THE PAKISTAN DEVELOPMENT REVIEW
Gender Differences in Child Health-care Practices: Evidence from the Pakistan Demographic and Health Survey, 1990-91
Among other factors, health care utilisation is important in determining the health status and survival chances of children. The patterns of childhood mortality, in general, indicate that deaths of male children have consistently exceeded those of females, with a much greater difference in the first month of birth (NNR). This has largely been attributed to differences in the genetic and biological factors between the sexes [Lopez and Ruzika (1983)]. The mortality level, thereafter, is influenced more by the socio-economic, environmental, and health care factors, indicating a mortality disadvantage for females in some populations. It has therefore been postulated that gender-based differences in health care practices partly explain the sex differentials in child mortality in some countries of South Asia, where healthseeking behaviour of parents discriminates against female children [Chen, et al. (1981); Das Gupta (1987); Sathar (1987); Ahmed (1990)]. Using data from Bangladesh, Chen, Haq, and D’Souza (1981) found that girls’ mortality risk was nearly 60 percent higher than that for boys after the neonatal period, and that girl children suffered more malnutrition and received lesser treatment for various infections. Das Gupta (1987) and Muhuri and Preston (1991) also explained the excess mortality of girls with a surviving elder sister in terms of conscious, selective neglect of the second daughter. Waldron (1983) in her extensive review of child mortality patterns in developing countries concluded that besides relative contributions of specific causes of death with different impact by sex, the variability in discrimination by gender, primarily in nutrition and health care utilisation, also contributes to excess female child mortality (1–4 age group).