bias at birth is highest in the North-West where excess female mortality among adult women is in turn relatively low (the “Group 1” states), while North-Eastern states have low gender bias at birth together with the highest excess female mortality in adulthood (the “Group 2” states). Southern states, like Kerala, exhibit the lowest excess female mortality in India (for this reason, Kerala was used as an alternative benchmark in their analysis). This evidence is confirmed by official statistics on sex ratios (2011 Indian Census) and maternal mortality (Office of the Registrar General India, 2011).<sup>29</sup> Two North-Western states, Punjab and Haryana, have the most male-biased sex ratio at birth of all Indian states. At the same time, they have below-national-average maternal mortality ratios. On the other hand, Assam and Bihar in the North-East have below-national-average (i.e., less male-biased) sex ratios at birth and are among the states with the highest maternal mortality ratios in India.

Figure 6 shows the share of women with first-born girls by age in Punjab, Haryana, Assam, Bihar, and Kerala. Panel (a) shows that Punjab and Haryana exhibit a steady share of women with first-born girls at all ages. Assam and Bihar, shown in panel (b), exhibit a strikingly different pattern: the share of living women with a first-born girl is steeply decreasing with women’s age. This is consistent with high prevalence of sex-selective abortions in the North-West (reflected in skewed sex ratios at birth) and higher maternal mortality in the North-East. Finally, as expected, Kerala shows a rather flat pattern, consistent with low excess female mortality across all age groups.

While more research is warranted, this paper offers a possible explanation for the apparent puzzle singled out in Anderson and Ray (2012). This is based on differential prevalence of sex selective abortion and son-preferring fertility behavior (as the two main ways through which parents can achieve the desired sex composition of children) across the states of India.

# **4.2 Health indicators**

Turning to health indicators (available only in NFHS-II and III), figure 7 shows the incidence of anemia by the sex of the first-born and women’s age at the time of the survey.<sup>30</sup> The general age pattern reflects the fact that anemia is typically higher during adolescence and the reproductive years due to higher physiological demand for iron while pregnant and lactating (Sharman, 2000; Mukuria, Aboulafia, and Themme, 2005). Notably, the figure shows that the incidence of anemia is significantly higher among women with a first-born girl (compared to women with a first-born boy) approximately up to age 30, while there is no differential incidence for older women.

Intuitively, this result might be the consequence of son preference: women with first-born girls tend to be pregnant (or breastfeeding) more often during their reproductive years than women who have first-born boys. Although higher iron needs during pregnancy are accounted for in the NFHS

> 29The sex ratio from Census data refers to all children aged 0 to 6.

> 30For a description of how hemoglobin testing is conducted in the NFHS and DHS surveys refer to Sharman (2000).

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