Guilmoto CZ, et al. - Researchers attempted to determine excess female under-5 mortality rate (U5MR) for India's 35 states and union territories and 640 districts. They reported that the considerable effect of gender bias on mortality in India highlighted the requirement for more proactive engagement with the issue of postnatal sex discrimination and a focus on the northern districts and these regions were not the same as those most affected by skewed sex ratio at birth.

Methods

• For this analysis, the researchers derived district-level estimates of U5MR by sex from 2011 census data using the summary birth history method (or Brass method).
• Data from 46 countries was used with no evidence of gender bias for mortality to evaluate the impacts and intensity of excess female mortality at district level.
• A detailed spatial and statistical analysis was used to highlight the correlates of excess mortality at district level.

Results

• Results of this study suggested that excess female U5MR was 18·5 per 1000 livebirths (95% CI 13·1–22·6) in India 2000–2005, which corresponds to an estimated 239,000 excess deaths (169,000–293,000) per year.
• Findings revealed that more than 90% of districts had excess female mortality, but the four largest states in northern India (Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh) accounted for two-thirds of India's total number.
• The main predictors of excess female mortality were low economic development, gender inequity, and high fertility.
• Data reported that spatial analysis confirmed the strong spatial clustering of postnatal discrimination against girls in India.