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

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.