Gender differences in infant survival: a secondary data analysis in rural North India

BMJ Open. 2017 Aug 11;7(8):e014179. doi: 10.1136/bmjopen-2016-014179.


Objective: To examine gender differences in infant survival on the first day of life, in the first week of life, and in the neonatal and post-neonatal periods by socio-demographic and economic variables.

Design: Secondary data analysis was performed on data from a cluster randomised trial on the effect of implementation of the Integrated Management of Neonatal and Childhood Illness programme, India.

Settings: The study setting was Palwal and Faridabad, districts of Haryana, a state in North India.

Measures: Multiple logistic regression models taking the cluster design into account were used to estimate gender differences in mortality in different periods of infancy.

Results: A total of 60 480 infants were included in these analyses. Of 4060 infant deaths, 2054 were female (7.2% of all females born) and 2006 were male (6.3% of all males born). The death rate was significantly higher in females in the post-neonatal period but not during the neonatal period. The odds of death at 29-180 days and at 181-365 days were 1.4 (95% CI 1.3 to 1.6) and 1.7 (95% CI: 1.4 to 2.0) higher in females compared with males, respectively. This increase was seen across all socio-demographic and economic strata.

Conclusion: Gender differences during the post-neonatal period are a major threat to the survival and health of female infants in India. Programmes need to identify measures that can specifically reduce female mortality.

Trial registration: Clinical trials NCT00474981.

Keywords: excess female mortality; gender; post neonatal period; rural India; socio-demographic strata.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cluster Analysis
  • Community Health Services / statistics & numerical data*
  • Educational Status
  • Female
  • Health Surveys
  • Humans
  • India / epidemiology
  • Infant
  • Infant Mortality / trends*
  • Infant, Newborn
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Program Evaluation
  • Randomized Controlled Trials as Topic
  • Rural Population / statistics & numerical data*
  • Sex Factors
  • Social Class
  • Socioeconomic Factors
  • Time-to-Treatment / statistics & numerical data

Associated data