Breastfeeding, contraception and female mortality in India

30th October 2014

News, Student news, Alumni news

Research Focus: Junior Research Fellow Jasmine Fledderjohann examines the links between economic shocks, food prices, and maternal and child health in India.

Jasmine Fledderjohann's research has shown that Indian girls are breastfed for shorter periods and consume less milk than boys, with important implications for the gender gap in mortality. India is the only country in the world where young girls have worse under-five mortality than boys. Jasmine and her collaborators have been working to explain these findings as she told Julia Banfield.

Jasmine’s most recent study examines the differences in the length of time that male and female babies are breastfed in India and the correlation with higher infant mortality rates for girls. “We are hoping that our findings will influence policymakers and healthcare providers, and that Indian women might be encouraged to breast feed their baby girls for longer, so reducing the infant mortality rate,” she said.

India is the only country in the world where girls face a mortality disadvantage compared to boys. In 2012, the under-5 mortality ratio in India was estimated at 108.5 female deaths for every 100 male deaths. Jasmine and her collaborators are working to find out why in the under-five age group, boys seemed to fare better than girls.

Interestingly, her research shows that much of the problem is related to the contraceptive effects of breast feeding.  “It isn’t that the Indian mothers are actively treating their boys preferentially. It seems that one of the key reasons that women stop breast feeding, particularly if their first and second born children are girls, is their desire to conceive a boy.”

WHO guidelines say that all infants should be breastfed within one hour of birth and, for the first six months, should be exclusively breast fed. They recommend that from six months to two years, complimentary foods should supplement breast feeding.

According to Jasmine’s research: “Indian girls are breastfed for shorter periods than boys and consume less milk. Differences in breastfeeding cessation emerged between 12 and 36 months in second born females. Compared with boys, girls had lower consumption of fresh milk by 14% and breast milk by 21%. Each additional month of breastfeeding was associated with a 24% lower risk of mortality. Girls’ shorter breastfeeding duration accounted for an 11% increased probability of dying before age 5, accounting for about 50% of their survival disadvantage compared with other low-income countries.”

The immunities which breast feeding provides are therefore crucial in an environment where under-fives are exposed to pathogens in the environment, for example from exposure to unclean water for drinking and food preparation.

Jasmine comments: “There are many considerations that come into play. We found that with firstborns, the duration of feeding was similar for boys and girls. However, these figures changed when we looked at second-borns. We found the second born girls who have an older sister were the most disadvantaged, while boys with older sisters were breast fed for longer. In fact boys with an older brother fared best and girls with an older sister fared worst.”

So is the preference for male children still important in Indian families? “When you ask women about their ideal family composition, the current figures show that women increasingly want a balanced family composition—that is, they want to have a boy and a girl,” said Jasmine. “However, because of their cultural and economic significance for families, having a boy is still seen as essential.”

So, says Jasmine,  the decision to stop breast feeding a baby girl is more a feeling of ‘I think I’ve breastfed for long enough’; the desire to conceive a boy is stronger than the realisation that the health of the baby girl is being put at risk by stopping breast feeding.

Jasmine and her collaborators have had their initial findings published in the Journal PlosOne:  Fledderjohann, J., Agrawal, S., Vellakkal, S., Basu, S., Campbell, O., Doyle, P., Ebrahim, S., & Stuckler, D. (Forthcoming). Do girls have a nutritional disadvantage compared with boys? Statistical models of breastfeeding and food consumption inequalities among Indian siblings. PLoS One. DOI: 10.1371/journal.pone.0107172