A new study has found that there is an average of 239,000 excess deaths per year of girls under the age of five in India, or 2.4 million in a decade, and excess female child mortality is found in 90% of districts in the country.
The average level of excess mortality in girls aged 0-4 in the study period of 2000-2005 was 18.5 per 1000 live births, compared to the expected mortality of girl children aged under five in areas of the world without known gender discrimination. Around 22% of the overall mortality burden of females under five is therefore due to gender bias.
IIASA postdoctoral research scholar Nandita Saikia says that the new research shows that the burden of excess female deaths in India is huge. It is the first time that the number of excess deaths amongst girls under five in India has been studied at the district level, showing specific geographic patterns of excess female mortality across India's 640 districts.
In all, 29 out of 35 states in India had overall excess mortality in girls under five, and all states and territories bar two had at least one district with excess mortality. However, the level varies.
The problem is most pronounced in northern India, where the four largest states in the region, Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh, account for two thirds of the total excess deaths of females under five. In Uttar Pradesh excess female mortality was calculated at 30.5. In Bihar, the rate is 28.5, in Rajasthan it was 25.4, and in Madhya Pradesh, it was 22.1. In parts of western Rajasthan and northern Bihar, excess mortality as a result of gender bias accounts for 30-50% of the mortality rate of females under five.
The worst affected areas are all rural, agricultural areas with lower levels of education, high population densities, low socioeconomic development and high levels of fertility. The researchers say that many deaths of females under five are partly down to unwanted child bearing and subsequent neglect. Higher levels of female literacy and employment in more modern industries is linked to lower levels of excess mortality in females under five.
"As the regional estimates of excess deaths of girls demonstrate, any intervention to reduce the discrimination against girls in food and health care allocation should therefore target in priority regions of Bihar and Uttar Pradesh where poverty, low social development, and patriarchal institutions persist and investments on girls are limited," says Saikia. "The sustained fertility decline currently observed in North India is likely to lead to a reduction in postnatal discrimination. Unless son preference diminishes, lower fertility, however, might bring about a rise in gender-biased sex selection as was observed 20 years ago in Western India. 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."
Interestingly, the results do not coincide with areas with known skewed sex ratios at birth, such as Punjab, Gujarat, and Mahrashtra. Co-researcher Christophe Guilmoto from the Université Paris Descartes, France, says that for too long, the focus has been on prenatal 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," he says. "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."
Saikia notes that if there were no excess female deaths in India, the country could have achieved its Millennium Development Goal target on child mortality, of 42 deaths per 1,000 births, very easily.
"Discrimination towards the girl child is not justified. There is a need to change mentality. Rather than discriminating against them it is necessary to raise their value through education and self-dependence," says Saikia.
Guilmoto CZ, Saikia N, Tamrakar V, Bora J (2018). Excess under-5 female mortality across India: a spatial analysis using 2011 census data. Lancet Global Health [pure.iiasa.ac.at/15246]
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The Lancet Global Health