Academic journal article International Perspectives on Sexual and Reproductive Health

The Relationship of Family Size and Composition to Fertility Desires, Contraceptive Adoption and Method Choice in South Asia

Academic journal article International Perspectives on Sexual and Reproductive Health

The Relationship of Family Size and Composition to Fertility Desires, Contraceptive Adoption and Method Choice in South Asia

Article excerpt

CONTEXT: Many countries in South Asia, including Nepal, India and Bangladesh, demonstrate a strong cultural preference for sons, which may influence fertility desires and contraceptive use.

METHODS: Demographic and Health Survey data from married, nonpregnant women aged 15-49 who had at least one child were used to examine the relationship of parity and number of sons to reproductive outcomes in Nepal, India and Bangladesh. Outcomes of interest were desire for another child, contraceptive use and type of contraceptive (modern vs. traditional, temporary vs. permanent). Odds ratios and relative risk ratios were calculated using binary and multinomial logistic regression.

RESULTS: In general, desire for another child decreased and contraceptive use increased as the number of children and number of sons increased. These associations were more prominent in Nepal and India than in Bangladesh. For example, compared with women who had three daughters and no sons, the odds of contraceptive use among women with two sons and one daughter were 4.8 in Nepal, 3.5 in India and 2.0 in Bangladesh. Within India, the associations of parity and number of sons with reproductive outcomes were generally stronger in northern states than in South India or West Bengal.

CONCLUSIONS: Son preference remains widespread in all three countries and has a major influence on reproductive behavior. Reducing such preference would require a change in social norms and attitudes of the people and an improvement of the status of women.

International Perspectives on Sexual and Reproductive Health, 2009,35(l):29-38.

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A strong cultural preference for sons exists in many countries in East and South Asia. (1), (2). Sons are more prized than daughters in these countries for a variety of social and economic reasons, including their financial and labor contributions to the family, their ability to support their parents and their perpetuation of the family name. (3) In some countries, especially in South Asia, sons also bring wealth into the family through dowry (4) and are solely entitled to perform certain religious ceremonies. Son preference may be a result of parents' simply following the societal norm of taking better care of males and ultimately devaluing females. (5) At the same time, many parents in this region want to have at least one daughter. (3)

Studies from Bangladesh, India, Nepal, Pakistan and Sri Lanka have confirmed the widespread presence of son preference in South Asia and its impact on reproductive attitudes. (3), (6) Son preference often translates into discrimination against girls in nutrition, schooling (7), (8) and health care, (5), (9-11) all of which can adversely affect their health and well-being, and may even lead to elevated rates of female mortality. (1), (4), (12-14) Not all studies have documented such adverse effects: A review of 306 child nutrition surveys failed to find any systematic bias toward female undernutrition, (15) and an analysis of 41 Demographic and Health Surveys yielded a similar conclusion with respect to stunting, underweight and wasting. (16) It is important to recognize, however, that there are considerable regional differences in son preference within South Asia. For example, son preference is much stronger in the northern and central uplands of India than in the south. (17), (18) Similarly, son preference has been strong in the state of Punjab, where the sex ratio has been particularly imbalanced. (5) According to the 2001 Census, among children aged 0-6, there were only 798 girls for every 1,000 boys in Punjab, compared with 927 girls per 1,000 boys in India as a whole.

Attaining the desired number of sons and the preferred sex composition within the family can lead to cessation of childbearing, female feticide and, in extreme cases, even female infanticide. (19), (20) A decline in fertility without a corresponding reduction in son preference may lead to increased use of sex-selective abortion or female infanticide. …

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