Functional Transitions Among Older Adults in Rural China: Examining the Differential Roles of Care From Daughters' and Sons' Families.

OBJECTIVES: Informal care provided by adult children is of great importance for older adults' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters' and from sons' families. METHODS: This study utilizes the "Well-being of Elderly Survey in Anhui Province" (WESAP) from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or older. Functional status was based on the activities of daily living and the instrumental activities of daily living. We employed a random-effects ordered logit model to examine the functional transitions among the older adults. RESULTS: Receiving care from daughters' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and older, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers. DISCUSSION: Nowadays, daughters' families can provide high-quality informal care, often surpassing that offered by sons' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources.

Family and job microsystems as mediators between social integration and depression among rural-to-urban migrant workers in China: does having sons make a difference?

Background: Rural-to-urban migrant workers are a vulnerable group at risk of developing depression. Based on the social-ecological systems theory, this study investigates the impact of the lack of social integration on depression, considering the mediating roles of migrant workers' microsystems (family happiness and job burnout). Additionally, the study explores whether having sons influences these associations. Methods: The sample of 4,618 rural-to-urban migrant workers was obtained from the 2018 wave of the China Labor Force Dynamics Survey (CLDS). All the measures in the survey exhibited good reliability, including the Center for Epidemiological Research Depression Scale (CES-D), family happiness, job burnout, and social integration. The data were primarily analyzed using a structural equation model. Results: Social integration had a direct impact on depression among migrant workers. Additionally, it indirectly affected depression through the mediating roles of family happiness not job burnout. The moderating effect of having sons mainly occurred on the path from social integration to family happiness. Limitations: The cross-sectional design impeded the ability to draw causal inferences. Conclusion: This finding highlights the potential benefits of social integration and family happiness in promoting early prevention of depression among migrant workers. It indicates that the inclination toward having sons among migrant workers continues to impact their mental health.

Isolating a culture of son preference among Armenian, Georgian and Azeri Parents in Soviet-era Russia.

A basic hypothesis is that cultural evolutionary processes sustain differences between groups, these differences have evolutionary relevance and they would not otherwise occur in a system without cultural transmission. The empirical challenge is that groups vary for many reasons, and isolating the causal effects of culture often requires appropriate data and a quasi-experimental approach to analysis. We address this challenge with historical data from the final Soviet census of 1989, and our analysis is an example of the epidemiological approach to identifying cultural variation. We find that the fertility decisions of Armenian, Georgian and Azeri parents living in Soviet-era Russia were significantly more son-biased than those of other ethnic groups in Russia. This bias for sons took the form of differential stopping rules; families with sons stopped having children sooner than families without sons. This finding suggests that the increase in sex ratios at birth in the Caucasus, which began in the 1990s, reflects a cultural preference for sons that predates the end of the Soviet Union. This result also supports one of the key hypotheses of gene-culture coevolution, namely that cultural evolutionary processes can support group-level differences in selection pressures that would not otherwise occur in a system without culture.

Gendered Parenting: Maternal Son Preference and Depressive Symptoms in Chinese Early Adolescents.

This study focused on the nuanced phenomenon of gendered parenting by exploring how maternal son preference is associated with depressive symptoms among Chinese early adolescents. Focusing on 1093 junior high school students from a relatively affluent city in Western China, this study examined the mediating roles of mother-child attachment and father-child attachment as well as the moderating role of school connectedness in the relationship between maternal son preference and depressive symptoms. The results revealed a noteworthy positive correlation between maternal son preference and depressive symptoms among female adolescents, with no significant association observed in males. In addition, mother-child attachment and father-child attachment mediated the relationship between maternal son preference and girls' depressive symptoms, supporting the "spillover effect" and "crossover effect". Moreover, a moderation effect analysis indicated that a higher level of school connectedness can buffer the effect of maternal son preference on girls' depressive symptoms, while a lower level of school connectedness can enhance the effect of maternal son preference on girls' depressive symptoms. In addition, maternal son preference was negatively correlated with boys' depressive symptoms in relation to high school connectedness. These insights help enhance people's understanding of gendered parenting, emphasizing the enduring necessity of addressing son preference within the broader context of promoting gender equality.

Birth order and children's health and learning outcomes in India.

India has a high prevalence of stunting among children under five years of age, despite marginal improvement over the years. In 2019-21, 35.5 per cent of children below five years were stunted (National Family Health Survey (NFHS), 2019-21). This has been attributed to several factors including open defecation, poor maternal nutrition and food insecurity. This paper examines if the birth order of children is associated with variation in height among them, using nationally representative data from the India Human Development Survey (IHDS 2005 & 2011). The objectives of this paper are to: (i) assess the association of a child's birth order with height (ii) test if the association of birth order with height changes with the degree of son preference (iii) analyse the relationship between birth order and educational outcomes of children. Our results suggest that (i) the height-for-age z score is negatively associated with the birth order of the child (ii) the negative association of birth order with height is stronger for mothers who have a moderate or high degree of son preference, especially when children have an older brother (iii) maternal characteristics such as education could mitigate the negative relationship between birth order and height when son preference is low but not when son preference is high (iv) birth order has a negative association with the reading, writing and mathematical ability of children, especially if the child was stunted in childhood. This indicates that the fertility behaviour of families has both a direct and an indirect impact, which could influence both long term nutrition and education of children.

How does a ban on sex-selective abortions affect child health?

Bans on sex-selective abortions are typically implemented to make sex ratios more equitable, but they may have adverse effects on surviving children. We examine the impacts of a ban on prenatal sex selection in India on postnatal health outcomes. We first show that the ban increased the share of female children born to mothers, especially among firstborn female families. Strikingly, we also find that the ban led to a worsening of mortality outcomes for both girls and boys in firstborn female families. In terms of mechanisms, we find that fertility increases in firstborn female families after the ban, pointing to the following channel: firstborn female families are disproportionately affected by the ban and are more likely to use the son-biased fertility stopping rule to achieve a desired number of sons. Children in firstborn female families likely face greater competition for parental resources, which may worsen their health.

Are daughters more preferred by young people in contemporary China? Qualitative evidence from one-child generation cohorts in urban Jiangsu.

The one-child policy in China brought about a fast decline in fertility levels and an increasingly skewed sex ratio at birth in China. The deep-seated tradition of son preference has been regarded as the main cause. However, news and recent research have pointed out that having daughters appears more popular among young people in urban areas. The analysis reported in this paper was based on empirical evidence drawn from 47 in-depth interviews. Findings highlighted that regarding the preference of sex at birth, a relatively balanced composition is sought in most cases. Other than the absolute dominance of one son and one daughter together, a preference for having a son remains. Although having two daughters has gained greater popularity among young couples, this turns out to be a compromise to some extent. Daughter preference cannot be regarded as a major trend. In practice, a stronger preference for a certain sex increases the fertility rate as couples attempt to fulfil their preferences, whereas no preference signals the least likelihood to realise fertility intentions. In this sense, the desire to have two children with at least one son may help boost fertility.

The intergenerational legacy of the 1959-1961 Great Chinese Famine on children's cognitive development.

We investigate the effect of early exposure to malnutrition on the cognitive abilities of the offspring of survivors in the context of a natural experiment; i.e., the Great Chinese Famine (GCF) of 1959-61. We employ a novel dataset - the China Family Panel Studies (CFPS) - to do so. The paper finds that the cognitive abilities of children whose fathers were born in rural areas during the famine years (1959-1961) were impaired by exposure to the GCF and the negative effect was greater for girls than boys, whereas children whose mothers were born in rural areas during the famine years were not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.

Income-Nutrition Gradient and Intrahousehold Allocation in Rural Pakistan.

OBJECTIVE: To estimate the relationship between household income and child health outcomes for male and female children, aged 0-5 years, in rural Pakistan. METHOD: The study uses 2014 round of Pakistan Rural Household Panel Survey (PRHPS) and regression analyses to estimate the relationship between household income and child health outcomes for male and female children in rural Pakistan. RESULTS AND POLICY IMPLICATIONS: We find that increase in income is associated with an increase in child weight-for-age and weight-for-height z-scores, and reduction in the likelihood of a child being underweight or wasted. However, our results suggest that these gains associated with an increase in income are greater for male children as compared to female children. These differences in income-nutrition gradient can be explained by the gender-differences in consumption of health inputs (e.g., food intake, vaccinations, and nutritional supplements) associated with an increase in income. Our results indicate the need for policy instruments that can encourage an equitable resource allocation within households.

This study documents the gender bias in income-health relationship for children in rural Pakistan. Our results imply that interventions that target poverty alleviation at the household level may not have equitable impacts on all members of the household because of possible 'son-preference'. This suggests that there is a need to design gender-sensitive interventions to ensure that improvements in nutritional outcomes are shared across genders within households.

Trends in female-selective abortion among Asian diasporas in the United States, United Kingdom, Canada and Australia.

Preference for sons and smaller families and, in the case of China, a one-child policy, have contributed to missing girl births in India and China over the last few decades due to sex-selective abortions. Selective abortion occurs also among Indian and Chinese diaspora, but their variability and trends over time are unknown. We examined conditional sex ratio (CSR) of girl births per 1000 boy births among second or third births following earlier daughters or sons in India, China, and their diaspora in Australia, Canada, United Kingdom (UK), and United States (US) drawing upon 18.4 million birth records from census and nationally representative surveys from 1999 to 2019. Among Indian women, the CSR in 2016 for second births following a first daughter favoured boys in India (866), similar to those in diaspora in Australia (888) and Canada (882). For third births following two earlier daughters in 2016, CSRs favoured sons in Canada (520) and Australia (653) even more than in India (769). Among women in China outside the one-child restriction, CSRs in 2015 for second order births somewhat favoured more girls after a first son (1154) but more heavily favoured boys after a first daughter (561). Third-birth CSRs generally fell over time among diaspora, except among Chinese diaspora in the UK and US. In the UK, third-birth CSRs fell among Indian but not among other South Asian diasporas. Selective abortion of girls is notable among Indian diaspora, particularly at higher-order births.

Ethnicity, Child Sex, and the Likelihood of Marriage in Pregnancy: A Novel Analysis of Gender Inequity.

Objective: We assessed the association between fetal sex and the likelihood of marriage during pregnancy. Methods: We analyzed a cohort of 1,334,911 women who were unmarried at conception and had a live birth between 1990 and 2018 in Quebec, Canada. The exposure was fetal sex, determined by ultrasound. The outcome was marriage during pregnancy. We estimated hazard ratios and 95% confidence intervals (CI) for the association of child sex with the likelihood of marriage during pregnancy according to region of origin. Results: Among women who were unmarried at conception, 13.1% of foreign-born women got married during pregnancy compared with 2.6% of Canadian-born women. Women from the Middle East and North Africa who were pregnant with boys were 1.13 times more likely to marry during pregnancy compared with women who were pregnant with girls (95% CI 1.02-1.26). There was no association among Canadian-born women. Conclusion: Women from some cultural minorities who are pregnant with boys may be more likely to marry during pregnancy in Western settings. Gender inequality may manifest as a preference for sons that influences the likelihood of marriage.

Cultural and Social Bias Leading to Prenatal Sex Selection: India Perspective.

Globally, 23.1 million missing female births have been documented, resulting in an imbalanced sex ratio at birth (SRB) between the late 1990s and 2017, with India accounting for almost half of this missing women population. While the country is progressively taking measures to enhance women's position in society and implementing policies toward augmenting the value of a girl child, some deeply rooted cultural and social beliefs propel a strong son preference, resulting in active daughter discrimination. The continuance of patriarchal norms and inequitable gender roles, resulting in son preference, fertility decrease, and reduction in preferred family sizes, and technical breakthroughs that allow for the identification of the sex of the fetus, is all connected to distortions in the sex ratio at birth. Son preference is a well-documented phenomenon in India, and its implications for skewed gender ratios, female feticide, and higher child mortality rates for girls have piqued researchers' and policymakers' interest. The fundamental factors of son preference as an ideology are less widely investigated. With this objective, an extensive secondary review was conducted of the socio-cultural norms and biases leading to increased prenatal sex selection in India despite the laws against it. The study findings suggest that it is imperative to emphasize the necessity for consistent and collective efforts from all stakeholders: changing the social perception of the value of girls requires collective effort and the equal participation of all stakeholders, including civil society organizations and the local community.

Gender, nutritional disparities, and child survival in Nepal.

BACKGROUND: This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five. METHODS: We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender. RESULTS: We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged. CONCLUSION: While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.

Conflicts and son preference: Micro-level evidence from 58 countries.

Research on the association between armed conflict and son preference has largely been based on single-country studies, often presenting descriptive patterns. This paper empirically analyzes the association between conflict and son preference using a sample of more than 1.1 million individuals from 58 countries over the period 2003-2018. We empirically show that both the incidence and intensity of conflict exposure are associated with greater son preference. Moreover, conflict-exposed individuals are likely to realise their preference for sons, as reflected in the systematically higher prevalence of sons over daughters among these individuals. To explore the aggregate effects of these findings, we conduct a cross-country analysis of sex ratios and show that history of conflict exposure plays an important role in explaining the cross-country differences in sex ratios.

Skewed Sex Ratios at Birth in Italian Migrant Populations: Evidence from a Longitudinal Register 1999-2017.

Many studies in different settings have suggested that migrants from countries with skewed sex ratios at birth tend to adjust the sex of their offspring to ensure the birth of at least one male child. Enlarging the scope of existing research, the present study explores the phenomenon by studying the sex ratio at birth and sex selection at birth among migrants in Italy, focussing on birth order and the sex of the previous child. We perform a descriptive analysis of SRB by birth order (first, second and third), sex of the previous children, inter-birth interval and citizenship of the child. We analyse data from the Longitudinal register on reproductive histories from 1999 to 2017 (ISTAT). Results show significantly higher values of SRB for third births among Indian and Chinese communities when the first and second births are girls. A skewed SRB is also present among Indian babies born after a female firstborn. A more detailed analysis of SRBs for immigrants from China and India, by the sex of the previous children and inter-birth interval between second and third birth, did not indicate significant changes in SRB when the inter-birth interval is longer. Our study provides evidence for policymaking. However, further research is needed to address the causes of sex selection among immigrant communities. Efforts to alter gender norms and reduce son preference within communities are required to tackle gender discrimination against second-generation girls.

Son preference and sex differentials in receipt of key dimensions of children's healthcare: Evidence from Pakistan.

Almost all research on son preference and the consequent sex differentials in child health has focused on India. Pakistan-a country with the second strongest stated desire for sons, no evidence of sex-selective abortion, and relatively high fertility-offers a different context in which to understand unequal health outcomes for boys and girls. I use three rounds of the Pakistan Demographic and Health Survey to examine sex differentials in child healthcare receipt across different family contexts. I find evidence of generalized discrimination: all girls, regardless of sibling composition or birth order, are less likely to receive full immunization or medical treatment. I do not find evidence that girls with older sisters face greater discrimination than other girls. For boys, I find some evidence of selective preferential treatment: among larger families, first sons are more likely to receive healthcare than other sons or daughters.

Estimation and probabilistic projection of levels and trends in the sex ratio at birth in seven provinces of Nepal from 1980 to 2050: a Bayesian modeling approach.

BACKGROUND: The sex ratio at birth (SRB; ratio of male to female births) in Nepal has been reported around the normal level on the national level. However, the national SRB could mask the disparity within the country. Given the demographic and cultural heterogeneities in Nepal, it is crucial to model Nepal SRB on the subnational level. Prior studies on subnational SRB in Nepal are mostly based on reporting observed values from surveys and census, and no study has provided probabilistic projections. We aim to estimate and project SRB for the seven provinces of Nepal from 1980 to 2050 using a Bayesian modeling approach. METHODS: We compiled an extensive database on provincial SRB of Nepal, consisting 2001, 2006, 2011, and 2016 Nepal Demographic and Health Surveys and 2011 Census. We adopted a Bayesian hierarchical time series model to estimate and project the provincial SRB, with a focus on modelling the potential SRB imbalance. RESULTS: In 2016, the highest SRB is estimated in Province 5 (Lumbini Pradesh) at 1.102, corresponding to 110.2 male births per 100 female births, with a 95% credible interval (1.044, 1.127) and the lowest SRB is in Province 2 at 1.053 (1.035, 1.109). The SRB imbalance probabilities in all provinces are generally low and vary from 16% in Province 2 to 81% in Province 5 (Lumbini Pradesh). SRB imbalances are estimated to have begun at the earliest in 2001 in Province 5 (Lumbini Pradesh) with a 95% credible interval (1992, 2022) and the latest in 2017 (1998, 2040) in Province 2. We project SRB in all provinces to begin converging back to the national baseline in the mid-2030s. By 2050, the SRBs in all provinces are projected to be around the SRB baseline level. CONCLUSIONS: Our findings imply that the majority of provinces in Nepal have low risks of SRB imbalance for the period 1980-2016. However, we identify a few provinces with higher probabilities of having SRB inflation. The projected SRB is an important illustration of potential future prenatal sex discrimination and shows the need to monitor SRB in provinces with higher possibilities of SRB imbalance.

Son preference and health disparities in developing countries.

Recorded history demonstrates the preference for sons in every aspect of life. Today, despite being considered a powerful manifestation of gender inequality and discrimination against women, the preference for sons over daughters is still prevalent worldwide. In this study, we investigate the extent to which son preference influences health disparities between sons and daughters in 66 developing countries. We find that the differences in height-for-age and weight-for-age z-scores between daughters and their peers are 0.135 and 0.098 standard deviation lower compared to the analogous differences between sons and their peers due to son preference. Our heterogeneity analysis further shows that son preference disproportionately affects children of disadvantaged backgrounds such as those living in rural areas, born to lower-educated mothers, and coming from poor families.

Girls unwanted - The role of parents' child-specific sex preference for children's early mental development.

We propose a novel son preference measure that relates the preference to a specific child. We find child-specific son preference to be more common among later born children and in families with fewer sons. Using the novel measure and an interaction instrumental variables approach, we estimate a penalty in early mental functions for unwanted girls of 0.7 standard deviations. This penalty appears to be partially driven by discrimination against girls and partially by pampering of boys. Children's health and parental inputs do not mediate the effect from son preference to mental development. Our findings highlight the relevance of parents' attitudes for a nurturing home environment and healthy brain development.

Conceptualizing aged reproduction: genetic connectedness, son preference and assisted reproduction in North India.

In this paper, I explore the narratives on the administration of assisted reproductive technology (ART) treatments amongst ageing men and women who are past their 'reproductive prime'. I use the phrase 'past their reproductive prime' with caution as ART has the capability to resurrect the desire, quest and conception of children amongst these ageing women and men. In rural agrarian Haryana in North India, ART panders to, and provides, potent narratives for perpetuation of the patrilineage for genetic continuity through the male line. The administration of ART treatments to this particular demographic is undertaken through the 'operation' of two particular forms of discourse: the desire for genetic perpetuity, and the pursuit of sons. In this enterprise, the aged pregnant body becomes an important trope of resurrecting childless marriages, evidenced by the secrecy surrounding the use of donated sperm, and the open rejection of adoption. Through an exploration of conceptualizations of pregnancy, age and legislation in India, I present the argument that ART supports the pursuit of genetic connectedness by resurrecting the social importance of genetic connectedness through sons and the pregnant wife. In this paper, I purposely engage with elements of the study of kinship and family in South Asia to undertake an analysis of how ART is used as part of a larger social narrative around conception and pregnancy amongst older married couples.