Nearly a quarter of a million girls under the age of five die annually in India because of neglect related to gender-based discrimination, according to a new study published in the medical journal the Lancet.

At an estimated 239,000 deaths per year, that amounts to about 2.4 million over a decade, not including pre-natal deaths.

The preference for a son is widespread in India, sometimes leading to pre-natal termination and, as the new research suggests, post-natal neglect.

“Gender-based discrimination towards girls doesn’t simply prevent them from being born, it may also precipitate the death of those who are born,” Christophe Guilmoto, the study’s co-researcher, said in a statement.

“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.”

The report analyzed excess female under-five deaths across 35 states and territories in 640 districts.

The report said that significant excess, or premature, mortality of girls under five was found in 29 out of India’s union states and territories. Aside from two, every Indian state or territory contained at least one district with excess mortality.

The problem is most severe in the north of India where the country’s four largest states are located, the report said, with two-thirds of the total excess deaths of girls under five found in Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh.

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