TheRelationshipof Family SizeandComposition ToFertilityDesires,ContraceptiveAdoptionand MethodChoice in SouthAsia

Volume 35,Number 1,March 2009 A strong cultural preference for sons exists in many countries in East and South Asia.1,2 Sons are more prized than daughters in these countries for a variety of social and economic reasons, including their financial and labor contributions to the family, their ability to support their parents and their perpetuation of the family name.3 In some countries, especially in South Asia, sons also bring wealth into the family through dowry4 and are solely entitled to perform certain religious ceremonies. Son preference may be a result of parents’ simply following the societal norm of taking better care of males and ultimately devaluing females.5 At the same time,many parents in this regionwant to have at least one daughter.3 Studies fromBangladesh, India, Nepal, Pakistan and Sri Lanka have confirmed the widespread presence of son preference in South Asia and its impact on reproductive attitudes.3,6 Son preference often translates into discrimination against girls in nutrition, schooling7,8 and health care,5,9–11 all of which can adversely affect their health and well-being, and may even lead to elevated rates of female mortality.1,4,12–14 Not all studies have documented such adverse effects: A review of 306 child nutrition surveys failed to find any systematic bias toward female undernutrition,15 and an analysis of 41 Demographic and Health Surveys yielded a similar conclusionwith respect to stunting, underweight and wasting.16 It is important to recognize, however, that there are considerable regional differences in son preference within South Asia. For example, son preference is much stronger in the northern and central uplands of India than in the south.17,18 Similarly, son preference has been strong in the state of Punjab, where the sex ratio has been particularly imbalanced.5 According to the 2001 Census, among children aged 0–6, there were only 798 girls for every 1,000 boys in Punjab, compared with 927 girls per 1,000 boys in India as a whole. Attaining the desired number of sons and the preferred sex composition within the family can lead to cessation of childbearing, female feticide and, in extreme cases, even female infanticide.19,20 A decline in fertility without a corresponding reduction in son preference may lead to increased use of sex-selective abortion or female infanticide.3,17,21–23 Recent studies in India have linked son preference to highmale-to-female sex ratios at birth, which provide strong evidence of sex-selective abortion.19,24,25 As fertility declines, two forces may exert opposing effects on sex ratios.24 The first is the parity effect: The survival of girls is expected to improve as the percentage of higher-order births declines, because fewer girls will be unwanted. This effect may result in a reduction in sex bias. The second is the intensification effect: When the desire for children falls at a faster rate than the desire for sons, the effects of son preference on sex-selective fertility behavior TheRelationshipof Family SizeandComposition ToFertilityDesires,ContraceptiveAdoptionand MethodChoice in SouthAsia