The figure does not include girls who are aborted simply for their gender, the researchers say.

An estimated 239,000 girls younger than the age of five die in India every year because many parents prefer boys over girls, according to a study published in The Lancet on Tuesday.

Scientists found India has a massively skewed ratio of men to women, and more than 63 million women are “statistically missing” across the country, likely as a result of excessively high female mortality, according to the government’s annual economic survey.

One of the common reasons cited for high female mortality in India is sex-selective abortion, but the study found there is “postnatal discrimination against girls in India,” which means the problem lies beyond prenatal care, carrying on after a girl is born.

“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 study co-author Christophe Guilmoto of the Paris Descartes University.

Most of these avoidable deaths of women in India happen during childhood.

“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,” Guilmoto said.

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The study found that densely populated rural areas were plagued with the most suffering for girls. The country’s largest states in northern India – Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh – accounted for two-thirds of India’s total female deaths.

The authors highlighted “the need for more proactive engagement with the issue of postnatal sex discrimination and a focus on the northern districts”.

The researchers gathered mortality data from 46 countries with no sign of gender bias to estimate the impact of excess female mortality in India at the district level. The study found that around 19 out of every 1,000 girls has died due to gender bias between the years of 2000 and 2005.

“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… where poverty, low social development, and patriarchal institutions persist and investments (in) girls are limited,” said co-author Nandita Saikia of IIASA, the International Institute for Applied Systems Analysis, in Laxenburg, Austria.