Discriminação de gênero na mortalidade de crianças em países de baixa e média renda

Abstract

Introduction: Mortality of children under five years reflects the living conditions as well as the coverage and quality of health care. Under natural conditions, it is expected that boys would die more than girls due their greater biological frailty. However, gender discrimination can change this relationship. Objective: To compare two approaches proposed in the literature to identify low- and middle-income countries where there is excess mortality of girls and explore some of its main determinants. Methods: We used data from Demographic and Health Surveys conducted in 60 low- and middle-income countries between 2005 and 2014. The mortality of girls observed in these countries was compared to expected values resulting from two distinct approaches to estimate the excess female mortality. The “prescriptive” approach provides an expected value based on historical mortality data from selected populations where gender discrimination was considered low or absent. The “descriptive” approach is derived from global estimates based on all countries with available data, including those affected by gender discrimination. To assess gender discrimination regarding access to healthcare, it was calculated the proportion of children with common childhood conditions (diarrhea, fever, or symptoms of pneumonia) who were taken to an appropriate healthcare provider. This indicator was stratified by sex at the national level and by wealth quintiles. Ecological analyses were performed to assess whether the excess mortality of girls and the health careseeking varied according to region of the world, the predominant religion, the national income, the wealth concentration and three different indices of gender inequality. Results: Although the magnitude of excess female mortality varies between the two models, the results at the national level were strongly correlated (r = 0.989; p <0.001). The “prescriptive” approach identified a significant excess female mortality in 20 countries; the descriptive model identified only one country. The thirteen countries with the highest excess of female mortality and the ten countries with lower values were the same for both models. The highest averages of excess female mortality were identified in South Asia and Middle East & North Africa. Regarding careseeking, eight countrieswere identified with significant differences between girls and boys, and among six of them, the frequencies were lower among girls. Four countries were identified in both gender bias analyses: India, Egypt, Liberia and Yemen. Furthermore, lower careseeking for girls tended to be more common in countries with high income concentration (p=0.039), and predominance of the Muslim religion (p=0.006). Conclusion: Despite the differences in the magnitude of the estimates, both models provide a similar ranking of countries with excess mortality of girls. Countries in which was identified gender bias require attention to be assured proper care and protection of girls.