Neglect to blame for skewed mortality rates, says Lancet report that urges looking beyond pre-natal sex selection at deaths from inequality of education and health

This article is more than 2 years old

This article is more than 2 years old

Hundreds of thousands of young girls in India die every year because of “invisible discrimination”, according to research published in the Lancet Global Health.

Researchers from the International Institute for Applied Systems Analysis estimate an average of 239,000 girls under five in India die each year, or 2.4 million in a decade, because of their gender.

Many of the deaths were due to neglect, both within their families and from health practitioners, as well as an “invisible, routine and continued”, bias Indian girls experience in food allocation. Studies have shown that Indian girls receive less education, have poorer nutrition and get less medical attention than boys.

Under natural conditions and in countries where no such gender bias exists, mortality rates for girls under five should be lower than those for boys due to a natural biological advantage.

But the researchers, who used census data from 2000-2005, found what they described as an “excess mortality rate” among girls under five across 29 out of 35 Indian states. The rate was 18.5 per 1,000 live births. The worst affected was northern India, which has a number of large rural agricultural states with low education and socio-economic development levels and high fertility.

Christophe Guilmoto from the Université Paris-Descartes, France, said that for too long, the focus had been on pre-natal sex selection.

“Gender-based discrimination towards girls doesn’t simply prevent them from being born, it may also precipitate the death of those who are born,” said Guilmoto. “Gender equity is not only about rights to education, employment or political representation. It is also about care, vaccination and nutrition of girls, and ultimately survival.”

India, in common with China, is known for having a skewed sex ratio, due to sex-selective abortions. Interestingly, the results did not coincide with states known for sex selection, such as Punjab, Gujarat and Mahrashtra.

But in northern India’s four largest states, Utter Pradesh, Bihar, Rajasthan, and Madhya Pradesh, the level of “excess mortality” among girls was much higher than the average – as high as 30 per 1,000 live births.

Dr Nandita Saikia, the paper’s co-author, said any intervention to reduce discrimination against girls should target priority states in northern India.

“Discrimination towards the girl child is not justified,” Saikia said. “As the regional estimates of excess deaths of girls demonstrate, any intervention to reduce the discrimination against girls in food and healthcare allocation should therefore target priority regions of Bihar and Uttar Pradesh where poverty, low social development and patriarchal institutions persist, and investments in girls are limited.

“This reinforces the need to address directly the issue of gender discrimination in addition to encouraging social and economic development for its benefits on Indian women.”