Why Are Adult Women Missing? Son Preference and Maternal Survival in India

Annamaria Milazzo, World Bank Group

This paper is the first to show that excess mortality among women of adult ages can be partly explained by strong preference for male children, the same cultural norm widely known to cause excess mortality before birth or at young ages. I compare the age structure and health indicators of women by the sex of their first-born and uncover several new findings. First, the share of living women with a first-born girl is a decreasing function of their age at the time of the survey. Second, women with a first-born girl are significantly more likely to be anemic when young while there is no differential incidence as they get older. These findings are consistent with a selection effect in which maternal and adult mortality is higher for women with first-born girls, especially the poor and uneducated among them with limited access to health care and to prenatal sex diagnostic technologies.