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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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