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Do boys complete the family: Sex selection by choosing when your family is complete?

OBJECTIVE
Preference for sons has sometimes resulted in adverse practices such as female infanticide or neglect in some cultures. We analyzed data from a population representative survey in an urban informal settlement in Rawalpindi, Pakistan to identify if there was a preference for boys by couples. The preferences of couples were measured by comparing the gender of the last child in the family with other relevant indicators.


METHODS
Data from a cross-sectional survey from Dhok Hassu, Rawalpindi are presented. Dhok Hassu is an urban informal settlement where an urban lab was established to test health and development interventions. Data were gathered from 1556 Married Women of Reproductive Age (MWRA) through cluster randomization and analyzed through descriptive statistics and a binomial regression.


RESULTS
The sex ratio for all children is 1.16 in favour of boys and increases 1.39 for the last child and increases to 2.45 among certain (Afghan) ethnic households. When a boy, as opposed to a girl, is the last child, the family size is 4.21 vs. 3.95 children (p: 0.044), Preference for sons is evident in Dhok Hassu where women desire and are on average likely to have another child if the youngest living child is a daughter. Family size was larger and contraceptive use was high in families where the last child was male with an AOR of 2.018, LL: 1.255, UL: 3.244.


CONCLUSIONS
A relatively less well described method of sex selection is described where couples continue to have children until they have a boy. In effect, having boys complete families. There is need to better understand motivations of families to have boys in the changing context of societies, particularly in the face of urbanization and increasing entry of women in work place.