Sex Bias in the Family Allocation of Food and Health Care in Rural Bangladesh

Conclusive evidence was provided in an earlier study by the authors of higher female than male mortality from shortly after birth through the childbearing ages in a rural area of Bangladesh.' Male mortality exceeded female mortality in the neonatal period, but this differential was reversed in the postneonatal period. Higher female than male mortality continued through childhood into adolescence and extended through the reproductive ages. The most marked differences were observed in the 1-4-year age group, where female mortality exceeded male mortality by as much as 50 percent. The higher male mortality rate during the neonatal period is consistent with evidence from many societies that the biological risk of death is higher among male children than among female children.2 The reversal of the sex differential of mortality, markedly so during childhood and persisting through adolescence, was postulated to be reflective of sex-biased health- and nutritionrelated behavior favoring male children. Son preference in parental care, intrafamily food distribution, feeding practices, and utilization of health services are some of the behavioral mechanisms by which sex-biased attitudes may have led to the observed mortality pattern. The purpose of this study is to examine the validity of this hypothesis. To do so, a framework is presented in which the mechanisms through which sex-biased attitudes and practices might operate to affect health, nutrition, and mortality are postulated. In-depth empirical data are presented from rural Bangladesh to examine the validity of the hypothesis that sex-biased health and nutrition behavior discriminates against female children, thereby causing an aberrant female predominance in the childhood mortality rate. The paper concludes by discussing policy and program implications associated with these findings.