Differential Sex Trends in Infant, Neonatal, and Child Mortality Before and After Decentralization in Pakistan

Differential sex child mortality is an important indicator of gender-based discrimination. Decentralization refers to the distribution of power from the federal to the provincial governments in Pakistan. Present research highlights the sex differential sex trends in infant, neonatal, and child mortality before and after decentralization.

The research utilizes the four waves of the Demographic and Health Survey from 1990 to 2018, applying Cox proportional regression in STATA. The sample size includes 164 005 total live births and 24 089 deaths across all years, with 8204 neonatal, 5107 infants, and 11 778 child deaths.

This study provides crucial insights into the gendered patterns of neonatal, infant, and child mortality in Pakistan before and after key policy reforms. This study reveals persistent gender disparities in neonatal, infant, and child mortality in Pakistan before and after policy reforms. While girls initially had a biological survival advantage, this diminished at higher birth orders, where they faced increased mortality risks. Despite some improvements post-reform, gender-based discrimination and son preference continue to disadvantage female children, particularly in larger families.

The findings highlight the need for targeted policies to address healthcare inequities and discriminatory practices. Strengthening gender-sensitive interventions is crucial to improving female child survival and achieving long-term progress in reducing mortality disparities.