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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 33  |  Issue : 1  |  Page : 29-37

Does gender discrimination transformed its face over few generations? exploring gender inequalities among under-6 year children in rural Haryana


1 Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
2 Centre for Community Medicine, All Institute of Medical Sciences, New Delhi, India

Date of Web Publication13-Feb-2017

Correspondence Address:
Kalaiselvi Selvaraj
Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.200089

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  Abstract 

Background: Gender differences can be in any stage in the life cycle including before birth (feticide/sex selective abortions) which have been objectively documented. This study tries to identify the gender differentials among the children which is a basic step in cascade process of female discrimination in the society. Objective: To study the gender differentials among children under 6 years in households of rural Ballabgarh, Haryana in terms of nutrition, health care seeking, social aspects and to see whether they differ by socio economic status. Methods: Two hundred households were selected purposively from four villages (50 households each) by multi stage sampling during Mar – June 2010. Pre tested interview schedule was used to assess gender differences in nutrition (breast feeding, 'z' score); in health care seeking and in social aspects (Expenditure on birth related ceremonies and toys and dresses). Differences are measured in means or proportions. Determinants of Gender differentials were identified by logistic regression. Results: Girls were breast fed for five months lesser than boys (P < 0.02). Even though occurrences of common childhood illnesses were equal between the two, expenditures incurred to treat these illnesses were more among the boys (Boys Vs girls: Rs 181.3 Vs Rs 123.9). Proportion of illnesses treated from health facilities located outside the villages was higher among the boys [boys (22.2%), girls (11.4%)]. Expenditures incurred during birth related social ceremonies were higher for boys (Rs 20311 and Rs 2487.5 respectively for boys and girls). Conclusion: In this patriarchal society, socio cultural norms have produced the gender gap which can have adverse impact on health of the female children.

Keywords: Gender differentials, health care seeking, nutrition, social determinants, social discrimination, under-5 children


How to cite this article:
Selvaraj K, Krishnan A, Gupta SK, Pandav CS. Does gender discrimination transformed its face over few generations? exploring gender inequalities among under-6 year children in rural Haryana. Indian J Soc Psychiatry 2017;33:29-37

How to cite this URL:
Selvaraj K, Krishnan A, Gupta SK, Pandav CS. Does gender discrimination transformed its face over few generations? exploring gender inequalities among under-6 year children in rural Haryana. Indian J Soc Psychiatry [serial online] 2017 [cited 2017 Jun 28];33:29-37. Available from: http://www.indjsp.org/text.asp?2017/33/1/29/200089


  Introduction Top


Gender inequalities can exist at any phase of life cycle.[1] Concept of gender is not static, it is amenable to change and it can vary between different cultures, religions, and regions.[2] Child health has both biological and behavioral components. Though biological component favors girls in the initial stages of life, behavioral component largely disfavors them, especially during their later stages of childhood period.[3],[4],[5] Gender bias is considered as identical to gender inequality. Gender inequality denotes the observable difference on particular aspect, but gender bias refers to the differences under the assumption that all persons should get equal share regardless of them being a male or female.[6] Social perceptions and values on gender, especially during childhood act as a critical step in the development of gender stereotypes.[7] In literature, South Asian region is portrayed as a typical platform for gender discrimination.[8],[9],[10] Many of the studies from South Asia have quantified the gender differentials mostly in nutrition and health care seeking. Child health includes holistic dimensions of nutrition, health care seeking, social determinants, sociocultural practices, and surrounding environment. Hence, understanding of gender differentials among children needs a comprehensive analysis of the same. Quantifying the differences by sex disaggregation of data is an essential step in gender studies.[11] More than quantitative differences, etiological process, which leads to these gender differentials, needs exploration.

From the literature review, common cross-cutting issue by which gender disparities manifested is choice of health care seeking by the parents and differential allocation of intrahousehold food distribution.[12],[13],[14],[15] Gender differences were consistently found in health care utilization, feeding patterns, and care providers attention to get the child immunized.[16],[17],[18] This existence of gender disparity in the midst of free service means that factors other than ability to pay are involved.

Strong son preference exists in North India.[19],[20],[21] To announce the birth of the son to the society, people arrange ceremonies. These ceremonies or expenditures on them, also serve as mechanisms to create or perpetuate gender stereotypism among the children. From these ceremonies, children in that household realize the value given to them. These cultural values lead to discrimination even though parents do not consciously neglect their female children compared to their sons. Status of gender differentials in Haryana: Recent census reports reveal alarming declining sex ratio in Haryana, especially child sex ratio. In 2001 and 2011, the child sex ratio in Haryana was 819 and 830, respectively, against the national figures of 927 and 914 for the corresponding years.[22] Son preference attitude and selective fertility behaviors were universal in Haryana regardless of rich or poor, urban or rural.[23],[24] Parents hesitate to invest on their daughters by calling them as “parayadhan” (someone else's asset).[25],[26] The cohort study from Faridabad district of Haryana which looked data from 2006 to 2011 observed less sex ratio at birth and high neo-natal deaths in female child among better socioeconomic groups. However, the number of child deaths (2–36 months) is more commonly reported among low socioeconomic groups. From this study, authors had opined that despite the birth of girl child was not the wanted one, the survived girls are wanted one in the high socioeconomic groups. In this study, authors have assessed the socioeconomic status by caste system, parental education, and wealth quintiles.[27]

This study was planned to estimate the gender differentials in nutrition, health care seeking, and social aspects among the under-6 year children in rural Ballabgarh, Haryana. Most previous studies have focused on one sector – nutrition, health care seeking, or social, but have not studied them together. Studying them together enables us to look at the problem more comprehensively, look at overlaps between them, etc., This study adds one more important domain of gender differentials in social aspects which mainly leads to the development of gender stereotypism among children from childhood onward. This study also attempts to identify influence of discrimination in one domain over the other and influence of parental discrimination on childhood discriminatory behavior. Up to our knowledge, the influence of parental discrimination (child's mother discriminated in nutrition, health care, and social aspects) on child's gender discrimination was not addressed in any of the previous literature. This also tries to identify the social and economic determinants of gender disparity in households as per the items considered for assessing socioeconomic status from the previous published literatures from the same region.[27] The full study looked at gender discrimination at all age groups whereas this paper focuses only on the results pertaining to children.


  Materials and Methods Top


This cross-sectional study was done in villages under Comprehensive Rural Health Services Project, Ballabgarh Block, Faridabad District of Haryana State during March 2010–June 2010. This project had a total of 28 villages. As health care seeking was also one of the domains under study, we used a sampling strategy stratified by health care facility. Among the 28 villages, two villages had primary health centers, out of which one was selected. Ten villages had subcenters and remaining 16 villages did not have any government health facilities. One village with subcenter and two villages with no health facility were selected randomly. To have a good representation of socioeconomic strata, in each village, two mohallas (groupings of houses usually based on caste) were selected – one from dominant caste (which is numerically strong and also wields the greatest economic and political power in that village) and the other from scheduled caste (represents the opposite of the spectrum and comprised disadvantaged and disempowered group) of that village. In each mohalla, 25 contiguous households were studied starting from a conveniently chosen first house resulting in a total of 200 households.

Eligible households were defined as households which had at least one male and one female pair in the following age group: Children 0–6 years, adolescents 10–19 years, adult 25–45 years, elderly 60 years, or more. For analysis purpose of this paper, households which had both a boy and a girl in the 0–6 years age group were considered. These 200 households contributed to 55 pairs of children <6 years.

In case more than two children were found in the same household, one boy and girl with closer birth interval was selected. Children belonging to different biological parents were excluded from the study even if they resided in the same house. In the same household, as a part of the larger study, gender differentials among their parents in the same three domains were studied using a separate set of variables such as nutrition (frequency of consumption of fruits and vegetables, dietary supplements, physical activity, and anthropometry), health care seeking (type of health facilities and health care expenditures), and social aspects (household decision-making process).

Data collection

Data were collected during house visits by using pretested interview schedule in Hindi. Caste, education, and occupation status of parents were collected. Color of the ration card was used to determine the level of poverty. If the respondent showed either red or yellow card, economic status was classified as below poverty line. Mother of the child was usually the informant. Age of the children was taken as reported by mother. Nutrition aspects of the children were assessed by feeding practices and anthropometry. Child height (length in infants) was measured by SECA scale with 5 mm accuracy. Child's weight was measured from Salter's scale with 100 g of accuracy. In health care seeking, occurrence of common childhood illnesses (acute respiratory illnesses, fever, and diarrhea), choice of the health care providers, and health care expenditures were studied for both outpatient as well as inpatient visits. Recall period was taken as 3 months and 2 years for outpatient and inpatient care, respectively. Illnesses were measured at child level. Health-seeking behavior and expenditures are measured at episodes of illnesses. In the social aspects, nature of ceremonies conducted within 1 month of birth and expenditures incurred for those ceremonies were asked for. Expenditure on dresses (in the past 6 months) and for toys (in the past 3 months) was also enquired.

Informed written consent was obtained from the informants before starting interview. This study was approved by the Ethics Committee of All India Institute of Medical Sciences, New Delhi.

Statistical analysis

Data were entered in Epi Info version 3.3.2 (Centers for Disease Control and Prevention, Atlanta, USA) and analyzed in Stata version 11 (Stacorp, Texas, USA). This study estimates the gender differentials quantitatively followed by the exploration of quantitative difference, which is an accepted concept of doing gender analysis. Z score for nutrition was calculated according to National Center for Health Statistics (NCHS) standards by using Epi Info ™ Nutcal.

This study assesses gender discrimination at aggregate and household level.

Aggregate differences between two sexes for individual continuous variables under each of the three domains were analyzed either by Wilcoxon rank-sum or t-test depending upon the distribution. Difference in health care seeking process and choice of the health care providers were analyzed by difference in proportions.

For each of the domains, the questions were summated to get a domain score. Each variable had a score of 0–2. The Cronbach alpha was satisfactory (0.70) for items in nutrition; hence, we calculated the domain score by summating individual items' score. For example, nutrition score was calculated from all five nutrition-related variables (initiation of breast feeding after birth, duration of exclusive breast feeding, duration of breast feeding, mean weight for age, and mean height for age). Thus, total nutrition score ranged between 0 and 10.

Household level

In the study design, one boy and one girl from the same household were included. Hence, gender differentials are reported for each domain by taking household as the unit of analysis. This was done by comparing the domain score between the two sexes in the same household. This difference in domain score was then divided by the standard error of difference to get Z scores. For example:

Household Z score (nutrition) = (Nutrition score for boy − Nutrition score for girl)/Standard error difference in mean nutrition score

Similarly, mean total health care expenditure was taken as a single summative or proxy indicator for health domain and expenditure on ceremonies, dresses, and toys was taken as a single summative or proxy indicator for social domain. If the Z score value exceeded two, in that household, it was taken as the presence of significant gender disparity in that household for that domain. Similarly, among the parents also, nutrition score and social decision-making scores were calculated.

Determinants of intrahousehold gender disparities

To assess the socioeconomic determinants of the gender difference at household level, a logistic regression analysis was performed. Based on the household level assessment, households were coded as gender disparity absent - 0 and present - 1. The predictor variables were caste, poverty level, parental literacy, discrimination in other domains, and finally discrimination noted at parent level in the same domains. Socioeconomically deprived (schedule caste, below poverty line, illiterate mother/father, and daily wagers) were taken as reference categories. If there was discrimination in any of the other two domains, it was coded as positive. While comparing gender discrimination with parental discrimination in the corresponding domain, three categories were made as follows: Mother's status favorable - 0, no discrimination - 1, and adverse for women - 2. Adjusted odds ratios (OR) were estimated with 95% confidence interval using Stata version 11.


  Results Top


Sample characteristics

A total of 55 pairs of children were studied, out of which 35 pairs were from scheduled caste and 20 were from dominant caste. Six pairs of children belonged to families below poverty line. One-fourth of the mothers were illiterate and one-fourth of the mothers were literate up to tenth class. Fathers of more than 30 pairs (55%) of children had studied beyond 10th class, only fathers of five pairs (9%) were illiterate. One-fifth of the children's fathers were farmers and more than one-third of them were daily wagers whereas more than 95% of mothers were homemakers. Out of 55 pairs of children, three adult male (father of the child) were not able to contact even after the fourth visit. Hence, multivariate analysis on parental discrimination has been limited to 52 pairs instead of 55. Mean age of both boys and girls were comparable (boys: 46 months girls: 43.5 months P > 0.05). Though boys' mean age was higher than girls' age, the mean age difference between the siblings when girl is elder was 22.6 ± 12.0 months and it was 32.5 ± 15.9 months when the boy was elder. Twenty boys were elder than their paired sisters. Mean difference in age between siblings was 32.5 ± 15.5 months.

[Table 1] describes the gender differentials in the three domains studied – nutrition, health care seeking, and social aspects.
Table 1: Gender differentials among children under 6 years

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Gender differentials in nutrition

Even though breast feeding was initiated sooner in boys (by 1.2 hours, mean delay in initiation of breast feeding after birth among boys: 6.2 hours) and were exclusively breast fed longer (by 1 month, mean duration of exclusive breast feeding among boys: 5.6 months), these differences were not statistically significant. Boys were breast fed for significantly longer duration (by 5 months, mean duration of breast feeding among boys: 20.4 months) compared to their sisters (P = 0.02). The mean Z score was negative for both boys and girls indicating overall poor nutritional status of both boys and girls in this community. As per the NCHS standards, 36 (65.4%) boys and 35 (63.6%) girls were malnourished (Z score >−2) according to “weight for age” classification. This included 19 (34.5%) boys and 21 (38.2%) girls who were severely malnourished (Z score <3). According to “height for age” classification, 25 (45.5%) boys and 19 (34.4%) girls were malnourished (including 9 (16.4%) boys and 12 (21.8%) girls who were severely malnourished).

Gender differentials in health care seeking

Out of 55 boys, 28, 36, and 31 had at least one episode of diarrhea, acute respiratory illnesses, and fever, respectively, in the last 3 months. Among 55 girls, 24, 35, and 35 had at least one episode of these above-mentioned illnesses, respectively, in the same period. Overall, 55 boys and girls contributed to 85 and 87 treatment-seeking visits, respectively. There were no significant differences by sex among children <6-year-old in terms of prevalence of common childhood illnesses and their treatment-seeking, which was consistently high. Private health facilities within the village were the main source of care for both boys and girls. While health facilities outside the village were more likely to be used for boys (22.2% vs. 11.4%), this was not statistically significant. The mean outpatient health care expenditure was more for boys, but not significantly so. Higher numbers of boys were admitted in hospital in the last 2 years as compared to girls (11 among boys vs. 5 among girls), but this was not statistically significant, probably owing to smaller numbers. This was despite a similar rate of illness requiring outpatient treatment. Majority of the children were admitted in private health facilities situated outside the village. None of the children were admitted in health facilities inside the village, mainly because the villages studied did not have such facilities. Health care expenditure was more than 3 times higher for boys. This was due to an outlier in a small sample and was not statistically significant.

Gender differentials in social aspects

Frequency of observing ceremonies related to birth was similar for both boys and girls. The proportion of boys who had birth-related ceremonies was 76.4% as compared to 69.1% among girls (P > 0.05). Ceremonies other than those related to birth were also similar (50.9% vs. 34.5%; P > 0.05). However, the nature and scale of the ceremonies were different. While Kuva poojan, Jasot Tan, and Jagren, which express gratitude to God for granting the wish, were done only for boys, purification ceremonies such as Chatti and Havan were more likely for girls. It is likely that purification ceremony, which is prescribed by religion, is done for all births. However, these were not specifically mentioned for boys. The scale of ceremony depends upon the type of ceremony, number of priests, and number of guests invited. It was seen that the scale of ceremonies, as measured by expenditure on it, was almost 8 times higher in case of boys as compared to girls (P < 0.00001). There were no statistically significant differences in terms of expenditures on dresses and toys for boys and girls among children <6 years.

[Table 2] describes overall gender differentials in the domains of nutrition, health care seeking, and social aspects.
Table 2: Gender differentials in total domain score among under-6 year children

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Gender differentials at household level

Out of these 55 households, 12 households did not report gender disparity in any of the three domains studied [Table 3]. Forty-three households showed significant gender disparity in at least one of the three domains. Within the households which revealed significant disparity, one-third of the households presented significant disparity in two or all of the three domains indicating concurrent occurrence of gender disparities in various dimensions. Among the 55 households, in 24 households (43.6%), there was a significant gender disparity in nutrition. Thirteen households (23.6%) had significant disparity in health care seeking. Twenty-four households (43.6%) reported significant disparity in social aspects.
Table 3: Significant gender differentials in intrahousehold level among children under 6 years

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Determinants of gender disparities

The households which had a mother who was educated beyond primary school were significantly more (OR 11.6; 1.02–131.4) likely to report a gender disparity in nutrition [Table 4]. There were indications that households with higher paternal literacy, regular occupation, and dominant caste were less likely to have gender disparity and households with gender disparity in other domains and at parental level were more likely to have gender disparity in children. However, these were not statistically significant, probably owing to small sample size.
Table 4: Determinants of gender differentials at household level

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The data for health care-related gender disparities show that girl children belonging to households of dominant caste had significant disparity compared to their brothers (OR 5.33; 1.08–26.2). Girl children who had a father with a regular income had higher likelihood of having gender disparity as compared to their brothers. In comparison, opposite findings were observed when father was literate and household belonged to above poverty line. Girl child of literate father and above poverty line families had lesser disparity in health care. Yet except caste, none of the other determinants were statistically significant. In other words, the study shows that higher the socioeconomic status, more is the likelihood of a larger gender differential in health care expenditure.

Children in households where father was better off in education were more likely to face gender discrimination on social aspects as well as if there was gender disparity in the other two domains in those households. Households which were not poor were less likely to report gender discrimination in social aspects [Table 4].

It appears that mothers who were sensitized by facing discrimination themselves and empowered by education could result in lower gender discrimination in children. However, that was not true for nutrition where mothers were more likely to be able to influence directly.


  Discussion Top


This community-based house-to-house study reports gender differentials among under 6-year children in nutrition and health care seeking for common childhood illnesses. The study used age-controlled pairs within each family to look at the gender differentials. This resulted in more pairs from scheduled caste group, probably due to higher fertility rate in them. Even National Family Health Survey-III (NFHS III), Haryana report also reflected the same by reporting total fertility rate among scheduled caste and dominant caste as 2.9 and 2.5, respectively.[28] The age difference between siblings was found to be less when girl was elder (mean age difference between siblings: The girl was elder: 22.6 ± 12.0 months vs. the son was elder: 32.5 ± 15.5 months). This indirectly shows the pressure to have the next child soon when the girl child was born.

This study found that there was no gender difference in the time of initiation of breast feeding (boys 6.2 h, girls 7.4 h). Some local customs tended to delay the initiation of breast feeding; however, these customs were common for both genders. Increasing trend of institutional deliveries could also blunt any gender differences as such customs are difficult to follow in hospitals, and hospital staff is expected to counsel them to initiate breast feeds at the earliest. This study found that 18.2% of boys and 16.4% of girls were breastfed within ½ h. This is consistent with NFHS III Haryana report which reports that 18.7% and 20% were breast fed within ½ h among the male and female children, respectively.[28] Contrary to NFHS III report, a study by Pal and Chaudhuri from West Bengal had reported 26.7% and 18% of breast feeding initiation within ½ h of birth among boys and girls, respectively.[29] The initiation of breast feeding is associated with special customs such as washing of breast by father's sister. These cultural practices are strictly followed in majority of the families in case of male babies, but this was not the case for females. The attitude of the people was further evident by the amount of gift received by the aunt for washing the breasts. For girls, it was hardly more than 100 rupees, whereas for almost all boys, they receive gold jewels. Recall bias of ½–1 h, postpartum health status of the mother (episiotomy given), and untoward events such as postpartum hemorrhage followed by a referral to another health facility can also result in delayed initiation of breast feeding, though these were not studied. This study noted a 1-month difference in median duration of exclusive breast feeding (6 months among boys and 5 months among girls). The probable reason could be that in this predominantly agricultural community, females tended to return to their field work at the earliest. After delivery, the working women are likely to start weaning early compared to a woman who is getting adequate rest after the delivery. Women reported in a lay language that “delivered mothers are given adequate rest to nurture the child, especially if it is a son.” In addition, son preference means that there is family pressure for the next child soon after a female child. Hence, they start complementary feeding earlier. At national level, the reported duration of exclusive breast feeding among boys and girls was 2.1 and 1.9 months, respectively. Even though the direction of gender gap was consistent with NFHS, the reported duration was high in this study. This could be because of intensity of intervention by health staff. This study also found out a 5-month difference in the total duration of breast feeding (boys: 20.4 months, girls: 15.1 months). Again, this gender gap is consistent with the study reported by Pal and Chaudhuri and other national reports, even though the duration of gender gap reported was 2 months in those studies.[29] This study had covered the age of 0–6 years children and recall bias, while reporting duration of breast feeding is a possibility. However, since the age distribution was equal for both the sex, the effect of this bias would get nullified. In contrast to other studies which found out higher prevalence of malnutrition among girls, this study did not find any gender differentials in malnutrition. Analysis of mean nutrition score across sub groups also showed decreasing gender differentials among socioeconomically better off. Previous studies which reported gender differentials were done more than a decade back and studied difference in the preference of food varieties given to male child.[12],[13],[14],[15] Anyway, we did not focus on energy intake or type of food in this study.

In the present study, equal occurrence of acute respiratory disease and diarrhea was reported among boys and girls. This is also consistent with other studies. The proportion of under-5 children treated for these illnesses was also comparable (more than 80% in both the gender). However, the gender gap was noted in the quality of health care they received. While both of them were usually treated by local private health care providers (boys [71.8%], girls [75.9%]), the difference was seen on treatment by home remedies (boys [4.7%], girls [9.2%]). Boys (22.2%) were taken to health facilities outside the village more as compared to girls (11.4%). This shows parents were ready to take their sons for treatment even outside the villages where expenditures were likely to be higher. Even if the girl child was taken to a hospital outside the village, most of the time, it was when her condition became serious. Thus, while for boys it was a privilege to get earlier cure, for girls it was only if it was a dire necessity to prevent death. The total medical expenditures spent on outpatient illnesses were 1.5 times higher for boys. This was consistent with a study in Punjab by Gupta who reported medical care expenditures which was 2 times higher for male children.[14] Other studies also reported poor quality of care received by female children.[13],[14],[30],[31] Evidence including the present study had shown that the occurrence of common illness was comparable between the genders.[14],[32] This being equal, the number of admissions is also expected to be equal between them if severity is also similar. Contrary to this, the number of admission was lesser among girls (number of admissions in boys-11, girls-5). Because of the above-said reasons, the medical care expenditures were higher among boys. This lesser amount of admissions among girls was also confirmed from hospital admission records. The hospital studies, say rate of female children admission was only 66% of male admissions.[33],[34] Health care expenditures for inpatient admissions were also less (88% of expenditure on boys). El Arifeen et al. had also reported from Bangladesh that the number of admissions was higher among boys (male: 0.068/child-year, female 0.041/child-year).[31] The reason for higher number of admissions among boys from this study was thought to be due to high perceived threat among caregivers, especially for male children.

In this patriarchal society, sons are considered as a boon to the family. The observance of ceremonies such as Jasot Tan, Jagren, and Kuva poojan only for boys is a reflection of that. However, all these expensive ceremonies were conducted only for the male child of first birth order, regardless of previous female child. Hence, in these ceremony expenditures, birth order could be a possible confounder. But, these differences remain even after stratification. None of the first-order female children had these ceremonies. The male children who did not have these ceremonies either belonged to scheduled caste or below poverty line. The reasons were either financial constraints or the child was hospitalized.

Gender differentials across the socioeconomic categories

As expected, in nutrition, gender differentials were more in the background of resource constraints such as scheduled caste, father's illiteracy, and no permanent income. In this predominant patriarchal society, scarce resources are spent for male children that could result the observed discrimination in this nutrition domain. Paradoxically, gender discrimination was seen more among mothers who are more educated. Though the literacy is better, this did not lead to any income generation and active decision making among women. The study report by Anand et al. reported more child mortality in low socioeconomic groups such as scheduled caste, low parent literacy, and low wealth index. Some studies even demonstrated “U-shaped relationship” between female education and sex ratio. Authors opined that improvement of women's education less than higher secondary school may not help in improving sex ratios; it can result in favored change when the education is attained up to college level.[27] The same phenomena can explain the more child gender discrimination observed even among the more educated mothers in this study.

In contrary to the observation for nutrition, in health care expenditure, the differentials were more in dominant caste, literate mother, literate father, and father's permanent income job. This could be due to utilization of private facilities located outside the village among these groups, especially for male children.

In this study, the social domain among children was assessed mainly from expenditures incurred for ceremonies. These observances of ceremonies are followed strictly in dominant caste, but not so in scheduled caste. Majority of the child's fathers from dominant caste had attained more than higher secondary education and permanent job with regular income. Hence, more gender discrimination in social domain was observed among dominant caste, families which had fathers' literacy beyond higher secondary, and fathers' occupation as government job.

Concurrent occurrence of gender discrimination in multiple domains explains the complex phenomena of gender differentials where more than paying capacity is involved in causing these gender differentials.

Gender discrimination among children in nutrition domain was more when the mother was also discriminated in nutrition. Though woman is discriminated in nutrition, factors such as family support and enough rest given during postpartum period when the male child is born will facilitate breast feeding and anthropometry among male children. In contrast to this, girl child is less likely to be discriminated in social domain when the mother is in disadvantaged position in the social domain. However, these observations could not achieve statistical significance in this study due to smaller sample size.

Small sample size in some of the analysis such as health care expenditures precluded achieving statistical significance. Considering these smaller sample size and complexities in carrying out cluster adjusted logistic regression analysis, we did not attempt any multi-level modeling to give cluster-adjusted estimates. Recall bias and social desirability bias cannot be excluded in these kinds of studies. Some trivial illnesses which were managed in outpatient care settings in the past 3 months would have been missed by mothers. There are inherent complexities in measuring the gender difference, and no composite indicators are available. To simplify the discrimination under one domain, variables in that domain were assigned a score, which was a simplistic approach. Tools used in this study need further validation. As the study required presence of two children of different gender in the family, this automatically exclude families with one child and those with same sex children. This study reports gender differentials within the same household by taking matched pairs in a particular age group. Hence, it automatically adjusted for confounders. While, previous studies report gender differentials in particular variables or domains, this study includes comprehensive set of variables which finds a way to explore an association of gender differentials between the domains.


  Conclusion Top


In this study, in almost all aspects (feeding practices, malnutrition, health care seeking, and social ceremonies), gender differentials were observed. These are mostly adverse for girls. However, reliance on statistical significance masked some of the existing differentials. Introduction of any child-related social security schemes, welfare and development projects has to consider these underlying factors in their gender main streaming exercise. Our study supports the existing evidence of poor quality of health care and lower health care investment provided to girl children. The main aim of this study was to report gender differentials in this community and to get some insight on process causing them not to generalize our results.

Acknowledgment

Author acknowledges help rendered by field workers during data collection process. Authors also acknowledge co-operation provided by parents of under-6 year children participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sen A. The many faces of gender inequality. New Repub 2001;17:35-9. Available from: http://www.prof.chicanas.com/readings/SenInequality.pdf. [Last accessed on 2015 Jun 05].  Back to cited text no. 1
    
2.
WHO|What Do We Mean by “Sex” and “Gender”? N.d. WHO. Available from: http://www.who.int/gender/whatisgender/en/. [Last accessed on 2015 Jun 27].  Back to cited text no. 2
    
3.
Khoury MJ, Marks JS, McCarthy BJ, Zaro SM. Factors affecting the sex differential in neonatal mortality: The role of respiratory distress syndrome. Am J Obstet Gynecol 1985;151:777-82.  Back to cited text no. 3
    
4.
D'Souza S, Chen LC. Sex differentials in mortality in rural Bangladesh. Popul Dev Rev 1980;6:257-70.  Back to cited text no. 4
    
5.
Stevenson DK, Verter J, Fanaroff AA, Oh W, Ehrenkranz RA, Shankaran S, et al. Sex differences in outcomes of very low birthweight infants: The newborn male disadvantage. Arch Dis Child Fetal Neonatal Ed 2000;83:F182-5.  Back to cited text no. 5
    
6.
Pal M, Bharati P, Ghosh B, Vasulu TS. Gender and Discrimination: Health, Nutritional Status, and Role of Women in India. New Delhi, India: Oxford University Press; 2011. Available from: http://www.econpapers.repec.org/bookchap/oxpobooks/9780198076643.htm. [Last accessed on 2015 Jun 28].  Back to cited text no. 6
    
7.
Neff KD, Cooper CE, Woodruff AL. Children's and adolescents' developing perceptions of gender inequality. Soc Dev 2007;16:682-99.  Back to cited text no. 7
    
8.
Fikree FF, Pasha O. Role of gender in health disparity: The South Asian context. BMJ 2004;328:823-6.  Back to cited text no. 8
    
9.
Abeykoon AT. Sex preference in South Asia: Sri Lanka an outlier. Asia Pac Popul J 1995;10:5-16.  Back to cited text no. 9
    
10.
Filmer D, King EM, Pritchett L. Gender Disparity in South Asia: Comparisons Between and Within Countries. Washington DC: World Bank Publications; 1998.  Back to cited text no. 10
    
11.
WHO|Global Health Cluster Guide N.d. WHO. Available from: http://www.who.int/hac/global_health_cluster/guide_glossary_of_key_terms/en/. [Last accessed on 2015 Jun 28].  Back to cited text no. 11
    
12.
Basu AM. Is discrimination in food really necessary for explaining sex differentials in childhood mortality? Popul Stud 1989;43:193-210.  Back to cited text no. 12
    
13.
Chen LC, Huq E, D'Souza S. Sex bias in the family allocation of food and health care in rural Bangladesh. Popul Dev Rev 1981;7:55-70.  Back to cited text no. 13
    
14.
Gupta MD. Selective discrimination against female children in rural Punjab, India. Popul Dev Rev 1987;13:77-100.  Back to cited text no. 14
    
15.
Miller BD. Social class, gender and intrahousehold food allocations to children in South Asia. Soc Sci Med 1997;44:1685-95.  Back to cited text no. 15
    
16.
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06, India. Mumbai: IIPS; 2007.  Back to cited text no. 16
    
17.
Pande RP. Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings. Demography 2003;40:395-418.  Back to cited text no. 17
    
18.
Arokiasamy P. Regional patterns of sex bias and excess female child mortality in India. Population (Engl Ed) 2004;59:831-63.  Back to cited text no. 18
    
19.
Kishor S. May god give sons to all: Gender and child mortality in India. Am Sociol Rev 1993;58:247-65.  Back to cited text no. 19
    
20.
Bhan G, Bhandari N, Taneja S, Mazumder S, Bahl R; Zinc Study Group. The effect of maternal education on gender bias in care-seeking for common childhood illnesses. Soc Sci Med 2005;60:715-24.  Back to cited text no. 20
    
21.
Pandey A. Gender Differences in Early Childhood Feeding Practices: Rural West Bengal. Gender and Discrimination: Health, Nutritional Status and Women in India. New Delhi: Oxford University Press; 2009.  Back to cited text no. 21
    
22.
Census India; 2011. Available from: http://www.censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_N.d. [Last accessed on 2015 Jun 28].  Back to cited text no. 22
    
23.
Arnold F, Choe MK, Roy TK. Son preference, the family-building process and child mortality in India. Popul Stud 1998;52:301-15.  Back to cited text no. 23
    
24.
Mutharayappa R. Son Preference and Its Effect on Fertility in India. Mumbai, India: International Institute for Population Sciences and Honolulu: East-West Center; 1997. Available from: http://www.scholarspace.manoa.hawaii.edu/handle/10125/3475. [Last cited on 2015 Dec 14].  Back to cited text no. 24
    
25.
Rajeshwari. Gender bias in utilisation of health care facilities in rural Haryana. Econ Polit Wkly 1996;31:489-94.  Back to cited text no. 25
    
26.
Jatrana S. Explaining Gender Disparity in Child Health in Haryana State of India. Asian MetaCentre for Population and Sustainable Development Analysis; 2003. Available from: http://www.populationasia.org/Publications/RP/AMCRP16.pdf. [Last accessed on 2012 Jun 28].  Back to cited text no. 26
    
27.
Krishnan A, Dwivedi P, Gupta V, Byass P, Pandav CS, Ng N. Socioeconomic development and girl child survival in rural North India: Solution or problem? J Epidemiol Community Health 2013;67:419-26.  Back to cited text no. 27
    
28.
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), India, 2005-06: Haryana. Mumbai: IIPS; 2008.  Back to cited text no. 28
    
29.
Pal I, Chaudhuri RN. Gender inequalities while rearing of children under 5 years in a rural area of West Bengal. Indian J Community Med 2007;32:215.  Back to cited text no. 29
  Medknow Journal  
30.
Larson CP, Saha UR, Islam R, Roy N. Childhood diarrhoea management practices in Bangladesh: Private sector dominance and continued inequities in care. Int J Epidemiol 2006;35:1430-9.  Back to cited text no. 30
    
31.
El Arifeen S, Baqui AH, Victora CG, Black RE, Bryce J, Hoque DM, et al. Sex and socioeconomic differentials in child health in rural Bangladesh: Findings from a baseline survey for evaluating Integrated Management of Childhood Illness. J Health Popul Nutr 2008;26:22-35.  Back to cited text no. 31
    
32.
Ganatra B, Hirve S. Male bias in health care utilization for under-fives in a rural community in western India. Bull World Health Organ 1994;72:101-4.  Back to cited text no. 32
    
33.
Khilnani P, Sarma D, Singh R, Uttam R, Rajdev S, Makkar A, et al. Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit. Indian J Pediatr 2004;71:587-91.  Back to cited text no. 33
    
34.
Shahab N. Analysis of pediatric medical admission pattern to a tertiary care hospital: Issues for future planning. Ann Pak Inst Med Sci 2010;6:219-22.  Back to cited text no. 34
    



 
 
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