• B B Nielsen, J Liljestrand, M Hedegaard, S H Thilsted, and A Joseph.
• Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.
• BMJ. 1997 May 24;314(7093):1521-4.

ObjectivesTo study reproductive pattern and perinatal mortality in rural Tamil Nadu, South India.DesignCommunity based, cross sectional questionnaire study of 30 randomly selected areas served by health subcentres.SettingRural parts of Salem District, Tamil Nadu, South India.Subjects1321 women and their offspring delivered in the 6 months before the interview.Main Outcome MeasuresNumber of pregnancies, pregnancy outcome, spacing of pregnancies, sex of offspring, perinatal and neonatal mortality rates.Results41% of the women (535) were primiparous; 7 women (0.5%) were grand multiparous (> 6 births). The women had a mean age of 22 years and a mean of 2.3 pregnancies and 1.8 live children. The sex ratio at birth of the index children was 107 boys per 100 girls. The stillbirth rate was 13.5/1000 births, the neonatal mortality rate was 35.3/1000, and the perinatal mortality rate was 42.0/1000. Girls had an excess neonatal mortality (rate ratio 3.42%; 95% confidence interval 1.68 to 6.98; this was most pronounced among girls born to multiparous women with no living sons (rate ratio 15.48 (2.04 to 177.73) v 1.87 (0.63 to 5.58) in multiparous women with at least one son alive).ConclusionsIn this rural part of Tamil Nadu, women had a controlled reproductive pattern. The excess neonatal mortality among girls constitutes about one third of the perinatal mortality rate. It seems to be linked to a preference for sons and should therefore be addressed through a holistic societal approach rather than through specific healthcare measures.

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