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Sex differences in infant mortality in India, in England and Wales and in Wolverhampton
- Angela Moore (24 November 2003)
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Angela Moore, Consultant Paediatrician (Community) Wolverhampton City PCT WV1 1NR
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EDITOR - Sex differences in infant mortality existed in Wolverhampton 20 years ago but have now disappeared.1,2 It is disturbing that Dawson has found that the situation still exists in England and Wales with excess mortality among girls whose mother was born in Pakistan.3 The relationship between poverty and infant mortality is undisputed 4 and although unacceptable, the reasons why boys are more valued than girls can be understood in socio-economic terms in countries where there is extreme poverty and poor standards of education. Thus, the sex differences in infant mortality reported by Khanna et al in India are not surprising 5 In Wolverhampton, there was a significant excess of preventable deaths in the first five years of life in Asian girls in Wolverhampton in the period from 1976-1982. (Table 1) 1 This reflected the situation in England and Wales in 1980, where there was a similar excess of deaths in infancy from possibly preventable causes in girls whose mother was born in India, Pakistan or Bangladesh (Table 2) and concerns about parental attitudes to the care of daughters was raised at that time.1 Since then, childhood mortality rates have fallen in Wolverhampton in line with the national trend and with improved standards of living (Table 3). Although the numbers are now very small, there were only 4 possibly preventable deaths amongst Asian children under the age of 5 years in Wolverhampton between 1996 and 2002 and 3 of these were boys. Most of the Asian mothers in Wolverhampton are now second generation, language is no longer a problem and cultural differences are less obvious.2 The suggestion that in some cultures sex discrimination exists to the extent that baby girls are at increased risk of death from preventable disease or even infanticide raises grave concerns particularly when the death is unexplained.5 The recognition by health workers that Asian baby girls were a vulnerable group may have been important in Wolverhampton. It may also be important in other areas where there are increasing numbers of first generation ethnic minority groups. Table 1 - Sex and ethnic differences between potentially preventable deaths and all other outcomes in Wolverhampton 1976-82 Preventable deaths All otheroutcomes (n) (survival or non-preventable death) Asian girls 20 13 406 ) X2 = 4.72; ) X2 =4.65; Non-Asian girls 37 46 884 ) 0.05>p>0.01 ) 0.05>p>0.01 Asian boys 8 13 803 ) X2 with Yates correction n= total number of deaths in category Table 2 - Sex and Ethnic differences amongst preventable infant deaths in England and Wales in 1980 (OPCS) Male Female X2 p Asian* preventable+ 34 50 4.39 <0.05>0.02 non-preventable 235 189 Non-Asian preventable 1130 799 81.99 <0.001 non-preventable 2069 2390 * Deaths of children whose mother was born in India, Pakistan or Bangladesh + Deaths due to respiratory diseases, sudden death cause unknown and accidents X2 with Yates correction for 2x2 tables. Table 3. Relationship between unemployment in Wolverhampton and postneonatal mortality rate (PNMR) Unemployment % PNMR 1981 16.5 4.5 1991 14.5 3.4 2001 5.3 2.8 1. Moore A. Preventable childhood deaths in wolverhampton BMJ 1986;293:656-658. 2. Moore A. Changing patterns of childhood mortality in Wolverhampton 1996 -2002 (in preparation) 3. Dawson I. Sex differences in infant mortality in India is reflected in England and Wales. BMJ 2003;327:1169 4. Acheson D. Inequalities in health: report of an independent inquiry. London HMSO 1998. 5. Khanna R, Kumar A, Vaghela JF, Sreenivas V and Puliyel JM Community based retrospective study of sex in infant mortality in India. BMJ 2003;327:126-0. Competing interests: None declared |
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