Mothers Who Are More Likely to Experience Child Mortality In India: The Role of Gender Empowerment

Purpose: Approximately nine million children, younger than five years of age, die each year. Most of these deaths occur in developing countries and they die from such preventable causes as under-nutrition, pneumonia, diarrhea, malaria, and neonatal conditions. India is one of the largest contributors of global child death with 2.2 million children under five years of age dying in 2005 alone. In 2002, the Millennium Development Goals called for a global reduction of under-five child mortality rate by two thirds by 2015 from the base year 1990. In response, developing countries including India have expanded their health infrastructures, trained a large number of health care providers and disseminated health education and nutrition information through mass media communication strategies and community health workers. Yet, millions of children continue to die before they reach five years of age. It appears that child mortality is associated with a complex set of variables that are not very well understood. Availability of health facilities alone will not increase health services use if mothers are unaware of the importance of these services. In South Asia, gender bias and male child preference have further exacerbated female child mortality. In this paper we examined if women's empowerment reduced child mortality in India using two conceptual frameworks-- gender relations framework and behavioral model of health service use.

Methods: We analyzed 75,034 Indian mothers who had given birth to at least one child and were married at the time of interview. We relied upon gender relations framework and Anderson's behavioral model of health services use to select the list of variables. We conducted GIS mapping, weighted descriptive analyses and multiple logistic regression models to predict the odds of a mother experiencing male and female child mortality in India. Results: Of the 14 indicators of empowerment, children of mothers with secondary (and higher) level of education were 19% less likely to experience child mortality. Women who had knowledge about STD or AIDS and those who engaged in purchase of household items for daily use had significantly lower odds of experiencing child mortality than their counterparts without knowledge about STD or AIDS and those whose opinion was not included in purchases of items for daily use. Women who experienced humiliation from their spouse were 23% more likely to lose a child. While physical abuse had no impact on male child mortality, the odds of female child mortality increased by 9% for abused mothers. Age at birth of first child correlated negatively with child mortality; as age of a mother at birth of first child increased by one year, child mortality dropped by about three percent. Implications: To reduce child mortality, India should not only focus on improving health infrastructures and incentives but also on gender empowerment including programs aimed at reducing domestic violence, delaying age at marriage and age at first birth, disseminating information about STD and AIDs, and increasing girls' access to education.