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SEX COMPOSITION OF TWINS AND ASSOCIATIONS WITH MORBIDITY, MORTALITY AND MATERNAL TREATMENT-SEEKING OUTCOMES IN RESOURCE-POOR SETTINGS

Published online by Cambridge University Press:  02 August 2017

Rob Stephenson ,
Mondie Blalock Tharp ,
John Mark Wiginton  and
Nicholas Metheny
Rob Stephenson*
Affiliation:
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, USA Center for Sexuality and Health Disparities, University of Michigan, USA
Mondie Blalock Tharp
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, USA
John Mark Wiginton
Affiliation:
Center for Sexuality and Health Disparities, University of Michigan, USA
Nicholas Metheny
Affiliation:
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, USA Center for Sexuality and Health Disparities, University of Michigan, USA
*
1Corresponding author. Email: rbsteph@umich.edu
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Summary

Societal gender inequality and a preference for male children has been shown to be detrimental to girls’ health. This is despite females’ innate biological advantage early in life. The negative effects of gender inequity on female health are most pronounced in resource-poor countries, where cultural norms supporting a preference for male children are strongest. However, most of what is known about gender inequality and child health comes from studies of singleton births. There is little evidence for how, or if, the disadvantages associated with gender bias and son preference extend to multiple births, a population inherently at risk for a number of health challenges. This analysis examines whether gender bias in health outcomes exists for twins. Data on live twin births from 38 Demographic and Health Surveys were compiled (n=11,528 individuals) and twins were categorized as girl/girl, girl/boy, boy/girl or girl/girl. Gender inequality was measured via the Gender Inequality Index. Multilevel logistic regression models examined associations between twin sex composition, gender inequality and eight outcomes of infant and child morbidity, mortality and mother’s treatment-seeking behaviours. Twin pairs containing girls had significantly lower odds of first-year mortality. Higher country-level gender inequality was associated with higher odds of reporting diarrhoea and fever/cough, as well as an increased odds of post-neonatal mortality. Results suggest that the biological advantage for females may be stronger than son preference and gender inequality in the first year of life. Understanding these relationships has the potential to inform efforts to curb the influence of gender preference on the health of female children in resource-poor settings.

Type
Research Article
Information
Journal of Biosocial Science , Volume 50 , Issue 4 , July 2018 , pp. 491 - 504
Copyright
Copyright © Cambridge University Press, 2017 

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References

Ahmed, S. A. & Talal, N. (1990) Sex hormones and the immune system - part 2. Animal data. Baillière’s Clinical Rheumatology 4(1), 13–31.Google Scholar
Altindag, O. (2016) Son preference, fertility decline, and the non-missing girls of Turkey. Demography 53(2), 541–566.Google Scholar
Asling-Monemi, K., Naved, R. T. & Persson, L. A. (2009) Violence against women and the risk of fetal and early childhood growth impairment: a cohort study in rural Bangladesh. Archives of Disease in Childhood 94(10), 775–779.Google Scholar
Bouman, A., Jan Heineman, M. & Faas, M. M. (2005) Sex hormones and the immune response in humans. Human Reproduction Update 11(4), 411–423.CrossRefGoogle ScholarPubMed
Brinda, E. M., Rajkumar, A. P. & Enemark, U. (2015) Association between gender inequality index and child mortality rates: a cross-national study of 138 countries. BMC Public Health 15(1), 97.Google Scholar
Brothwood, M., Wolke, D., Gamsu, H., Benson, J. & Cooper, D. (1986) Prognosis of the very low birthweight baby in relation to gender. Archives of Disease in Childhood 61(6), 559–564.Google Scholar
Brunson, J. (2010) Son preference in the context of fertility decline: limits to new constructions of gender and kinship in Nepal. Studies in Family Planning 41(2), 89–98.Google Scholar
Carmignani, F., Shankar, S., Tan, E. J. & Tang, K. K. (2014) Identifying covariates of population health using extreme bound analysis. European Journal of Health Economics 15(5), 515–531.Google Scholar
Chamarbagwala, R. (2011) Sibling composition and selective gender-based survival bias. Journal of Population Economics 24(3), 935–955.Google Scholar
Corsi, D. J., Bassani, D. G., Kumar, R., Awasthi, S., Jotkar, R., Kaur, N. & Jha, P. (2009) Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006. BMC International Health and Human Rights 9 (Supplement 1), S3.CrossRefGoogle ScholarPubMed
Das Gupta, M., Zhenghua, J., Bohua, L., Zhenming, X., Chung, W. & Hwa-Ok, B. (2003) Why is son preference so persistent in East and South Asia? A cross-country study of China, India and the Republic of Korea. Journal of Development Studies 40(2), 153–187.CrossRefGoogle Scholar
Derrick, D. (2014) Empowering Women and Girls: The Impact of Gender Equality on Public Health. URL: http://globalhealth.thelancet.com/2014/08/08/empowering-women-and-girls-impact-gender-equality-public-health Google Scholar
Diez-Roux, A. V. (2000) Multilevel Analysis in Public Health Research. doi: 10.1146/annurev.publhealth.21.1.171 Google Scholar
Dyson, T. (2012) Causes and Consequences of Skewed Sex Ratios. doi: 10.1146/annurev-soc-071811-145429 Google Scholar
Fikree, F. F. & Pasha, O. (2004) Role of gender in health disparity: the South Asian context. British Medical Journal (Clinical Research Edition) 328(7443), 823–826.Google ScholarPubMed
Filippi, V., Ronsmans, C., Campbell, O. M., Graham, W. J., Mills, A., Borghi, J. & Osrin, D. (2006) Maternal health in poor countries: the broader context and a call for action. The Lancet 368(9546), 1535–1541.Google Scholar
Fledderjohann, J., Agrawal, S., Vellakkal, S., Basu, S., Campbell, O., Doyle, P. & Stuckler, D. (2014) Do girls have a nutritional disadvantage compared with boys? Statistical models of breastfeeding and food consumption inequalities among Indian siblings. PloS One 9(9), e107172.CrossRefGoogle ScholarPubMed
Fuse, K. (2010) Variations in attitudinal gender preferences for children across 50 less-developed countries. Demographic Research 23, 1031–1048.CrossRefGoogle Scholar
Garenne, M. & Hohmann, S. (2014) Gender saturation in the Southern Caucasus: family composition and sex-selective abortion. Journal of Biosocial Science 46(6), 786–796.CrossRefGoogle ScholarPubMed
Hesketh, T. & Xing, Z. W. (2006a) Abnormal sex ratios in human populations: causes and consequences. Proceedings of the National Academy of Sciences of the USA 103(36), 13271–13275.Google Scholar
Hesketh, T. & Xing, Z. W. (2006b) Abnormal sex ratios in human populations: causes and consequences. Proceedings of the National Academy of Sciences of the USA 103(36), 13271–13275.Google Scholar
Jaffar, S., Jepson, A., Leach, A. & Greenwood, A. (1998) Causes of mortality in twins in a rural region of the Gambia, West Africa. Annals of Tropical Paediatrics 18(3), 231.Google Scholar
Jayachandran, S. (2014) The roots of gender inequality in developing countries. Annual Review of Economics 7(1), 63–68.CrossRefGoogle Scholar
Justesen, A. & Kunst, A. (2000) Postneonatal and child mortality among twins in Southern and Eastern Africa. International Journal of Epidemiology 29(4), 678–683.Google Scholar
Kalanda, B. F., Verhoeff, F. H. & Brabin, B. (2006) Size and morbidity in Malawian twins. European Journal of Clinical Nutrition 60(5), 598–604.Google Scholar
Koolwal, G. B. (2007) Son preference and child labor in Nepal: the household impact of sending girls to work. World Development 35(5), 881–903.Google Scholar
Kraemer, S. (2000) The fragile male. British Medical Journal 321(7276), 1609.Google Scholar
Milazzo, A. (2014) Son preference, fertility and family structure: evidence from reproductive behavior among Nigerian women. World Bank Policy Research Working Paper No. 6869.Google Scholar
Miyahara, R., Jasseh, M., Mackenzie, G. A., Bottomley, C., Hossain, M. J., Greenwood, B. M. & Roca, A. (2016) The large contribution of twins to neonatal and post-neonatal mortality in the Gambia, a 5-year prospective study. BMC Pediatrics 16(1), 1.CrossRefGoogle ScholarPubMed
Naeye, R. L., Burt, L. S., Wright, D. L., Blanc, W. A. & Tatter, D. (1971) Neonatal mortality, the male disadvantage. Pediatrics 48, 902–906.Google Scholar
Raj, A., McDougal, L. P. & Silverman, J. G. (2014) Gendered effects of siblings on child malnutrition in South Asia: Cross-sectional analysis of Demographic and Health Surveys from Bangladesh, India, and Nepal. Maternal and Child Health Journal 19(1), 217–226.Google Scholar
Smits, J. & Monden, C. (2011) Twinning across the developing world. PLoS One 6(9), e25239.Google Scholar
Snow, R. C. (2008) Sex, gender, and vulnerability. Global Public Health 3(S1), 58–74.Google Scholar
Steele, F., Diamond, I. & Amin, S. (1996) Immunization uptake in rural Bangladesh: a multilevel analysis. Journal of the Royal Statistical Society, Series A 159(2), 289–299.Google Scholar
Stevenson, D. K., Verter, J., Fanaroff, A. A., Oh, W., Ehrenkranz, R. A., Shankaran, S. & Papile, L. A. (2000) Sex differences in outcomes of very low birthweight infants: the newborn male disadvantage. Archives of Disease in Childhood. Fetal and Neonatal Edition 83(3), F182–F185.Google Scholar
United National Development Programme (2015) Gender Inequality Index (GII). URL: http://hdr.undp.org/en/content/gender-inequality-index-gii (accessed July 2017).Google Scholar
Van der Mei, J., Heijstra, T. & Boersma, E. (2003) Growth patterns and survival rates of twins in a rural area of Ghana: a follow-up study from birth to adulthood. Annals of Tropical Paediatrics 23(2), 107–120.Google Scholar
Vogel, J. P., Torloni, M. R., Seuc, A., Betrán, A. P., Widmer, M., Souza, J. P. & Merialdi, M. (2013) Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries. PLoS One 8(8), 270549.Google Scholar
Waldron, I (1983) Sex differences in human mortality: the role of genetic factors. Social Science & Medicine 17(6), 321–333.Google Scholar
World Health Organization (2006) Provision of Effective Antenatal Care. URL: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/effective_antenatal_care.pdf (accessed July 2017).Google Scholar
World Health Organization (2011) WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia. WHO, Geneva.Google Scholar
World Health Organization (2015) The Global Goals. URL: http://www.globalgoals.org/ (accessed July 2017).Google Scholar
Yount, K. M. (2003) Provider bias in the treatment of diarrhea among boys and girls attending public facilities in Minia, Egypt. Social Science & Medicine 56(4), 753–768.Google Scholar