Introduction Achieving Millennium Development Goals on childhood mortality in developing countries requires that inequities be addressed. This study examined changing gender differentials as social and economic improvement occurred in a rural north Indian community.
Methods A dynamic cohort of children aged <5 years old in 10 villages under Ballabgarh HDSS were followed from 1st January 2008 to death, age 5 or data censoring on 31st December 2010. Data on births, mortality, caste and parental literacy are routinely collected and stored in electronic databases to which information on wealth Index was appended in 2010. Cox proportional hazards modelling was used to produce HRs for mortality in girls according to socioeconomic strata after adjustment for birth order, number of siblings and other socioeconomic variables.
Results The mortality rate for the cohort was 67.9 per 1000 live births (B=74.4; G=62.4). This declined significantly as wealth index improved (from 102.4 to 25.4 per 1000 live births). The HR for girls declined from 1.57 (95% CI 1.0 to 2.5) in the wealthiest to 0.67 (0.3 to 1.4) in the lowest tertile. There was no change in total or sex specific mortality rates according to caste or father's education. Mothers' education beyond 10th grade resulted in sharp decline in mortality (14 per 1000 live births) but did not impact the sex differential in mortality. The sex ratio at birth was worst for population with highest wealth index and highest level of maternal educational attainment.
Conclusion Major social and gender differentials persisted in this study population with gender discrimination moving from after to before birth.
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