has shown that sex-selective abortion is more common among educated women and _after_ the first child is born (Das Gupta, 1987; Jha et al., 2011).

The central idea of this paper is that maternal and adult mortality is higher among women with a first-born daughter. As a result of strong son preference, such women are more likely to engage in fertility behavior that adversely affects their health. This effect should and is found to be stronger among women with generally more vulnerable health, lower access to maternal care and to technologies for fetal sex determination, typically the poor and uneducated.

I pool three rounds of the India National Family Health Survey (NFHS) and find several significant findings. First, there are no systematic differences between women whose first birth is male and women whose first birth is female close to the time they give birth. Significant differences appear in the sample of older women (i.e., aged 30 to 49), both in terms of variables related to fertility behavior, and predetermined characteristics. The latter is suggestive of selection among women with a first-born girl as a result of higher mortality. The empirical strategy rests on the identifying assumption of conditional exogeneity of the sex of the first-born. Second, compared to women with first-born sons, women with first-born daughters are 5.1 percentage points more likely to desire more children, 6.8 percentage points less likely to be sterilized, 2.5 percentage points more likely to have undergone an ultrasound test, 1.1 percentage points more likely to have had a terminated pregnancy, and to have given birth to 0.3 additional children. These results reinforce findings from the existing literature on son-preferring stopping behavior and sex-selective abortion. I investigate heterogeneous effects by women’s education level (with education as a proxy for socioeconomic status) and find that, as expected, educated women with a first-born girl are more likely to have had a terminated pregnancy and to exhibit an attenuated effect on fertility (compared to uneducated women). Moreover, a first-born girl increases the probability of a short birth interval by 0.5 percentage points (the effect is 0.8 percentage points for women with a second-born girl conditional on a first-born girl). This result is robust to the inclusion of mother fixed effects and is larger for uneducated women. Although the effects of two or more successive daughters on fertility outcomes are consistently larger (reflecting increasing pressure for having a son), I focus on the sex of the first-born to maintain a causal interpretation. Third, among women under the age of 30, those with a first-born girl develop anemia at a higher rate: they are in fact 1.4 percentage points more likely to be anemic (compared to those with a first-born boy), even after controlling for height, current pregnancy and breastfeeding status. Fourth, differences in anemia prevalence disappear for women older than 30. Fifth, the share of living women whose first birth is female decreases with mother’s age at the time of the survey, especially among the uneducated. This suggests that maternal and adult mortality is higher among uneducated women with a first-born girl. State-wise variation confirms that this decreasing pattern is found in states with the highest proportion of missing women of adult ages (Assam and Bihar), and not in states with the most 3