Birth order and children's health and learning outcomes in India

India has a high prevalence of stunting among children under five years of age, despite marginal improvement over the years. In 2019-21, 35.5 per cent of children below five years were stunted (National Family Health Survey (NFHS), 2019-21). This has been attributed to several factors including open defecation, poor maternal nutrition and food insecurity. This paper examines if the birth order of children is associated with variation in height among them, using nationally representative data from the India Human Development Survey (IHDS 2005 & 2011). The objectives of this paper are to: (i) assess the association of a child's birth order with height (ii) test if the association of birth order with height changes with the degree of son preference (iii) analyse the relationship between birth order and educational outcomes of children. Our results suggest that (i) the height-for-age z score is negatively associated with the birth order of the child (ii) the negative association of birth order with height is stronger for mothers who have a moderate or high degree of son preference, especially when children have an older brother (iii) maternal characteristics such as education could mitigate the negative relationship between birth order and height when son preference is low but not when son preference is high (iv) birth order has a negative association with the reading, writing and mathematical ability of children, especially if the child was stunted in childhood. This indicates that the fertility behaviour of families has both a direct and an indirect impact, which could influence both long term nutrition and education of children.

The intergenerational legacy of the 1959-1961 Great Chinese Famine on children's cognitive development

We investigate the effect of early exposure to malnutrition on the cognitive abilities of the offspring of survivors in the context of a natural experiment; i.e., the Great Chinese Famine (GCF) of 1959-61. We employ a novel dataset - the China Family Panel Studies (CFPS) - to do so. The paper finds that the cognitive abilities of children whose fathers were born in rural areas during the famine years (1959-1961) were impaired by exposure to the GCF and the negative effect was greater for girls than boys, whereas children whose mothers were born in rural areas during the famine years were not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.

Conflicts and son preference: Micro-level evidence from 58 countries

Research on the association between armed conflict and son preference has largely been based on single-country studies, often presenting descriptive patterns. This paper empirically analyzes the association between conflict and son preference using a sample of more than 1.1 million individuals from 58 countries over the period 2003-2018. We empirically show that both the incidence and intensity of conflict exposure are associated with greater son preference. Moreover, conflict-exposed individuals are likely to realise their preference for sons, as reflected in the systematically higher prevalence of sons over daughters among these individuals. To explore the aggregate effects of these findings, we conduct a cross-country analysis of sex ratios and show that history of conflict exposure plays an important role in explaining the cross-country differences in sex ratios.

Gender, nutritional disparities, and child survival in Nepal

BACKGROUND

This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five.

METHODS

We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender.

RESULTS

We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged.

CONCLUSION

While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.

Skewed Sex Ratios at Birth in Italian Migrant Populations: Evidence from a Longitudinal Register 1999-2017

Many studies in different settings have suggested that migrants from countries with skewed sex ratios at birth tend to adjust the sex of their offspring to ensure the birth of at least one male child. Enlarging the scope of existing research, the present study explores the phenomenon by studying the sex ratio at birth and sex selection at birth among migrants in Italy, focussing on birth order and the sex of the previous child. We perform a descriptive analysis of SRB by birth order (first, second and third), sex of the previous children, inter-birth interval and citizenship of the child. We analyse data from the Longitudinal register on reproductive histories from 1999 to 2017 (ISTAT). Results show significantly higher values of SRB for third births among Indian and Chinese communities when the first and second births are girls. A skewed SRB is also present among Indian babies born after a female firstborn. A more detailed analysis of SRBs for immigrants from China and India, by the sex of the previous children and inter-birth interval between second and third birth, did not indicate significant changes in SRB when the inter-birth interval is longer. Our study provides evidence for policymaking. However, further research is needed to address the causes of sex selection among immigrant communities. Efforts to alter gender norms and reduce son preference within communities are required to tackle gender discrimination against second-generation girls.

Girls unwanted - The role of parents' child-specific sex preference for children's early mental development

We propose a novel son preference measure that relates the preference to a specific child. We find child-specific son preference to be more common among later born children and in families with fewer sons. Using the novel measure and an interaction instrumental variables approach, we estimate a penalty in early mental functions for unwanted girls of 0.7 standard deviations. This penalty appears to be partially driven by discrimination against girls and partially by pampering of boys. Children's health and parental inputs do not mediate the effect from son preference to mental development. Our findings highlight the relevance of parents' attitudes for a nurturing home environment and healthy brain development.

"My father told me 'child, there is no son in this house, so you should wear these boy clothes'": perspectives on gender norms, roles, and bacha posh among Afghan migrant women in Melbourne, Australia

Objectives

In Afghanistan, strong son preferences render women with lower social capital. A practice was created to overcome this gender bias, known as bacha posh, which literally translates to ‘dressing up as a boy’. This exploratory study aims to understand gender roles, identities, and experiences of Afghan women in order to understand why this cultural practice has arisen.

Design

Utilising a social constructivist approach, qualitative data was collected from Afghan migrant women in Melbourne, Australia, using semi-structured in-depth interviews (n=10) and a group discussion (n=1). The interviews were conducted in Dari, translated and transcribed to English and thematically analysed using NVivo 12.

Results

Key findings identified include the perception of an easy transition for girls to become and return from being bacha posh, community members knowing bacha posh are girls but concealing the truth to maintain family honour, and societal and familial son preferences playing a significant role in becoming bacha posh. Most participants perceived bacha posh to be an unnecessary practice, but understood that it may be an act of desperation forced upon them by the rigidity of Afghan society.

Conclusions

This exploratory analysis makes an important contribution to understanding gender roles, identities and bacha posh in Afghanistan, and is the first qualitative study exploring how gender roles and norms in Afghanistan have led to the bacha posh phenomenon. Exploring how social and gender norms and son preferences contribute to the emergency of bacha posh is critical to understand challenges faced by this group, and how these power structures influence daily living.

Investigating the Structure of Son Bias in Armenia With Novel Measures of Individual Preferences

Sex ratios at birth favoring boys are being documented in a growing number of countries, a pattern indicating that families selectively abort females. Son bias also explains why, in many countries, girls have more siblings and are born at relatively earlier parities compared with their brothers. In this study, we develop novel methods for measuring son bias using both questionnaire items and implicit association tests, and we collect data on fertility preferences and outcomes from 2,700 participants in Armenia. We document highly skewed sex ratios, suggesting that selective abortions of females are widespread among parents in our sample. We also provide evidence that sex-selective abortions are underreported, which highlights the problem of social desirability bias. We validate our methods and demonstrate that conducting implicit association tests can be a successful strategy for measuring the relative preference for sons and daughters when social desirability is a concern. We investigate the structure of son-biased fertility preferences within households, across families, and between regions in Armenia, using measures of son bias at the level of the individual decision-maker. We find that men are, on average, considerably more son-biased than women. We also show that regional differences in son bias exist and that they appear unrelated to the socioeconomic composition of the population. Finally, we estimate the degree of spousal correlation in son bias and discuss whether husbands are reliably more son-biased than their wives.

Effects of cultural transmission of surnaming decisions on the sex ratio at birth

The patriarchal tradition of surnaming a child after its father in Han Chinese families may contribute to their preference for sons, a major cause of the abnormally high SRB (sex ratio at birth) in China. This high SRB can subsequently contribute to the marriage squeeze on males of marriageable age. Encouraging matrilineal surnaming has been proposed as a strategy that could potentially reduce son preference and help to adjust the imbalance in SRB. Here, we model factors that are likely to influence surnaming decisions, including cultural transmission of parents' surnaming decisions, the cultural value of a daughter, reward given to matrilineal surnaming, and awareness of current imbalance in SRB. Mathematical and computational analyses suggest that offering a significant reward and raising public awareness of the problems inherent in an excess of marriage-age males may overcome the son preference and reduce the male-biased SRB.

Gender Discrimination and Excess Female Under-5 Mortality in India: A New Perspective Using Mixed-Sex Twins

Son preference has been linked to excess female under-5 mortality in India, and considerable literature has explored whether parents invest more resources in sons relative to daughters—which we refer to as explicit discrimination—leading to girls’ poorer health status and, consequently, higher mortality. However, this literature has not adequately controlled for the implicit discrimination processes that sort girls into different types of families (e.g., larger) and at earlier parities. To better address the endogeneity associated with implicit discrimination processes, we explore the association between child sex and postneonatal under-5 mortality using a sample of mixed-sex twins from four waves of the Indian National Family Health Survey. Mixed-sex twins provide a natural experiment that exogenously assigns a boy and a girl to families at the same time, thus controlling for selectivity into having an unwanted female child. We document a sizable impact of explicit discrimination on girls’ excess mortality in India, particularly compared with a placebo analysis in sub-Saharan Africa, where girls have a survival advantage. We also show that explicit discrimination weakened for birth cohorts after the mid-1990s, especially in northern India, but further weakening has stalled since the mid-2000s, thus contributing to understandings of how the micro-processes underlying the female mortality disadvantage have changed over time.

Son Preference and Fertility Decisions: Evidence From Spatiotemporal Variation in Korea

Using Korean data, this study investigates whether son-favoring ideas or the preference for sons affect fertility decisions. Son-favoring fertility behavior in Korea is of interest because the sex ratio at birth has recovered to a natural level after having been very skewed. To isolate the effects of the preference for sons from the effects of the surrounding environment, we compare the fertility behavior of individuals living in the same region but who were born in different regions or years. Exploiting the male-female gap in educational achievement at the parents' time and place of birth as exogenous variation in the 2000 Census Korea 2% sample, we find that the strength of son preference formed at an early age is associated with the strength of son-favoring fertility behavior as adults. Our results indicate that parents are more likely to have a third child if they happen to have only daughters as their first two children. More importantly, this tendency is stronger if parents were born in a spatiotemporal region with more skewed gender gap in educational investment. These findings are robust against various alternative specifications, including endogenous migration issues.

Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?

To investigate whether elements of Chinese culture, such as son preference, influence women's mode of child delivery, this paper analyzes how fetal sex affects C-section rates among Chinese mothers compared with Japanese mothers in the United States. It uses birth certificate data from 1990 to 2000, a period when women were routinely able to learn the sex of the fetus during pregnancy. Compared with Japanese mothers, Chinese mothers were 1 percentage point more likely to undergo C-section when giving birth to boys than when giving birth to girls. This result is robust to the addition of a rich set of controls and the restriction of the sample to infants without congenital diseases or anomalies at birth. The effects are concentrated in subgroups that are more likely to prefer sons-specifically, where both parents are Asian or where mothers are first-generation immigrants. The findings offer valuable insights for health professionals into culturally driven pregnancy behaviors among Chinese women, potentially enabling them to offer more culturally appropriate healthcare as they support women in making a healthy transition to motherhood.

Parents' son preference, childhood adverse experience and mental health in old age: Evidence from China

BACKGROUND

Son preference is an enduring phenomenon in China and may often be related to childhood adverse experiences. According to a life-course perspective, adverse experiences during a childhood period may have a long-term effect on mental health in later age. However, little is known about this relationship between parents' son preference, childhood adverse experiences and adulthood mental health in China.

OBJECTIVE

The study aims to evaluate the association of parents' son preference and individual mental health in old age in China. The mediating role of childhood adverse experiences was also estimated.

PARTICIPANTS AND SETTING

The China Health and Retirement Longitudinal Study (CHARLS) 2015 combined with CHARLS life history survey was analyzed (N = 11,666).

METHODS

Mental health was measured by a shortened modification of the Center for Epidemiologic Studies Depression scale including seven items, and higher scores indicated worse mental health status. A four-step mediating model was applied.

RESULTS

Respondents growing in families with son preference had on average 0.75 (P < 0.001) points higher on the mental health scale than their counterparts, and the effects were consistent for both males and females. Childhood adverse experiences measured by physical maltreatment, emotional adverse experiences and witnesses of inter-parent violence mediated the relationship between parents' son preference and individual adulthood mental health by 47.87%. For females, physical maltreatment and emotional adverse experiences explained the most parts of health effects of parents' son preference, whereas witnesses of inter-parent violence was the most influential mediator for males.

CONCLUSION

Parents' son preference led to adverse childhood experiences, which influenced mental health in adulthood.

Sex selection and health at birth among Indian immigrants

I use birth-certificate data for Spain to document extremely son-biased sex ratios at birth among Indian immigrants (122 boys per 100 girls), especially at higher parities. I also show that the children of Indian immigrants display poor health outcomes during infancy. For instance, almost 10% of boys with Indian parents are born prematurely, compared with 6% of boys with native parents. However, there is no evidence of a gender gap in infant health among the children of Indian immigrants. I provide evidence suggesting that the poor outcomes of Indian children at birth may be attributed to the low endowments of Indian mothers, while the absence of a gender gap may be driven by the fact that the parents who would invest less in girls are less likely to carry the pregnancies of girls to term (more likely to practice sex-selective abortion), combined with the lower cost of prenatal investments in Spain (compared with India).

Missing Time with Parents: Son Preference among Asians in the United States

We study prevalence of son preference in families of East and South Asian origin living in the U.S. by investigating parental time investments in children using American Time Use Surveys. Estimates show that East and South Asian mothers spend an additional hour of quality time per day with their young (aged 0-2 years) sons than with young daughters; son-preference in mothers' time allocation declines as children get older. East and South Asian fathers' time with young children is gender neutral. We find gender specialization in time with children aged 6-17 with fathers spending more time with sons and mothers spending more time with daughters.

Sex composition and its impact on future childbearing: a longitudinal study from urban Uttar Pradesh

Background

The sex composition of existing children has been shown to influence childbearing decision-making and behaviors of women and couples. One aspect of this influence is the preference for sons. In India, where son preference is deeply entrenched, research has normally focused on rural areas using cross-sectional data. However, urban areas in India are rapidly changing, with profound implications for childbearing patterns. Yet, evidence on the effect of the sex composition of current children on subsequent childbearing intentions and behavior in urban areas is scant. In this study, we analyze the impact of sex composition of children on subsequent (1) parity progression, (2) contraceptive use, and (3) desire for another child.

Methods

We analyze prospective data from women over a four year period in urban Uttar Pradesh using discrete-time event history logistic regression models to analyze parity progression from the first to second parity, second to third parity, and third to fourth parity. We also use logistic regression models to analyze contraceptive use and desire for another child.

Results

Relative to women with no daughters, women with no sons had significantly higher odds of progressing to the next birth (parity 1 – aOR: 1.31; CI: 1.04–1.66; parity 2 – aOR: 4.65; CI: 3.11–6.93; parity 3 – aOR:3.45; CI: 1.83–6.52), as well as reduced odds of using contraception (parity 2 – aOR:.58; CI: .44–.76; parity 3 – aOR: .58; CI: .35–.98). Relative to women with two or more sons, women with two or more daughters had significantly higher odds of wanting to have another child (parity 1 – aOR: 1.33; CI: 1.06–1.67; parity 2 – aOR: 3.96; CI: 2.45–6.41; parity 3–4.89; CI: 2.22–10.77).

Conclusions

Our study demonstrates the pervasiveness of son preference in urban areas of Uttar Pradesh. We discuss these findings for future programmatic strategies to mitigate son preference in urban settings.

The Dynamics of Son Preference, Technology Diffusion, and Fertility Decline Underlying Distorted Sex Ratios at Birth: A Simulation Approach

We present a micro-founded simulation model that formalizes the "ready, willing, and able" framework, originally used to explain historical fertility decline, to the practice of prenatal sex selection. The model generates sex ratio at birth (SRB) distortions from the bottom up and attempts to quantify plausible levels, trends, and interactions of son preference, technology diffusion, and fertility decline that underpin SRB trajectories at the macro level. Calibrating our model for South Korea, we show how even as the proportion with a preference for sons was declining, SRB distortions emerged due to rapid diffusion of prenatal sex determination technology combined with small but growing propensities to abort at low birth parities. Simulations reveal that relatively low levels of son preference (about 20 % to 30 % wanting one son) can result in skewed SRB levels if technology diffuses early and steadily, and if fertility falls rapidly to encourage sex-selective abortion at low parities. Model sensitivity analysis highlights how the shape of sex ratio trajectories is particularly sensitive to the timing and speed of prenatal sex-determination technology diffusion. The maximum SRB levels reached in a population are influenced by how the readiness to abort rises as a function of the fertility decline.

Son-biased sex ratios in 2010 US Census and 2011-2013 US natality data

If gender bias is receding, demographic manifestations of son preference should also tend to decrease. The sex composition of US children provides a key barometer of gender preference. In the 2010 US Population Census, Chinese and Asian-Indian families are more likely to have a son after a daughter, consistent with previous research. Korean-American families, by contrast, do not show this same pattern, paralleling recent declines in sex selection observed for South Korea. Non-Hispanic White families have sex ratios within the range of the biologically norm regardless of the sex composition of previous children. We corroborate the 2010 Census data with 2011-2013 birth certificate microdata, which likewise show elevated sex ratios for Chinese and Asian Indians at higher birth orders.

Old Habits Die Hard? Lingering Son Preference in an Era of Normalizing Sex Ratios at Birth in South Korea

South Korea was among the first countries to report both an abnormally high sex ratio at birth (SRB) and its subsequent normalization. We examine the role of son preference in driving fertility intentions during a period of declining SRB and consider the contribution of individual characteristics and broader social context to explaining changes in intentions. We employ data from the National Survey on Fertility, Family Health and Welfare that span 1991–2012. We find that reported son preference declined to a great extent but remained substantial by the end of the observation period, and that the intention to have a third child still differed by sex of existing children. Change in individual-level factors does not explain the decline in son preference, suggesting that broad social changes were also important. This study provides a better understanding of how son preference evolves in the post-transitional context of very low fertility.

Son Preference and Children's Housework: The Case of India

We use a nationally representative survey of Indian households (NFHS-3) to conduct the first study that analyzes whether son preference is associated with girls bearing a larger burden of housework than boys. Housework is a non-negligible part of child labor in which around 60 % of children in our sample are engaged. The preference for male offspring is measured by a mother's ideal proportion of sons among her offspring. We show that when the ideal proportion increases from 0 to 1, the gap in the time spent on weekly housework for an average girl compared to that of a boy increases by 2.5 h. We conduct several robustness analyses. First, we estimate the main model separately by caste, religion, and family size. Second, we use a two-stage model to look at participation into housework (as well as other types of work) in addition to hours. Third, we use mother's fertility intentions as an alternative measure of son preference. The analysis confirms that stated differences in male preference translate in de facto differences in girl's treatment.