Parental gender discrimination in health investment : evidence from umbilical cord blood hematopoietic stem cell banking in China

Abstract

This article studies gender bias in parental investment in children’s health, especially focusing on gender discrimination against girls in enrollment and de-enrollment for umbilical cord blood hematopoietic stem cell (UCB-HSC) banking. Using data on births and UCB-HSC banking from 2019 to 2024 in 15 prefectural cities in Shandong Province, China, it finds significant discrimination against baby girls in enrollment but no discrimination in de-enrollment, which appears to be predominantly driven by household financial challenges. There is substantial heterogeneity across cities in the degree of discrimination, which is significantly negatively correlated with socioeconomic variables such as per capita gross domestic product, disposable household income, education expenditure, healthcare expenditure, and higher education prevalence, and positively correlated with illiteracy rate and son preference. The relaxation of China’s one-child policy did not decrease the discrimination against girls in enrollment. A questionnaire survey of 5,168 maternity women reveals that, controlling for household income, the chances of baby girls enrolling in UCB-HSC banking increase significantly with the contribution of women to household income, women being the head of the household, having already had a male offspring or living together with their own parents. The results are consistent with a collective bargaining model of household decision making, not with the unitary model of family behavior. Parental decision in enrolling boys versus girls is more driven by their perceived reliability of sons versus daughters for old age support than by their perceived higher need for using the UCB-HSC for likely treatment.