Do Young Indian Girls Have a Nutritional Disadvantage Compared with Boys? Regression Models Examining Disparities in Breastfeeding and Food Consumption among Indian Siblings

Objective: India is the only nation where girls have greater risks of under-5 mortality than boys. We analyze whether female disadvantage in nutrition can account for India’s gender disparities in under-five mortality rates.

Design: Multivariate regression and Cox proportional hazards models were performed for children aged 0-59 months (n = 20,395) using India’s National Family and Health Survey 2005-2006. Models were disaggregated by birth order and sibling gender, and adjusted for maternal age and education, maternal fixed effects, urban residence, household deprivation, and other sociodemographics.

Outcomes: Breastfeeding initiation, exclusivity, and duration; children’s consumption of 24 individual food items (ages 6-59 months); child survival (ages 0-59 months).

Results: Girls were breastfed on average 0.45 months less than boys (95% CI: = 0.15 months to 0.75 months). There was no gender difference in the likelihood of breastfeeding initiation (OR = 1.04, 95% CI: 0.97 to 1.12) or exclusive breastfeeding (OR = 1.06, 95% CI: 0.99 to 1.14). Compared with boys, girls also had lower reported consumption of fresh milk by 14% (95% CI: 79% to 94%) and breast milk by 21% (95% CI: 70% to 90%). Each additional month of breastfeeding duration was associated with a 24% lower risk of mortality (OR=0.76, 95% CI: 0.73 to 0.79).  Girls’ shorter breastfeeding duration accounted for about an 11% increased probability of dying before age 5, accounting for about one-half of their survival disadvantage compared with other low-income countries.

Conclusions: Young Indian girls are breastfed for shorter periods than boys and consume less fresh milk.