|Year : 2022 | Volume
| Issue : 1 | Page : 14-17
Gender of the baby and its impact on the health-related quality of life of postpartum women
Pallika Singh, SK Rasania
Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
|Date of Submission||16-Dec-2021|
|Date of Decision||18-May-2022|
|Date of Acceptance||27-May-2022|
|Date of Web Publication||30-Jun-2022|
Department of Community Medicine, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Health-related quality of life (HRQoL) is a multidimensional concept and is relatively neglected in both research and practice. Gender equality is a crucial measure of human rights for millions of women and girls around the world. Most postpartum researches have focused on physical complications. This study was conducted to analyze the impact of gender of the baby on the HRQoL of postpartum women at 6 weeks.
Material and Methods: The study was conducted in a resettlement colony, Kalyanpuri, located in Delhi, India, with a sample size of 330 postpartum women. The data were collected in the 6th week of postpartum period using the Medical Outcomes Study Short Form 36 Health Survey for HRQoL.
Results: The findings showed that the birth of a male baby led to a significantly (P < 0.05) better mean HRQoL score than the birth of a female baby. The mean scores of general health, vitality, social functioning, and mental health domains were significantly less in the case of a female newborn child.
Conclusion: The male dominance in the Indian society which leads to financial supremacy and coercion for continuation of family lineage was an important predictor of lower HRQoL of the women in the postpartum period. This demonstrates the need for risk factor for gender equity to and achieve universal health coverage.
Keywords: Gender discrimination, health-related quality of life, postpartum women, gender, quality of life, sociocultural factors, universal health coverage
|How to cite this article:|
Singh P, Rasania S K. Gender of the baby and its impact on the health-related quality of life of postpartum women. Indian J Community Fam Med 2022;8:14-7
|How to cite this URL:|
Singh P, Rasania S K. Gender of the baby and its impact on the health-related quality of life of postpartum women. Indian J Community Fam Med [serial online] 2022 [cited 2022 Aug 17];8:14-7. Available from: https://www.ijcfm.org/text.asp?2022/8/1/14/349376
| Introduction|| |
Gender equality is a crucial measure of human rights, and millions of women and girls around the world still continue to face gender discrimination. The preference for a male child is found to be deeply rooted in the Indian society, and this study evaluates the gender of the baby as a predictor affecting the quality of life which might open realms of social, maternal, and child health interventions. health-related quality of life (HRQoL) of postpartum mothers is relatively neglected in both research and practice as most researches have focused on physical complications in the postpartum period. The postpartum period is a time span of 6 weeks after childbirth and is a period of great happiness for the mother and the entire family, and it marks a transition phase in the life of the mother at physical, mental, social, and emotional levels, especially of an underprivileged community, which needs to be addressed for the health of the mother. This research aims to study the impact of gender of the baby on the HRQoL of postpartum women at 6 weeks. The World Health Organization describes the postnatal period as the most critical and yet the most neglected phase in the life of women where most maternal and newborn deaths occur during this period. De Tychey et al. in France (2003) studied quality of life, postnatal depression (PND), and gender of the baby using Medical Outcomes Study Short Form 36 Health Survey and found that PND and male baby strongly reduce all dimensions of quality of life in postpartum women. In a country like India where prevalence of malnutrition, poverty, illiteracy, and poor health-care services is common, providing postpartum support to the mother is of utmost importance. HRQoL is an important indicator of the quality of health care. Quality of life is a broad and a complex concept which is defined as an individual's perception of their position in life in relation to the culture and value systems, their goals, expectations, standards, and concerns. A systemic review done in South Asia showing higher mortality among female neonates due to differences in care-seeking behavior as socioeconomic and cultural norms give greater preference to boys over girls. Moreover, women who already have a female child face greater stress because of male child preference in the family and thus putting the mother at risk of depression in the postpartum period. This study aims to evaluate the gender of the baby as a predictor affecting the quality of life of postpartum women. Furthermore, paucity of literature and dearth of community-based research in the aspects of quality of life among postpartum women in the study area and largely in India is also one of the major concerns being addressed through this study.
| Material and Methods|| |
A community-based cross-sectional study was conducted in a resettlement colony located in Delhi, India. The area is divided into 11 blocks with a total population of 25,754 with 4596 eligible couples in 4302 households. The study was carried out from November 2018 to March 2020 postpartum women in the age group of 15–49 years who delivered in the year 2019 were the study participants. The study subjects were asked questions, and the data were collected in the 6th week of postpartum period. The study area was visited before planning the study, and it was observed that the blocks of the area had multifarious distribution of population according to social class, religion, economic standards, health perceptions, and health-seeking behaviors.
Enrolment of study subjects was started by registration during antenatal period during the third trimester from the registers of ASHA/Anganwadi workers. The sample size was calculated within 95% confidence limit, where N is the required sample size, σ is the standard deviation (SD), and d is the precision. Based on SD of HRQoL = 22, precision (d) = 2.5 at 95% confidence interval, and power of 80%, calculated sample size is 298. While calculating the sample size, the non response rate or loss to follow up rate was taken as 10%. The calculated minimum sample size is 328. A total number of 330 study subjects were included in the study.
A predesigned, pretested, and semi-structured interview schedule was used in the form of a questionnaire in the study. The questionnaire consisted of three parts. Part I included general information of the subjects. Part II consisted of maternal and child health factors in antepartum, intrapartum, and postpartum periods. Part III included a standardized questionnaire, namely the Medical Outcomes Study Short Form 36 Health Survey that was used in this study for information related to HRQoL, followed by general physical examination of the study subject. The scoring of SF-36 was done according to the SF-36 Health Survey Manual and Interpretation Guide.
Data analysis and interpretation
Data collected in the proforma were coded, entered, and analyzed using the IBM SPSS Statistics 25 SPSS Inc. released in 2017. All quantitative observations were analyzed using the Chi-square test, unpaired t-test, and analysis of variance (ANOVA), and P < 0.05 was considered to be statistically significant.
The study protocol was approved by the Institutional Ethical Committee, Lady Hardinge Medical College, New Delhi. Written consent was taken from the study subjects in the language that they understood before the administration of the study questionnaire. The privacy and confidentiality of the study subjects was maintained.
| Results|| |
Among the 330 women taken as study subjects, 50.9% of women gave birth to male babies and 49.1% delivered female babies in the present pregnancy and the study subjects with birth of a male baby had a better mean HRQoL score of 66.9 ± 19.1 in comparison to the birth of a female baby (61.8 ± 19.4). The difference was found to be statistically significant, unpaired test (P < 0.05) [Table 1].
|Table 1: Distribution of mean health-related quality of life score of the study subjects according to the gender of the baby|
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Among the study subjects, 64 subjects had male preference for their child in the present pregnancy while 80.6% had no gender preference [Table 2].
|Table 2: Distribution of the study subjects according to their male preference in the present pregnancy|
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The mean score of 8 domains of HRQoL using SF-36 (8) for male and female genders of the baby was observed in postpartum women at 6 weeks. The study subjects who delivered a male child had a higher mean HRQoL score under all the domains as compared to a female baby. The mean scores of general health (72.3 ± 23.5), vitality (56.6 ± 15.0), social functioning (64.3 ± 16.9), and mental health (70.5 ± 14.7) were significantly less in the case of a female newborn child. The abovementioned associations were statistically significant, ANOVA (P < 0.05) [Table 3].
|Table 3: Distribution of average health-related quality of life scores of study subjects for various domains and modes of delivery|
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| Discussion|| |
Women form an important pillar of society, and they are the primary caretaker of children in every country of the world. Therefore, improving the well-being of women is an important public health goal for India. The preference for a male child and the gender issues are found to be deeply rooted in the Indian society which is ideologically motivated and has started shedding its presence off lately. The socioeconomic stigma attached to the birth of a female child is a matter of concern because it impacts the quality of life of a new mother. The male preference in the family and such socio-cultural issues and gender biases often make pregnancy a stressful experience as well as stress in the postpartum period. It affects the mental health domain of health related quality of life score, as in the present study. The findings of the current study showed that the birth of a male baby had a significantly (P < 0.05) better mean HRQoL score in comparison to the birth of a female baby. The male dominance in the Indian culture is often associated with financial supremacy of the males along with the system of family lineage culture leading to a gender based risk factor leading to poor health related quality of life. In a similar study by De Tychey et al. in 2003 using SF-36 in France, the findings were incongruent with our study as these countries have sociocultural, economic, and demographic differences. They observed that the birth of a boy reduced several dimensions of the mothers' quality of life which was opposite to the results of our study. The birth of a male baby showed a significant effect on the domains of HRQoL of the mother in the postpartum period at 6 weeks in our study. Significantly reduced scores of vitality, social functioning, and mental health are evidence of the reality of sex bias among the people which these child mortality, education, health, and nutrition among the female gender. Patel et al. (2002) interviewed postpartum women at 6–8 weeks and 6 months after childbirth in Goa, India, and observed that the gender of the infant was highly related to PND and the risk was signiﬁcantly greater on the birth of female gender. According to a study on gender discrimination in India (Parvathi S, 2020), the preference of a male child among the Indian population is not only averting a female child from being born but also causing higher mortality among the newborn girls as the death rate among the girl children under 5 is more than that of the male child. In spite of advancements in the world, even today, the girl child is discriminated in most of the Indian families. Following the sociocultural norms, the birth of a male child is celebrated with boundless enthusiasm whereas the birth of a girl child is received with consternation and distress among the family members. Women are usually blamed for the birth of a female child which eventually adversely affects their quality of life and health. In our study, the presence of male preference among the study subjects was 19.4%, but there was also a significant effect of gender of the baby on the quality of life of the mother as birth of a male baby had a better mean HRQoL. Patel et al. (2002) also concluded that the women who already have a female child face greater stress because of their wish that their new infant should be a boy. Male preference could also be related to the fact that mothers are usually blamed for the birth of a female child, which explains our study where the mental health, vitality, and social functioning scores were reduced, thereby reducing the quality of life of the mothers. The stress due to cultural norms of the society, marriage expenses in future, and social pathologies such as dowry and violence against women also possess as a stressor to the new mothers and the family members. The perinatal period is considered to be the most vulnerable and critical and yet the most neglected phase in the lives of mothers and babies which, on the other hand, is the most suitable for impactful interventions. It can be used for creating awareness, imparting knowledge regarding the importance of quality of life, meaning of quality in health care, availability and utilization of health-care services, and rising against various social concerns and issues faced by this vulnerable gender during pregnancy and the postpartum period. Early age marriages and pregnancies have always posed a threat to the health and development of a female which affects their quality of life and thus needs an advocacy by not only health-care providers but also the social sector leaders and experts. These factors and expectations for a particular gender usually result in poor quality of life of a female which is purely based on societal and cultural pressures. Our study thus demonstrates the need for further consideration of sociocultural factors across communities and cultures for equity among all the genders.
| Conclusion|| |
This study demonstrates the need for further consideration of socio-cultural factors across communities and cultures for quality in health among all the genders to achieve universal health coverage.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Parvathi S, Thamizhchelvi P. Gender discrimination in India – A study. J Xi'an Univ Archit Technol 2020;12:2901-7.
de Tychey C, Briançon S, Lighezzolo J, Spitz E, Kabuth B, de Luigi V, et al.
Quality of life, postnatal depression and baby gender. J Clin Nurs 2008;17:312-22.
Romero M, Vivas-Consuelo D, Alvis-Guzman N. Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation? Springerplus 2013;2:664.
Bahrami N, Karimian Z, Bahrami S, Bolbolhaghighi N. Comparing the postpartum quality of life between six to eight weeks and twelve to fourteen weeks after delivery in Iran. Iran Red Crescent Med J 2014;16:e16985.
Ismail SA, McCullough A, Guo S, Sharkey A, Harma S, Rutter P. Gender-related differences in care-seeking behaviour for new-borns: A systematic review of the evidence in South Asia. BMJ Glob Health 2019;4:e001309.
Rezaei N, Azadi A, Zargousi R, Sadoughi Z, Tavalaee Z, Rezayati M. Maternal health-related quality of life and its predicting factors in the postpartum period in Iran. Scientifica (Cairo) 2016;2016:8542147.
Ware JE, Snow KK, Kosinski M, Gandek B.SF-36 Health Survey Manual and Interpretation Guide. Boston, MA: New England Medical Center, the Health Institute; 1993.
Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: A study of mothers in Goa, India. Am J Psychiatry 2002;159:43-7.
[Table 1], [Table 2], [Table 3]