No country for old women
EPW carries an article by Siwan Anderson and Debraj Roy which has the potential to change the public perception of gender imbalance in the Indian population. First they recall the recognition of the problem:
“Missing women” – a concept developed by Amartya Sen (1990, 1992) – refers to the observation that in parts of the developing world, notably in India and China, the ratio of women to men is suspiciously low. Sen translated those skewed sex ratios into absolute numbers by calculating the number of extra women who would have been alive (say in China or India) if these countries had the same ratio of women to men as in areas of the world in which they purportedly receive similar care. Sen estimated that more than 100 million women were “missing”, presumably from inequality and neglect leading to excess female mortality.
Their main conclusion is dramatic:
It is instructive to look, first, at Haryana, Rajasthan and Punjab. They typify what is perhaps the generic viewpoint regarding excess female mortality: that the bulk of missing females are missing at birth or at young ages. Over two-thirds of the missing women are missing by the age of 15. For Punjab, close to 60% of the excess female mortality is at birth, and for Haryana and Rajasthan, the numbers are well over 40%. These are disturbing numbers that reflect the conventional wisdom on missing women. The numbers at birth are not very different from what we found for China.
But Haryana, Punjab and Rajasthan account for well under 15% of the 16-state total for missing women. Their profile is emphatically not the case for India as a whole. The majority of missing women in India die in adulthood (older than age 15).
Following this, they present a verbal description of the results of their statistical analysis:
Roughly 12% of missing women are found at birth, 25% die in childhood, 18% at the reproductive
ages, and 45% die at older ages. With the possible exception of Gujarat, the majority of missing women die in adulthood in all the other states.
To be sure, among this latter set of states, there is variation as well. In some states, a large proportion of excess female mortality does occur in childhood, particularly in Bihar, Madhya Pradesh and Uttar Pradesh. More than 20% of the missing women in Assam, Madhya Pradesh, Uttar Pradesh and West Bengal die in the reproductive ages. Finally, more than half of the missing women are at older ages (greater than 45) in Andhra Pradesh, Himachal Pradesh, Kerala, Maharashtra, Tamil Nadu and West Bengal.
Missing women at birth are mainly found in Uttar Pradesh, Punjab, Haryana, Rajasthan and Maharashtra. Punjab and Haryana are exceptionally over-represented relative to their populations. Most of the missing girls who die in childhood are to be found in Bihar, Madhya Pradesh and Uttar Pradesh. Missing women at the reproductive ages in India are mainly found in Bihar, Maharashtra, Madhya Pradesh, Uttar Pradesh and West Bengal. Relative to population shares, this number is highest in Madhya Pradesh and Uttar Pradesh. Finally, missing women at older ages are distributed more uniformly across the states; larger numbers are to be found in Bihar, Maharashtra, Madhya Pradesh, Uttar Pradesh and West Bengal. Relative to population shares, there is overrepresentation particularly in Madhya Pradesh and Maharashtra.
The remainder of the paper contains a closer analysis and sets out a future program of research:
Consistent with our earlier work, we find significant excess female mortality at the reproductive ages, particularly in the central and north-eastern states. Our earlier work demonstrated that there were two key causes behind these excessdeaths of women in India at this stage in their lives. The first is maternal mortality. If we compare maternal mortality rates and the percentage of the female population that is missing at reproductive ages across the states, we do indeed see a positive correlation.
The other main cause of excess female mortality at the reproductive ages was identified in our earlier work to be “Injuries”. In particular, in a given year, we estimated that excess female deaths for women in India from this cause exceeded 2,25,000, a number that dwarfed our maternal mortality estimates of 1,30,000 each year. These excess female deaths from “Injuries” would appear to be an indicator of overt violence against women.
Again consistent with our earlier work, the majority of missing women in India are found at older ages. Comparing the different states, excess female mortality in this age group is highest in the north-eastern states and lowest in the southern ones. Our earlier work demonstrated that excess burden falls mainly on noncommunicable diseases. Cardiovascular disease is particularly implicated. In India, women die at a rate closer to men from cardiovascular disease relative to developed countries.
At older ages, excess female deaths may stem from “unequal treatment”, but the notion needs to be amplified. A good example is the cardiovascular deficit which presents another sort of interpretative quandary. We have already remarked that heart disease accounts for a large fraction of excess female mortality. There is an entire array of hypotheses to explain the phenomenon. It could be genetic: for instance, the recently discovered “heart disease gene” so prevalent in south Asia may be equally present in males and females, thereby lowering the gender skew in incidence. Lifestyle differences by gender may be important: diet, attention to personal health and well- being, and so on. Or it may truly be lack of overt “similar care”: women seek or receive medical care less often in developing countries, or may be subject to greater stress. Put another way, if we want to restrict ourselves to defining missing women as the number of females who have died due to overt discrimination, then the original estimates need to be seriously revised downwards. Moreover, such a computation is not at all straightforward.