A gender discrimination study has found that 2,39,000 girls under the age of five die in India every year because of society’s preference for sons. The study, conducted by the Austria-based International Institute for Applied Systems Analysis, did not include the figures of female foetuses that are aborted.

“Gender-based discrimination towards girls doesn’t simply prevent them from being born, it may also precipitate the death of those who are born,” said Christophe Guilmoto, the study’s co-author. “Gender equity is not only about rights to education, employment or political representation, it is also about care, vaccination, and nutrition of girls, and ultimately survival.”

The researchers found that the problem was most pronounced in Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh, which account for two thirds of the total excess deaths. In Uttar Pradesh, excess female mortality was calculated at 30.5 while in Bihar it was 28.5. In Rajasthan and Madhya Pradesh it was 22.1 and 25.4, respectively. The worst-affected areas are rural, agricultural areas with low levels of education, high population densities, low socioeconomic development and high levels of fertility.

“As the regional estimates of excess deaths of girls demonstrate, any intervention to reduce the discrimination against girls in food and healthcare allocation should therefore target in priority regions of Bihar and Uttar Pradesh where poverty, low social development and patriarchal institutions persist and investments on girls are limited,” said researcher Nandita Saikia.

If the preference for sons does not diminish, lower fertility in North India might bring about a rise in gender-based sex selection, Saikia added. “This reinforces the need to address directly the issue of gender discrimination in addition to encouraging social and economic development for its benefits on Indian women.”