Association of birth of girls with postnatal depression and exclusive breastfeeding: an observational study

OBJECTIVES AND HYPOTHESIS: To examine the influence of gender of the baby on exclusive breastfeeding and incidence of postnatal depression (PND). We hypothesise that in a society with a male gender bias there may be more PND and less exclusive breastfeeding of the girl child. DESIGN: Prospective study. SETTING: The study was conducted in an urban, tertiary hospital in Delhi. PARTICIPANTS: Mothers delivering normally with their babies roomed-in.1537 eligible women participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Exclusive breastfeeding within the first 48 h of life and score on the Edinburgh Postnatal Depression Scale (EPDS) were recorded. RESULTS: 3466 babies were born in the hospital. There were 792 girls for every 1000 boys. Among primiparous women, the sex ratio was 901 girls per 1000 boys. For second babies, the sex ratio was 737:1000. If the first child was a girl the birth ratio fell to 632. 1026 mothers were exclusively breastfeeding. Exclusive breastfeeding of boys was significantly higher (70.8% vs 61.5%, p<0.001). The EPDS score was significantly higher with the birth of girls (EPDS 6.0±3.39 vs 5.4±2.87, p<0.01). Women with an EPDS score >11 were less likely to exclusively breastfeed (p<0.01). CONCLUSIONS: The results point to a pro-male gender bias evidenced by a low sex ratio at birth, higher EPDS score in mothers of girls and less breastfeeding of female children.