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