Excess under-5 female mortality across India: a spatial analysis using 2011 census data

Area of Science:

• Global Health
• Demography
• Public Health

Background:

• Excess female mortality contributes significantly to the global 'missing women' phenomenon.
• Avoidable deaths of women disproportionately occur in childhood, especially in India and China.

Purpose of the Study:

• To estimate excess female under-5 mortality rate (U5MR) across India's states and districts.
• To identify factors associated with excess female mortality at the district level.

Main Methods:

• Utilized the summary birth history (Brass) method to derive district-level U5MR estimates by sex from 2011 census data.
• Employed spatial and statistical analyses, referencing data from 46 countries without gender mortality bias, to assess excess female mortality correlates.

Main Results:

• India experienced an excess female U5MR of 18.5 per 1000 livebirths (2000-2005), equating to approximately 239,000 excess deaths annually.
• Over 90% of districts showed excess female mortality, with northern states (Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh) accounting for two-thirds of the total.
• Low economic development, gender inequity, and high fertility were key predictors; spatial analysis revealed clustering of postnatal discrimination against girls.

Conclusions:

• Gender bias significantly impacts mortality in India, necessitating targeted interventions for postnatal sex discrimination.
• Focus on northern districts is crucial, as these areas are most affected by postnatal discrimination, distinct from regions with skewed sex ratios at birth.