Do girls have a nutritional disadvantage compared with boys? Statistical models of breastfeeding and food consumption inequalities among Indian siblings.

Jasmine Fledderjohann,Sukumar Vellakkal,Pat Doyle,Shah Ebrahim,David Stuckler,Oona Campbell,Sutapa Agrawal,Sanjay Basu,Judith Homberg

doi:10.1371/journal.pone.0107172

Abstract

BackgroundIndia is the only nation where girls have greater risks of under-5 mortality than boys. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality.Methods and FindingsSecondary, publicly available anonymized and de-identified data were used; no ethics committee review was required. Multivariate regression and Cox models were performed using Round 3 of India’s National Family and Health Survey (2005–2006; response rate = 93.5%). Models were disaggregated by birth order and sibling gender, and adjusted for maternal age, education, and fixed effects, urban residence, household deprivation, and other sociodemographics. Mothers’ reported practices of WHO/UNICEF recommendations for breastfeeding initiation, exclusivity, and total duration (ages 0–59 months), children’s consumption of 24 food items (6–59 months), and child survival (0–59 months) were examined for first- and secondborns (n = 20,395). Girls were breastfed on average for 0.45 months less than boys (95% CI: = 0.15 months to 0.75 months, p = 0.004). There were no gender differences in breastfeeding initiation (OR = 1.04, 95% CI: 0.97 to 1.12) or exclusivity (OR = 1.06, 95% CI: 0.99 to 1.14). Differences in breastfeeding cessation emerged between 12 and 36 months in secondborn females. Compared with boys, girls had lower consumption of fresh milk by 14% (95% CI: 79% to 94%, p = 0.001) and breast milk by 21% (95% CI: 70% to 90%, p<0.000). Each additional month of breastfeeding was associated with a 24% lower risk of mortality (OR = 0.76, 95% CI: 0.73 to 0.79, p<0.000). Girls’ shorter breastfeeding duration accounted for an 11% increased probability of dying before age 5, accounting for about 50% of their survival disadvantage compared with other low-income countries.ConclusionsIndian girls are breastfed for shorter periods than boys and consume less milk. Future research should investigate the role of additional factors driving India’s female survival disadvantage.

Highlights

India is the only country in the world where young girls have worse under-five mortality than boys
Indian girls are breastfed for shorter periods than boys and consume less milk
Over the past four decades, declines in infant mortality have been greater in boys than girls, further widening inequalities in India’s male-female child survival rates [3]

Summary

Introduction

India is the only country in the world where young girls have worse under-five mortality than boys. Over the past four decades, declines in infant mortality have been greater in boys than girls, further widening inequalities in India’s male-female child survival rates [3]. This trend starkly contrasts with the rest of the world, where young girls have clear survival advantages [4]. In neighbouring Bangladesh, the sex mortality ratio is 86.4 female per 100 male deaths [5,6]. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality

Methods

Results

Discussion

Conclusion