Sex Differences in U5MR: Estimation and Identification of Countries with Outlying Levels or Trends

Leontine Alkema, National University of Singapore
Cheryl C. Sawyer, United Nations

Under natural circumstances, the ratio of the male to female under-five mortality rate is greater than one. However, deprivation of girls’ access to health care or proper nutrition could lead to distorted ratios of under-five mortality. Monitoring of mortality by sex is challenging because of issues with data availability and quality. Moreover, the sex ratio is expected to vary with under-five mortality, which makes it challenging to define "expected levels". We present a Bayesian hierarchical model to estimate the sex ratio of under-five mortality for all countries. In addition, we estimate the relative difference between national sex ratios and expected sex ratios based on the global relation between under-five mortality and the sex ratio. All estimates include an uncertainty assessment to enable assessments of whether differences between countries or within countries over time are significant or highly uncertain. Preliminary results suggest that girls may be disadvantaged in several countries.