Abstract
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The study objective was to determine the impact that sex-selective abortion has had upon gender differentials in child morbidity and mortality in India. If prenatal discrimination against girls has been substituting for postnatal discrimination, then eliminating sex-selective abortion may lead to an increase in excess female infant and child mortality. Using data from the National Family Health Survey, characteristics associated with a higher proportion of male births during the period 1977-1999 were identified by logistic regression, from which a propensity score for sex-selective abortion was calculated. Multi-level logistic regression analysis and propensity score methods were used to examine the effect of prenatal sex-selection on gender differentials in neonatal, postneonatal, and young child (ages 1-4) mortality, and in the use of preventive and curative care, and nutritional deficiency/infection co-morbidity. Male births were more likely among residents of the North, Central, and Northeast regions, and, only in the later time period, among high school educated mothers and families with no surviving sons. Births were less likely to be male in remote villages, among Muslim families, and, in the later time period, in families with no surviving daughters. Among those with the highest propensity to selectively abort female fetuses, neonatal mortality was lower for girls than boys prior to the 1990s, but the rates converged over time, and in the postneonatal period, girls were 33% more likely to die than boys, with no change over time. Child mortality was elevated for girls, and declined over time only among those with the lowest propensity for sex selection. Girls were more likely to not be fully vaccinated only among those with the highest propensity scores. Girls were 22% more likely to not receive curative care, and were 11% less likely to suffer from nutrition/infection co-morbidity, neither of which varied by propensity score. No evidence was found that the diffusion of sex-selective abortion has led to a decrease in gender differentials in infant or child mortality, health care or co-morbidity. Full enforcement of the Prenatal Diagnostic Techniques Act of 1994 is warranted to improve the sex imbalance in the juvenile population of India.
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