In India, a girl’s life is often shaped by her family’s perceptions long before she takes her first breath. From the moment her gender is known, cultural beliefs, economic pressures, and deep-rooted traditions begin to influence decisions that affect her health, education, and future opportunities. Understanding how families perceive daughters is essential for anyone working in healthcare, social work, or community development-and for creating meaningful change in the lives of millions of girls across the country.

Table of Contents

The burden perception: why daughters are seen differently

In many Indian households, daughters are often associated with a “double loss”-they leave their natal family upon marriage, and the investments made in their upbringing benefit another family. This perception is further compounded by the burden of dowry and marriage expenses that fall on the girl’s family. Sons, on the other hand, are viewed as assets worthy of investment who will eventually contribute to the family’s economic security and carry forward the family name.

This economic framing has profound consequences. Research using National Family Health Survey data demonstrates that son preference continues to shape family dynamics, influencing everything from fertility decisions to how resources are distributed among children. The birth of a boy is often celebrated, while the birth of a girl-especially a second or subsequent daughter-may be met with disappointment or even crisis.

Gender bias experienced within the family unit reinforces traditional stereotypes from a young age, creating psychological impacts that persist into adulthood. Studies show that perceived familial gender discrimination has a significantly positive relationship with feelings of entrapment among young women, highlighting the mental health consequences of growing up feeling less valued than male siblings.

Health and nutrition: where discrimination begins early

The effects of family perceptions manifest physically in the health and nutritional status of girls. When families prioritize sons, girls often receive less food, fewer medical interventions, and delayed healthcare-sometimes with fatal consequences.

The nutrition gap

Studies conducted in urban slum areas have found alarming disparities. Research from Maharashtra revealed that among children attending community nutrition centers, 72% of females were stunted and 43% were severely malnourished. The same study highlighted how birth order, mother’s education, and socioeconomic status significantly influenced nutritional outcomes, with girls from larger families facing compounded disadvantages.

While India has made progress-reducing stunting rates among children over the past three decades-girls continue to face specific challenges. The reduction in stunting has been slightly lower for girls compared to boys, suggesting persistent gender-based disparities in how nutrition is distributed within families.

Mortality and survival

Perhaps the starkest indicator of discrimination is found in survival statistics. India remains one of the few large countries where more girls die than boys in early childhood-contrary to biological expectations that favor female survival. Parents often invest more resources in sons through immunizations, medical treatment, and nutrition, leading to girls experiencing poorer health outcomes.

This discrimination is not always generalized across all girls. Research indicates that daughters born at later parities and without brothers face the greatest disadvantage-these “redundant” daughters experience the most severe neglect. In some regions, particularly in northern India, the female mortality disadvantage has historically been pronounced, though improvements have occurred since the mid-1990s.

Educational barriers shaped by family attitudes

Education represents both a symptom and a potential solution to gender discrimination. Girls’ access to education often depends heavily on whether families view educating daughters as a worthwhile investment.

According to the National Commission for Protection of Child Rights, approximately 40% of girls aged 15-18 were out of school, and among them, nearly 65% were engaged in household work. This reflects family decisions that prioritize domestic contributions over educational opportunities for daughters.

The literacy gap persists despite decades of intervention. While male literacy stands at over 82%, female literacy remains lower at approximately 64%-a gap of nearly 18 percentage points that reflects accumulated disadvantage over generations.

The cycle of early marriage

Families viewing daughters as burdens often seek to “discharge” this responsibility through early marriage. Despite laws setting minimum marriage ages, poverty and tradition continue to drive families to marry daughters young. India has among the highest numbers of child brides globally, with surveys suggesting approximately 1.5 million girls under 18 marry each year. Early marriage ends education, increases health risks during pregnancy, and perpetuates the cycle of poverty and discrimination into the next generation.

Breaking the cycle: government initiatives and community change

Recognizing these challenges, the Government of India launched Beti Bachao Beti Padhao (Save the Daughter, Educate the Daughter) in January 2015. This initiative specifically targets the declining child sex ratio and promotes the survival, protection, and education of girls through a multi-ministerial approach involving the Ministry of Women and Child Development, Ministry of Health and Family Welfare, and Ministry of Education.

Measurable progress

After a decade of implementation, the scheme has achieved notable improvements. The national Sex Ratio at Birth has increased from 918 girls per 1,000 boys in 2014-15 to 933 in 2022-23. The Gross Enrollment Ratio for girls in secondary education improved from 75.51% to 79.4% during the same period. Institutional deliveries-ensuring safer childbirth-rose from 87% to over 94%, reducing maternal and infant mortality rates.

Community-level activities like “Beti Janmotsav” (celebrating the birth of girl children) and the viral “Selfie with Daughter” campaign have helped shift social attitudes, making public declarations of pride in having daughters more acceptable and even celebrated.

Integrated approaches to nutrition

The Integrated Child Development Services scheme represents India’s primary national nutrition programme targeting maternal and child undernutrition. Delivered through the Ministry of Women and Child Development, it provides nutrition education, supplementary nutrition, growth monitoring, pre-school education, immunization, and health referral services. This comprehensive approach addresses multiple factors simultaneously, recognizing that improving girls’ outcomes requires tackling interconnected issues of health, nutrition, and education together.

The role of mothers and maternal education

Interestingly, research consistently identifies maternal factors as crucial determinants of child outcomes. Children of educated mothers have significantly lower chances of being undernourished-maternal education correlates with better nutritional awareness and healthcare practices. Similarly, household wealth and maternal autonomy play key roles in improving child nutrition.

This creates a generational pathway: educating today’s girls means better outcomes for tomorrow’s children. When women have greater autonomy in household decisions-including those related to food allocation, healthcare seeking, and family planning-their children, regardless of gender, tend to have better health and nutritional outcomes.

The path forward: cultural transformation

Changing family perceptions requires sustained effort across multiple fronts. Legal frameworks exist-the Pre-Conception and Pre-Natal Diagnostic Techniques Act prohibits sex-selective abortion, and laws mandate minimum marriage ages-but enforcement remains inconsistent, and cultural attitudes often persist despite legislation.

More promising are approaches that demonstrate the value of investing in girls. When families see educated daughters contributing to household income, gaining respectable employment, and providing support in old age, perceptions shift. Financial incentive programs encouraging investment in daughters’ education and delayed marriage show promising results in changing family calculations.

Healthcare workers, nurses, and community health workers play vital roles in this transformation. By ensuring equal attention to girls during health visits, counseling families on nutrition for all children regardless of gender, and identifying signs of neglect early, frontline workers can intervene before discrimination causes permanent harm.

Looking ahead

The situation for girls in India is slowly improving, but progress remains uneven. Northern states that historically showed the strongest son preference have made gains, while challenges persist in other regions. Urban-rural divides, socioeconomic disparities, and deeply embedded cultural beliefs mean that change happens gradually and requires constant reinforcement.

Understanding how family perceptions shape girlhood is the first step toward intervention. Every professional working with families-whether in healthcare settings, schools, or community organizations-has opportunities to challenge discriminatory attitudes and model equal treatment of children regardless of gender.

What do you think? How can healthcare professionals and community workers better identify signs of gender-based neglect in families, and what approaches have you seen work effectively in changing parental attitudes toward daughters?

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References
  1. https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Publication-39865.pdf
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC7732804/
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12457248/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3793383/
  5. https://in.childhelpfoundation.in/index.php/Media/girlchild
  6. https://www.ibef.org/government-schemes/beti-bachao-beti-padhao
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC10753286/
  8. https://pmc.ncbi.nlm.nih.gov/articles/PMC6572133/

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Behavioural Sciences

1 Application of Behavioural Sciences in Health

  1. Definition and Scope of Behavioural Sciences
  2. Relevance of Behavioural Sciences in Health
  3. Sociology As Science
  4. Relationship of Sociology with other Sciences
  5. Relationship between Sociology and Social Anthropology
  6. The Field of Sociology
  7. The Field of Medical Sociology
  8. The Field of Medical Anthropology
  9. Need for Sociological Perspective for Health Professionals
  10. Role of a Nurse as an Agent of Change
  11. Key Ingredients for Nurse as Change Agent

2 Basic Concepts in Sociology

  1. Society
  2. Community
  3. Institution
  4. Social Organisation
  5. Social Structure
  6. Association
  7. The Origin of Understanding Society
  8. Sociological Approach to Understand Human Society
  9. Functional Approach to Understand Society
  10. Development of Social Complexities
  11. Evolution Theory
  12. Organic Theory
  13. Social Contact Theory
  14. Relationship between Individual and Society
  15. Socialization and its Meaning
  16. Process of Socialization
  17. Elements of Socialization
  18. Concept/Definition of Social Structure
  19. Elements of Social Structure
  20. Types of Social Structure

3 Family as a Social Unit

  1. Family
  2. Group
  3. Marriage
  4. Kinship
  5. Role of Family in Socialisation
  6. Role of Family in Psycho-Social Needs
  7. Role of Family in Conflict Management
  8. Role of Family in Health and Disease
  9. Choice of Food
  10. Maternal and Child Health
  11. Role of the Family in Mental Health Care
  12. Need to Study about Family
  13. Distinctive Features of Family
  14. Types of Family
  15. Functions of Family
  16. Role of the Family in the Context of Women’s Health in India
  17. Girlhood: Perceptions of Family in India
  18. Status and Role of Women within the Family
  19. Stresses Faced by Most Women
  20. Women’s Status and Nutritional Needs
  21. Changes in the Family and Implications for Socialisation
  22. Backdrop of Overall Social Change
  23. Factors Affecting Changes in the Family
  24. Transitional Phase of Indian Family

4 Social Stratification

  1. Meaning of Stratification
  2. Systems of Social Stratification
  3. Slavery
  4. Caste
  5. Class
  6. Estate
  7. Meaning of Caste
  8. Classification
  9. The Origin of Caste System
  10. Interdependence of Castes
  11. Theories of Stratification in Modern Society
  12. Karl Marx Theory
  13. Marx Weber
  14. Class-concept
  15. Difference between Caste and Class
  16. Type of Class
  17. Influence of Caste on Accessibility to Health Care

5 Social Mobility and Social Control

  1. Concept of Social Mobility
  2. Types of Social Mobility
  3. Reasons for Social Mobility
  4. Social Control — Concept and Meaning
  5. Need for Social Control
  6. How Social Control is Maintained?
  7. Concept of Culture
  8. Importance of Study of Culture
  9. Components of Culture
  10. Cultural Practices Influencing Health and Health Programmes
  11. Norms and Values as Means of Social Control
  12. Importance
  13. Conformity and Conflict of Norms
  14. Folkways and Mores
  15. Customs and Laws
  16. Concept of Deviance
  17. Crime and Punishment
  18. Religion and Morality

6 Social Change

  1. Concept of Social Change
  2. Urbanisation
  3. Present Health Programmes/Related Strategies
  4. Industrialization
  5. Agricultural Modernization
  6. Changes in Traditional Societies and its Impact on Health
  7. Emergence of Industrial Societies : Change of Traditional Society
  8. Role of Nurse in Specific Societal Problems

7 Social Development

  1. Concept of Social Development
  2. Indicators of Social Development
  3. Planning for Development
  4. Financial Outlay for Health in the Plans
  5. State/Central Government’s Role in Health Planning
  6. Factors Influencing State’s Ability for Financing Health Care
  7. State Versus the Market in the Health Care

8 Community and Community Participation

  1. Meaning of Community
  2. Social Interaction among Different Groups
  3. Organisation of Society and Rise of Different Modes of Systems of Production
  4. Community Participation in Health Care
  5. Community Participation as a Process

9 Sociological Perspective on Health and Disease

  1. Society and Health
  2. Socio-economic Status and Disease
  3. Utilization of Health Services

10 Guidelines for Visit to Orphanages, Nari Niketan, Jail Reforms, Schools and Old Age Homes

  1. Orphanages
  2. Nari Niketan
  3. Jails
  4. Old age homes

11 Introduction to Psychology and its Application to Nursing

  1. Definitions of Psychology
  2. Nature of Psychology
  3. Subject Matter
  4. Scope of Psychology
  5. Methods of Psychology
  6. Importance of Psychology in Nursing

12 Human Development

  1. Domains of Development
  2. Process of Development
  3. Developmental Theories
  4. Patterns of Development
  5. Nurse’s Role in Sickness During Development

13 Dynamics of Behaviour – Motivation, Frustration, Conflict, Emotion and Stress

  1. Motivation
  2. Frustration
  3. Conflict
  4. Emotion
  5. Stress

14 Sensory and Perceptual Processes

  1. Sensation: Meaning and Definition
  2. Types of Sensation
  3. Characteristics of Sensation
  4. Common Sensory Disorders and Defects
  5. Meaning and Definition of Attention
  6. Types of Attention
  7. Phenomena of Attention
  8. Determinants of Attention
  9. Meaning and Definition of Perception
  10. Form Perception
  11. Perceptual Constancies
  12. Perception of Movement
  13. Observer Characteristics
  14. Errors of Perception

15 Personality

  1. Definition, Meaning and Nature
  2. Strategies for Studying Personality
  3. Characteristics of Personality
  4. Traits of Personality
  5. Factors Influencing the Development of Personality
  6. Theories of Personality
  7. Type and Trait Theories
  8. Psychodynamic Theories
  9. Humanistic Theories
  10. Learning Theories
  11. Cognitive Theories
  12. Assessment of Personality

16 Introduction to Educational Psychology

  1. Definitions
  2. Scope of Educational Psychology
  3. Methods of Educational Psychology
  4. Special Education
  5. Significance of Educational Psychology to Nursing

17 Individual Differences

  1. How Individual Differences Originate
  2. Measurement of Individual Differences
  3. Role of Individual Differences

18 Intelligence and Abilities

  1. Nature of Intelligence
  2. Growth of Intelligence
  3. Determinants of Intelligence
  4. Assessment of Intelligence
  5. Extremes of Intelligence
  6. Applications of Intelligence

19 Learning

  1. Types of Learning
  2. Making Learning Effective
  3. Transfer of Learning
  4. Significance of Learning for Nursing

20 Memory and Forgetting

  1. Memory Process
  2. Types of Memory
  3. Causes of Forgetting
  4. Methods to Improve Memory

21 Attitudes

  1. Development of Attitudes
  2. Measurement of Attitudes
  3. Methods to Change Attitudes
  4. Importance of Attitudes for Nursing