Background: The desire for sons has long been recognised as a significant determinant of childbearing decisions throughout most of South Asia. This paper provides an overview of the stated desire for sons and the manifestations of son-preferring behaviour in relation to parity progression and contraceptive use.
Methods: This paper uses the most recently available Demographic and Health Survey (or equivalent) data from five South Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. The extent of son preference in these countries is compared in terms of reported latent son preference as well as in terms of revealed son preference in relation to differential stopping behaviour, and choices about contraceptive use and contraceptive method.
Results: Parity progression is driven by son preference to some extent in all five countries studied. It is found that son preference is also a major factor in determining use of permanent contraceptive methods in every country apart from Afghanistan. The association is particularly strong in Nepal, India and Pakistan. Women with fewer than two sons are generally much less likely to use permanent contraceptive methods. On the other hand, son preference has little association with temporary or traditional contraceptive use in any country.
Conclusion: The desire for sons has a significant impact on fertility and contraceptive choices across much of South Asia, even in places where high fertility persists. Family planning programmes in these areas need to change deeply embedded attitudes in order to be successful. In Pakistan and Afghanistan in particular, future reductions in fertility could be hindered by high levels of son preference.