1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

Reduction of mortality in children younger than 5 years of age (U5MR) is a key aspect of the United Nations Sustainable Development Goals (SDG 3.2). There is continuing concern about gender bias in the deaths of young children, with evidence that excess girl child mortality continues to be prevalent in low- and middle-income countries, most commonly in China and India. Excess mortality in girl children under 5 years of age may be defined as the estimated deficit of women in countries with a suspiciously high proportion of female deaths (Guilmoto, Saikia, Tamrakar, & Bora, 2018). Gender bias is of great concern globally (Costa, da Silva, & Victora, 2017). Gender differences in mortality are not due to biological differences in the sexes, but rather other factors including lack of health-seeking behaviors engaged in by families and the withholding of family resources such as food for young girls.


The issue is complex and multilayered. In many countries, there are incomplete registration data available and therefore indirect estimates may be inaccurate. Studies have been done on prenatal mortality rates related to selected abortion based on fetal gender. Less information is available on gender differences in newborn and under-5 female mortality. Tragic discrimination often means that families may fail to access healthcare for their young daughters, resulting in treatment deficits and unequal food allocation, with preference given to feeding sons.


Female child mortality varies widely within the country, regions, states, and districts. In India as a whole during 2000-2005, excess female U5MR was 18.5 per 1,000 live births, with an estimated 239,000 excess deaths of girl children each year. Between 2000 and 2005, researchers concluded that 178,100 out of 13 million girls born in India died due to childhood gender discrimination (Guilmoto et al., 2018). The highest rates of excess female U5MR are found primarily in four states in northern India: Uttar Pradesh (U5MR in females 30.5 per 1,000 live births), Bihar (U5MR in females 28.5 per 1,000 live births), Rajasthan (U5MR in females 25.4 per 1,000 live births), and Madhya Pradesh (U5MR in females 22.1 per 1,000 live births) (Guilmoto et al.). These states have residents with low education levels, high-density populations, low socioeconomic development, and higher rates of fertility. Researchers concluded that predictors of excess U5MRs include gender inequity related to cultural and religious traditions, low financial resources, and high fertility rates (Guilmoto et al.). Large states in India showing the least evidence of excess female U5MRs include Maharashtra, West Bengal, and Tamil Nadu (Guilmoto et al.).


Reported findings in recent studies (Bhutta, 2016; Guilmoto et al., 2018) are of deep concern. Recommendations are as follows:


* Systematically monitor differences in under-5 child mortality rates by gender through mapping the geography of child mortality (Bhutta, 2016)


* Conduct qualitative studies documenting the distribution of family resources (often unequitable and hidden), with identification of the cultural and religious reasons for gender preference


* Strengthen creative initiatives that promote the social and economic development of women such as microcredit projects


* Empower women through educational initiatives


* Address this issue from a gender perspective in global health policy discussions on this topic, which is essential as excess female U5MR has a profound impact on the achievement of SDGs as well as the tragic loss of the lives of girl children.





Bhutta Z. A. (2016). Mapping the geography of child mortality: A key step in addressing disparities. The Lancet. Global Health, 4(12), e877-e878. doi:10.1016/S2214-109X(16)30264-9 [Context Link]


Costa J. C., da Silva I. C. M., Victora C. G. (2017). Gender bias in under-five mortality in low/middle-income countries. BMJ Global Health, 2(2), e000350. doi:10.1136/bmjgh-2017-000350 [Context Link]


Guilmoto C. Z., Saikia N., Tamrakar V., Bora J. K. (2018). Excess under-5 female mortality across India: A spatial analysis using 2011 census data. The Lancet. Global Health, 6(6), e650-e658. doi:10.1016/S2214-109X(18)30184-0 [Context Link]