Do girls have a nutritional disadvantage compared with boys? Statistical models of breastfeeding and food consumption inequalities among Indian siblings.
Do girls have a nutritional disadvantage compared with boys? Statistical models of breastfeeding and food consumption inequalities among Indian siblings.
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DOI：
10.1371/journal.pone.0107172
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Stuckler D
中科院分区：
文献类型：
--
作者：
Fledderjohann J;Agrawal S;Vellakkal S;Basu S;Campbell O;Doyle P;Ebrahim S;Stuckler D
印度是唯一一个5岁以下女童死亡率高于男童的国家。我们测试女性在母乳喂养和食物分配方面的劣势是否会导致死亡率的性别差异。使用了次要的、公开可用的匿名和去识别数据;不需要伦理委员会审查。采用第3轮印度全国家庭和健康调查（2005-2006年;应答率= 93.5%）进行多变量回归和考克斯模型。 模型按出生顺序和兄弟姐妹性别分类，并根据母亲年龄、教育程度和固定效应、城市居住、家庭贫困和其他社会人口统计数据进行调整。在第一次和第二次母乳喂养中，对母亲报告的世卫组织/儿童基金会关于母乳喂养开始、排他性和总持续时间（0-59个月）、儿童24种食物的消费（6-59个月）和儿童生存（0-59个月）的建议的做法进行了检查（n = 20 395）。 女孩平均母乳喂养时间比男孩少0.45个月（95% CI：= 0.15个月至0.75个月，p = 0.004）。 在母乳喂养开始（OR = 1.04，95%CI：0.97至1.12）或排他性（OR = 1.06，95%CI：0.99至1.14）方面没有性别差异。 第二胎女性在12个月至36个月之间出现母乳喂养停止的差异。与男孩相比，女孩的鲜奶摄入量低14%（95% CI：79%至94%，p = 0.001），母乳摄入量低21%（95% CI：70%至90%，p<0.000）。 母乳喂养每增加一个月，死亡风险降低24%（OR = 0.76，95%CI：0.73 - 0.79，p<0.000）。 女孩母乳喂养时间较短导致5岁前死亡概率增加11%，与其他低收入国家相比，约占其生存劣势的50%。印度女孩母乳喂养的时间比男孩短，消耗的牛奶也少。未来的研究应该调查导致印度女性生存劣势的其他因素的作用。
India is the only nation where girls have greater risks of under-5 mortality than boys. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality. Secondary, publicly available anonymized and de-identified data were used; no ethics committee review was required. Multivariate regression and Cox models were performed using Round 3 of India’s National Family and Health Survey (2005–2006; response rate = 93.5%). Models were disaggregated by birth order and sibling gender, and adjusted for maternal age, education, and fixed effects, urban residence, household deprivation, and other sociodemographics. Mothers’ reported practices of WHO/UNICEF recommendations for breastfeeding initiation, exclusivity, and total duration (ages 0–59 months), children’s consumption of 24 food items (6–59 months), and child survival (0–59 months) were examined for first- and secondborns (n = 20,395). Girls were breastfed on average for 0.45 months less than boys (95% CI: = 0.15 months to 0.75 months, p = 0.004). There were no gender differences in breastfeeding initiation (OR = 1.04, 95% CI: 0.97 to 1.12) or exclusivity (OR = 1.06, 95% CI: 0.99 to 1.14). Differences in breastfeeding cessation emerged between 12 and 36 months in secondborn females. Compared with boys, girls had lower consumption of fresh milk by 14% (95% CI: 79% to 94%, p = 0.001) and breast milk by 21% (95% CI: 70% to 90%, p<0.000). Each additional month of breastfeeding was associated with a 24% lower risk of mortality (OR = 0.76, 95% CI: 0.73 to 0.79, p<0.000). Girls’ shorter breastfeeding duration accounted for an 11% increased probability of dying before age 5, accounting for about 50% of their survival disadvantage compared with other low-income countries. Indian girls are breastfed for shorter periods than boys and consume less milk. Future research should investigate the role of additional factors driving India’s female survival disadvantage.
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