Gender inequities in curative and preventive health care use among infants in Bihar, India.

BACKGROUND: India has the highest rate of excess female infant deaths in the world. Studies with decade-old data suggest gender inequities in infant health care seeking, but little new large-scale research has examined this issue. We assessed differences in health care utilization by sex of the child, using 2014 data for Bihar, India. METHODS: This was a cross-sectional analysis of statewide representative survey data collected for a non-blinded maternal and child health evaluation study. Participants included mothers of living singleton infants (n = 11 570). Sex was the main exposure. Outcomes included neonatal illness, care seeking for neonatal illness, hospitalization, facility-based postnatal visits, immunizations, and postnatal home visits by frontline workers. Analyses were conducted via multiple logistic regression with survey weights. FINDINGS: The estimated infant sex ratio was 863 females per 1000 males. Females had lower rates of reported neonatal illness (odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.6-0.9) and hospitalization during infancy (OR = 0.4, 95% CI = 0.3-0.6). Girl neonates had a significantly lower odds of receiving care if ill (80.6% vs 89.1%; OR = 0.5; 95% CI = 0.3-0.8) and lower odds of having a postnatal checkup visit within one month of birth (5.4% vs 7.3%; OR = 0.7, 95% CI = 0.6-0.9). The gender inequity in care seeking was more profound at lower wealth and higher numbers of siblings. Gender differences in immunization and frontline worker visits were not seen. INTERPRETATION: Girls in Bihar have lower odds than boys of receiving facility-based curative and preventive care, and this inequity may partially explain the persistent sex ratio imbalance and excess female mortality. Frontline worker home visits may offer a means of helping better support care for girls.

Association between having no sons and using no contraception among a nationally representative sample of young wives in Nepal.

OBJECTIVE: To examine whether a lack of sons predicts non-use of contraception among young wives in Nepal. METHODS: Data were obtained from married females aged 15-24 years who participated in the Nepal 2011 Demographic and Health Survey (n=2439). Multivariate models were used to test predictions of modern contraception use with the following variables: having no sons, social inequities (wealth, education, rural residence, and caste), gender inequities (early age at marriage, spousal age, and education gaps), respondent age, parity, and geographic region. RESULTS: Most wives (79%) reported using no modern contraception. Non-use was more likely among those with no living sons (adjusted odds ratio [AOR], 1.6; 95% confidence interval [CI], 1.2-2.2), and those who married as a minor (AOR, 1.4; 95% CI, 1.02-1.9) and/or resided in a rural area (AOR, 1.6; 95% CI, 1.3-2.5). Having no daughters was negatively associated with non-use of contraception (AOR, 0.7; 95% CI, 0.5-0.9). CONCLUSION: Contraception use is not common among young wives in Nepal. It is, however, more likely among wives with sons and less likely among wives with daughters, demonstrating that son preference continues to affect contraception use among the next generation of mothers in Nepal.