WATERING THE NEIGHBOUR'S GARDEN: THE GROWING - CICRED

DECREASES IN MALE AND FEMALE MORTALITY AND MISSING WOMEN …
area) than in an adjacent area with less easy accessible primary health
care services (the comparison area) (ICDDR,B, 2004).
While increasing availability of health (preventive and curative)
services and changing attitudes towards girls are important for lowering,
if not for stopping, maltreatment of girls, the fertility decline which
has taken place in the 1980s and early 1990s also lowers female disadvantage
by lowering the percent of families with higher order girls
(who experience higher mortality) (Muhuri and Preston, 1991). For
example, in Matlab the percent of third and higher rank order female
births was reduced from 27.5 percent in the 1982-84 birth cohort to
16.8 percent in the 2000-2003 birth cohort.
Another factor that could account for high female compared to
male mortality is higher prevalence of illness among girls compared to
boys. However, in Matlab it was found that sex differences in prevalence
of childhood diseases were in general insignificant (Hossain and
Glass, 1988; Alam, 2000). Therefore, the explanation for excess female
child mortality must be found in differences in the case-fatality rate.
Case-fatality is largely determined by nutritional status and curative
care, provided both within home and by health care providers. Undernourished
children are at higher risk of dying than well-nourished
children (Bairagi, 1981). Poor nutritional intake in combination with
repeated illnesses results in malnutrition. Discrimination against female
children in distribution of food has been noted in Bangladesh and
India in the 1980s (Chen et al., 1981; Das Gupta, 1987) and more
research is needed to determine the role of this factor as well as unequal
access to health care.
Basu (1989) debates the issue whether discrimination in feeding
practices is a cause of excess female child mortality, especially in India.
A strong preference for sons may induce parents to provide better
medical treatment to sons than to daughters when they become ill.
Only girls who are considered to be in excess may suffer more from
relatively poor treatment. Several small-scale studies have shown modest
sex differences in the treatment of sick children (Hossain and
Glass, 1988; Alam, 2000). Timaeus et al. (1998) raise the question
whether moderate or small sex differences in sickness care are enough
to explain the excess female mortality.
A very different mechanism that may contribute to female disadvantage
in survival is the family formation pattern. In Bangladesh the
birth of a daughter is often followed swiftly by another birth (Chowdhury
and Bairagi, 1990) in the hope that the additional child will be a
son. Conversely, parents to whom a son has been born may be more
likely to discontinue childbearing or delay the next birth. Such a pattern
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