<figure><img width="1400" height="933" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412114/6372218c9c7e80680e0c02c1jpeg.jpg" alt=""/><figcaption>Photo: GOPEN RAI/NEPALI TIMES ARCHIVE</figcaption></figure>A new study in Nepal has found that more female babies die after the third week of birth than male ones. Even though more male babies die in the first week after birth, the survey points to how gender discrimination may be disproportionately claiming the lives of girl children.The findings have larger implications for Nepal’s target to reduce the Neonatal Mortality Rate (NMR) to 12 deaths per 1,000 live births by 2030 as per the Sustainable Development Goals (SDGs). At present, the figure stands at 21. Neonatal mortality is the death of a child between 0- 28 days of birth. It can be categorised into early (0-7 days) and late neonatal death (7-28 days). NMR is an important indicator of maternal and newborn health, which shows a country’s quality of life. Generally, male children are at an approximately 20% greater risk of succumbing to neonatal mortality than girls. Several factors associated with higher neonatal mortality among male children include intrauterine growth restriction, respiratory distress syndrome, prematurity and birth asphyxia. Animal model studies have shown that testosterone suppresses the immune system, while oestradiol and progesterone in females improve immune responses which means they are better able to fight infections. Data from high-income countries reveal that it is true not only during the neonatal period, but later on in life as well. In low and middle-income countries males are at a higher risk of mortality in the early neonatal period but more females die in the late neonatal stage. But the specific age (days) where this reversal takes place was not previously known.Which is why <a href="https://www.researchgate.net/publication/360724893_Does_higher_eArticle_Does_higher_early_neonatal_mortality_in_boys_reverse_over_the_neonatal_period_A_pooled_analysis_from_three_trials_of_Nepal#fullTextFileContent" target="_blank" rel="noopener noreferrer">we conducted a study</a> to examine sex differentials in neonatal mortality by detailed ages (0-1, 1-3, 3-7, 7-14,14-21 and 21-28 days). This is the first study to look at the sex differentials by such granular ages.We looked into data from three sequential, community-based randomised controlled trials (RCTs) in Sarlahi district of the southern plains of Nepal. The studies provide pregnancy cohorts from 1999 through 2017.Neonatal mortality was 41.9 (44.2 vs 39.7 in boys and girls), 30 (30.5 vs 29.6 in boys and girls) and 31.4 (33.4 vs 29.4 in boys and girls) in 1999, 2002 and 2010 studies respectively. A common finding in all three studies was that male mortality was higher in the early neonatal period (0-7days), but there was a reversal after the third week of life (21-28 days), where female mortality was higher. <figure><img width="1210" height="880" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/637221909c7e80680e0c02c2jpeg.jpg" alt=""><figcaption>Graphs: SEEMA SUBEDI</figcaption></figure><img width="1210" height="880" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/637221949c7e80680e0c02c3jpeg.jpg" alt=""><img width="1210" height="880" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/637221969c7e80680e0c02c4jpeg.jpg" alt="">Data from the three studies were combined and analysed with average neonatal mortality coming to 31.6 (33.0 vs 30.2 in boys and girls). When we break this down to sex differentials in mortality by granular ages, male mortality was 1.17 times higher in the early neonatal period. However, this natural pattern was quickly reversed after the third week when female mortality was 2.43 times higher.This begs a question: why this reversal?Our paper does not examine the reasons, but studies in South Asia have found higher care-seeking behaviour for male neonates than females, particularly in households with older female siblings. Moreover, for male babies, care-seeking was more frequent with better-qualified care providers and higher expenditure compared to that of girls. Studies have also shown that households with female children were more likely to report discrimination because family members perceived that care for illness was not so important leading to reduced care-seeking.Nepal has been categorised to have a high level of son preference ever since the 1980s in World Fertility Surveys. Not much has changed since then as proven by a 2012 survey where 90% of 1,000 Nepali men aged 18-49 years said that a man with only daughters was unfortunate, and not having a son reflects a lack of moral virtue. Nearly half of them said that a woman’s important roles were limited to taking care of her home and cooking for her family. Nepal’s patrilineal and patrilocal social structure combined with socio-economic and religious values lead to son preference and gender discrimination. Traditionally, sons have been given certain cultural and economic roles such as the lighting of the funeral pyre, continuing the family lineage and providing old-age economic security for their parents. This places them above girls who are considered an economic liability because they have to be married off and with a dowry. And upon marriage, they become part of the economy of the husband’s family. Given the social norms, the baby survival differential may be explained by poorer nutrition, care and rest provided to mothers giving birth to daughters, son preference being the root cause of discrimination in the family. It could also point to specific parental behaviours that take place starting at that age (21-28 days of a child’s life).  <img width="1210" height="880" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111412118/637221999c7e80680e0c02c5jpeg.jpg" alt="">However, the 3-week threshold could also just be an indication that the gender discrimination starts from birth or even earlier, but takes at least three weeks for the biological and natural survival advantage of females to be overcome by the social advantage of males.Neonatal mortality in Nepal has continued to decrease from 39 to 21 per 1,000 live births, with male neonatal mortality decreasing from 52 to 24 (reduction of 28 per 1,000) and female neonatal mortality from 43 to 17 (reduction of 26 per 1,000) from 2001 to 2016. Given that boys have a biological disadvantage in neonatal survival, one would have expected female neonatal mortality to decrease significantly over time. A reduction in female neonate mortality would also mean an overall decrease in neonatal mortality. But as it is, it is unlikely Nepal will meet its target of reducing NMR to 12 by 2030. Gender discrimination not only affects the quality of life of girls and women, but also reduces their survival in the neonatal period. A cross-national study from 138 countries also showed that higher the gender inequality index, higher the neonatal mortality of a country. Read more: <a href="http://archive.nepalitimes.com/regular-columns/GUEST-COLUMN/Saving-one-mother-at-a-time,816">Saving one mother at a time</a>, Bikash GauchanAddressing gender discrimination by removing cultural and social barriers at the household level may help reduce overall neonatal mortality. Interventions to strengthen gender equality, such as counselling women and their families during antenatal and postnatal care visits may significantly improve female and male neonatal survival.Since the reversal takes place during the fourth week, specific interventions should be targeted in the first three weeks of a child’s life.Seema Subedi is Faculty Associate in the Global Disease Epidemiology and Control Division of the International Health Department at the Johns Hopkins Bloomberg School of Public Health in Baltimore, USA.

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Fatal discrimination

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636bade89c7e80680e077fbdjpeg.jpg" alt="" width="1496" height="1146"/><figcaption>Min Bajracharya’s iconic photograph of Durga Thapa, 22, as she leapt up during a victory rally on 9 April 1990 to shout “Long live democracy!” All photos: MIN RATNA BAJRACHARYA</figcaption></figure>The <a href="https://www.nepalitimes.com/banner/one-moment-30-years-ago-today/" target="_blank" rel="noopener noreferrer">People’s Movement in 1990</a> erupted because for three decades of partylessness, Nepalis could not let off steam and socio-political pressure had been building up.We got a constitutional monarchy, the parties were unbanned, the mass media was unshackled. And soon enough, we started using our newfound freedoms to complain about the <a href="https://archive.nepalitimes.com/article/nation/nepal-from-royal-to-republic,3736" target="_blank" rel="noopener noreferrer">king and queen</a>. When the Maoists took the country to war, we complained about the violence.After the ceasefire of 2006, we were not happy about the restoration of peace – we started complaining about the political transition. Our constant moaning and groaning probably prolonged that transition.Then the <a href="http://archive.nepalitimes.com/blogs/kundadixit/2015/05/27/a-month-that-felt-like-a-year/" target="_blank" rel="noopener noreferrer">earthquake struck in 2015</a>, and even as the aftershocks rocked us, we whined about the relief being poorly distributed, and the slow pace of reconstruction. We then had the <a href="http://archive.nepalitimes.com/article/editorial/autopsy-of-a-blockade%20,2863" target="_blank" rel="noopener noreferrer">Indian blockade</a> to complain about. And as soon as the 2017 election was over, we started criticising the very leaders we had just elected to power.We were about to run out of things to complain about when there was the <a href="https://www.nepalitimes.com/editorial/nepals-new-normal/" target="_blank" rel="noopener noreferrer">COVID-19 pandemic</a>, and we could complain about <a href="https://www.nepalitimes.com/editorial/reduce-harm/" target="_blank" rel="noopener noreferrer">the lockdown</a> and the corruption in the procurement of medical supplies and the government’s general incompetence.It is human nature. Like most people around the world, Nepalis are never happy with the state of affairs. In fact, we do not score very high in the Happiness Index. That itself is a positive thing because it means we know there is plenty of room for improvement. Things can always be better. That is the whole idea behind the need to see the world as half full.Remember the days when there were 16 hour power cuts every day? <a href="https://www.nepalitimes.com/here-now/an-electric-shock-to-nepals-energy-future/" target="_blank" rel="noopener noreferrer">Now that there is surplus power</a>, we are complaining that the electricity we generate is going waste. What to do with it? Where to sell it?There was a time in the 1980s when the proponents of the Himalayan Degradation Theory predicted that Nepal would be a desert by the turn of the century. Here we are four decades later, and <a href="https://www.nepalitimes.com/banner/tree-mendous/" target="_blank" rel="noopener noreferrer">Nepal has doubled forest cover</a>. We have almost a quarter of our area designated as national parks, and 15% of Nepal is covered in <a href="https://www.nepalitimes.com/banner/who-now-owns-nepals-forests/" target="_blank" rel="noopener noreferrer">community-managed forests</a>.Enrollment in school is nearly 100%, infant and <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener noreferrer">maternal mortality</a> have seen dramatic reductions. Absolute poverty has been halved in 25 years. The education we got and the remittance economy has exposed many Nepalis to jobs all around the world, and the quality of life for many have improved with the money sent home.Yet we complain that our youth are away. But that is also good because the end goal should be to create jobs for them at home.There are many products in the market that require energy to produce. If Nepal is to select a few of these and manufacture them near our many <a href="https://www.nepalitimes.com/opinion/decentralising-hydropower/" target="_blank" rel="noopener noreferrer">hydropower</a> plants, we could become productive and competitive.In Birganj, for example, there are truck loads of metal sheets coming in from India. They are rolled into pipes and poles, and sent back out. This is the value added for Nepal’s abundant, clean, reliable energy.Entrepreneurs will begin to look for energy production sites where goods can also be produced. We will then see how education will be valued in these areas because it means jobs at the local level. We will no longer have the debate about exporting energy, and sending Nepali youth abroad to prop up the <a href="https://www.nepalitimes.com/editorial/remit-for-remittances/" target="_blank" rel="noopener noreferrer">remittance based economy</a>. Local agriculture will have a local market. Nepalis will also understand the true meaning of Value Added Tax.We can use spilled hydropower at night to pump water for to irrigate farms and boost food production, and during the day use the water to generate power. This is the chance for an entrepreneur to set up a factory to manufacture rice cookers and electric kettles so we <a href="https://www.nepalitimes.com/opinion/look-whats-cooking-in-nepal/" target="_blank" rel="noopener noreferrer">reduce our reliance on imported LPG</a>.Nepal’s poverty related problems can be solved with political will. Nepal’s problems are simple and so are their solutions. Unfortunately, we like to complicate things so we can seek complicated solutions. It is almost as if we want to remain poor so we keep getting grants for poverty alleviation, so our experts and consultants have jobs. It is precisely because we have only complained and not implemented solutions over the past seven decades that we would rather export manpower than value-added good and services.Historically we have always described Nepal with what we do not have. For example, we do not have access to the sea. Or the terrain is not easy. These were always top reasons given for why we remain poor, rather than look at poor governance and mediocre leadership.More and more Nepalis now live in comfortable homes, drive fancy cars, send their children to the best schools. And yet we complain. Human progress is about not being content and wanting things to improve. There is so much to do as we move ahead whether you see the glass half empty, or half full. It is time to take the lead and move ahead.Anil Chitrakar is President of Siddharthinc. This is his last written column, he will now be hosting a fortnightly Anil’s Walkabout video program on the Nepali Times YouTube channel.

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Fatal discrimination

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