This study sought to examine the association between sibling composition (in terms of sex) and chronic malnutrition among children in Ghana. It further aimed to answer the question of whether having siblings of either the same or opposite sex matters in stunting analysis. Evidence from this study suggests that sibling composition influences stunting among children under the age of 5. This finding is consistent with the findings of previous studies on the role of siblings’ sex in influencing chronic malnutrition(14, 9, 12, 15). The analysis further revealed that, unlike having only female siblings, having only male siblings significantly predicts stunting among children under 5 years of age. Specifically, children with only male siblings have a heightened risk of being stunted. However, having female siblings was not a threat of being stunted. This is in stark contradiction to the findings of prior research by Raj et al., which suggested a lower risk of stunting among boys with many male siblings than among girls with many female siblings (12). Their research suggested that having more female siblings increased girls’ odds of being stunted, which is inconsistent with the findings of the present study.
In an attempt to understand the nuanced relationship between sibling composition and childhood stunting, a sex-stratified analysis was performed for both male and female children. In the context of childhood stunting, having only male siblings was a problem for both male and female children, which is consistent with the findings from the composite model. This finding also agrees with findings from a study by Chaudhuri that examined the effect of sibling sex on nutritional outcomes in children (16). The study revealed that having male siblings negatively impacted both boys and girls, even though the impact was more severe among boys than girls. Chaudhuri explains that in households where there are only male children, there is strong competition for household resources, including food and nutrition (16). A plausible explanation is given by Helfrecht & Meehan, Kramer et al., and Magvanjav et al., who opine that there is fierce competition for resources, including nutrition, among children, especially among those from resource-constrained households (17, 18, 15).
Within the Ghanaian cultural context, where the majority of ethnic groups practice the patrilineal inheritance system and where priority is given to male children, parents might want to invest greater resources such as attention, food, and nutrition in male children at the expense of female children because they (male children) are thought to be successors and future breadwinners of their families. Additionally, in all-male-children families, parents may invest scarce resources equally in their children. As is well articulated by Helfrecht and Meehan, the seemingly equal treatment given to male children in a household tends to deepen their rivalry, extending to competition over scarce resources (17). Biologically, boys and girls experience significant growth and development during childhood (19). However, boys tend to grow faster in height, weight, and muscle development (20). This rapid growth necessitates additional nutrients for tissue building and repair (21). As a result, male children may require more energy and nutrients to support their growth and development. The need for the nutrients required for healthy growth and development among boys may exacerbate competition for scarce resources such as food, especially in resource-constrained households (17).
Adding to the hypothesized objectives of the gendered influences of siblings on chronic childhood malnutrition, this study documents some of the child, maternal, and household context factors that put children at risk of being stunted. Consistent with prior research, the sex of the child (22, 23), breastfeeding duration (24, 25), and birth weight (26, 27, 28) were the child factors that showed a significant association with childhood stunting. Specifically, while male children had greater odds of being stunted than female children, children with normal birth weight had greater odds of stunting than children with low birth weight.
Like other cross-sectional studies, the present study has several limitations. Because this was a cross-sectional study where data collection was performed at a single point in time, the study is limited in making causal inferences or observing variable changes with time. Even though a robust sampling technique was utilized to ensure that a representative sample was obtained, the DHS survey may be fraught with biases due to errors in measurement, underrepresentation of certain population subgroups, or nonresponse. Additionally, because the DHS allows for self-reporting of some measurements, such as birth weight (which is a key variable in this analysis), the data may face errors of social desirability bias.
Furthermore, since the sibling composition variable was generated from both the ‘sons at home’ and ‘daughters at home’ variables, it may bias the results. This is because it is assumed in this study that mothers’ resource allocation is limited to only children living in the same household as their parents. This assumption may not be accurate, especially in instances where mothers allocate resources (food and nutrition) to children who are not presently living in the same household as them. Nevertheless, children living with their mothers are usually considered a good representation for sibling composition analysis.