desired boy, which likely results in greater investment for that boy and exacerbates the sex ratio imbalance and excess female mortality, with these effects demonstrated in wealthier more than poorest populations [1], [12], [20], [21]. Our findings also demonstrate stronger protective effects for boys in the wealthier and wealthiest populations.…”

“…Importantly, these findings as well as other research highlight that neither efforts to address sex ratio imbalance through restricted abortion access nor financial incentives for two girl only families have proven sufficient to tackle sex ratio imbalance in India [3], [22], nor have they had any impact on treatment or survival of girls once born [12]. Likely this is because they do not address the underlying social norms that maintain son preference and sex discrimination across India.…”

“…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].…”