2014年-世界发展银行全球_Why_Are_Adult_Women_Missing__Son_Preference_and_Maternal_Survival_in_India_53页_1mb

Summary of "Why Are Adult Women Missing?" by Annamaria Milazzo

Core Content

This paper investigates the phenomenon of "missing women" in India, focusing on how son preference contributes to higher maternal and adult mortality among women who have a first-born daughter. It challenges the traditional view that son preference only affects child and infant mortality, suggesting that it also has long-term consequences on women's health and survival.

Main Findings

• Excess mortality among adult women is partly attributed to son preference, which leads to fertility behaviors that increase maternal health risks.
• The age structure of women with a first-born girl shows a decreasing trend in the proportion of living women as their age increases, especially among the uneducated.
• Anemia prevalence is higher among women with a first-born girl under 30, but this difference disappears for older women.
• Fertility behavior among women with a first-born girl includes:
  • A higher likelihood of desiring more children
  • Lower rates of sterilization
  • Increased use of prenatal ultrasound tests
  • Higher rates of terminated pregnancies
  • Shorter birth intervals, which increase the risk of maternal mortality and anemia
• The effect of short birth intervals is more pronounced among uneducated women, and more robust to mother fixed effects.
• Domestic violence is more prevalent among women with a first-born girl, particularly among the uneducated, and is associated with son preference.
• State-wise variation confirms that the pattern of missing women is more pronounced in states with high maternal mortality, such as Assam and Bihar, rather than in states with male-biased sex ratios like Punjab and Haryana.

Key Information

• Son preference leads to fertility behavior that increases the risk of maternal mortality and morbidity.
• Anemia is a major indirect cause of maternal mortality in India, and its prevalence is higher among women with a first-born girl under 30.
• Prenatal sex diagnostic technologies, such as ultrasound, have been associated with increased sex ratios at birth, indicating sex selection.
• Educated women are more likely to engage in sex-selective abortion, but the effect on fertility behavior is attenuated.
• The empirical strategy relies on the conditional exogeneity of the sex of the first-born to isolate the effect of son preference on maternal health outcomes.
• Nonparametric evidence suggests that son-preferring fertility behavior is responsible for the decreasing share of women with first-born girls as they age.
• Maternal health outcomes are worsening over time, particularly for uneducated women, who have poorer access to maternal care and are more likely to experience adverse health consequences due to repeated pregnancies and unsafe abortions.

Implications

• The selection effect among women with first-born girls, particularly the poor and uneducated, leads to higher maternal and adult mortality.
• The increased risk of anemia and domestic violence among these women indicates that son preference has behavioral and health-related consequences that extend beyond the immediate postnatal period.
• The implied fraction of missing women due to son preference ranges from 2.2 to 8.4 percent among women aged 30 to 49.
• Improved maternal care for all women, especially those engaging in son-preferring fertility behavior, is associated with lower maternal mortality, even without increased access to sex-selective abortion.

Conclusion

This paper contributes to the literature on missing women by highlighting the long-term health and mortality impacts of son preference. It provides empirical evidence that son preference influences fertility behavior and maternal health outcomes, leading to higher mortality among women who have a first-born daughter. The findings underscore the importance of addressing son preference in maternal health policies to reduce the gender gap in mortality and improve women's health and survival in India.