Journal of Health and Medical Sciences

Introduction: Son preference is a form of gender discrimination based on the belief that girls are inadequate and of lesser value than boys. It affects couples' fertility and may act as an obstacle to fertility decline. Aim: The study is aiming for estimating prevalence of son preferences among mothers in Mosul, Iraq and detecting its relation with actual and desired parity. Subjects and Method: Cross-sectional study was achieved in Mosul, Iraq. Inclusion criteria were "currently married mothers who consulted one of the primary health care centers. Results: The study interviewed 1761 mothers who their mean age was 36.3 years and ranged 15-79 years. More than half of them (54.1%). Most of them were Muslims (93.9%) and Arabs (83.7%). The study reported 338 mothers preferred to have only sons (making prevalence of son preference as 19.2%).It was significantly associated with having or desire to have high parity (22.8%, 0.01 and 29.2%. p=0.000). Social and economic gains were the most motivations (82.2%, 17.8%) for preferring sons. Conclusions: Two out of 10 mothers in Mosul prefer to have only sons for mainly social welfare.


Introduction
Son preference refers to parents' attitude for a male child. It is based on the belief that girls are inadequate and of lesser value than boys so that their births are not being welcomed. Such attitude is considered as a major form of gender discrimination that associated with neglect of the girl child in terms of withholding access to health, education, economic welfare and many other basic necessities. Even so, it may manifest itself through the practice of sex selective abortion.
So, having at least one son, especially in East and South Asia, North Africa and Middle East, where the societies are mostly patrilineal and patriarchal, is imperative for the continuation of the family ancestry. Furthermore, having many sons provide additional status to the family. All these areas are described as most high-fertility societies.
Son preference is the result of deeply rooted traditions that state "sons are desired for the purpose of family propagation, old-age security, the provision of labor, and the performance of ancestral rites. Many still hold to the old Chinese belief that "many sons bring much happiness." Since the general fertility rate reflects peoples' preferences for the number of children they would like to have. Preference of sons, in particular, affects fertility behaviours of couples trying to achieve a desired number of sons, since the parents of girls are more likely to continue reproduction as an effort to acquire sons. A strong preference for sons may be an obstacle to fertility decline if couples are not satisfied with sex composition of their children.
The study is aiming for estimating prevalence of son preferences among mothers in Mosul, Iraq and detecting its relation with actual and desired parity.

Subjects and Method
Administrative and ethical agreements were obtained from Nineveh Health Directorate to achieve the current cross-sectional study in Mosul, the largest city at the north of Iraq over 10 months duration.
The studied sample was selected by a multi-stage stratified technique in order to confirm representativeness of the three social strata were recognized. Inclusion criteria were "currently married mothers who consulted one of the primary health care centers (PHCCs) during the study period (from 1st of April 2011 to the end of January 2012). The selected PHCCs were having the highest coverage rate and representing 70% of all health centers in Mosul.
Verbal consents were mandatory to be obtained from studied sample and a special form of questionnaire was constructed to inquired the required data.
More than half of the studied sample (54.1%) were urban while 45.9% were residing peri-urban and rural areas. Most of them were Muslims (93.9%) and Arabs (83.7%). Almost two thirds of studied sample had get consanguineous marriage (68.2%) and living within an extended family-structure (73.4%).
The study has reported 338 mothers preferred to have only sons and 56.6% of mothers preferred to have sons and daughters. Thus, prevalence of son preference was 19.2%. On the other side, 5.5% of mothers preferred to have only daughters (Figure 1).

Figure 1: Preferred children's sex among studied mothers
Son preference was reported more frequently among mothers who aged 40 years or older (25.1%, p=0.000) and illiterate (22.0%, p=0.000) Table (1).  Most of the studied mothers who preferred to birth only son (82.2%) expressed social motivations beyond their preference (Figure 2).

Since 2005, World Health Organization (WHO) has established the Commission on Social Determinants of
Health in order to highlight the role that social factors play in determining all aspects of health. It showed interest on Medical Sociology, to which the current study is belong to, that investigates social (rather than biological) factors in causation of any health state and fertility behaviours.
The general methodology that has a long tradition in alike studies is the cross-section design, so that it was adopted by the current study. Besides, it has the advantage of being fairly quick and easy to be performed. However, it associated with selection bias. The present study included all social strata distributed in urban, suburban and rural setting in order to ensure representativeness.
Son preferences is worldwide phenomenon and is not unique to one region. A 2011 Gallop poll revealed that 40 % of American would prefer to have a son if they only had one child. In Pakistan, as an example for developing countries, study revealed that mothers were treated better by their families when they were carrying a male baby; they were provided special care, good nutrition and rest. One the other hand, conceiving a girl may associated with unhappiness and depression and even divorced for bearing daughters.
A panel data covering eleven Arab countries is analyzed by Al-Qudsi in 2008 revealed that high fertility level and son preference are among the most remarkable demographic aspect of the Arab region. Women tried to improve her social position by having an extra sons. This stat that can be explained by integration of son preference with low educational level (P=0.001) and ultimately desired and actual high parity (P=0.01, P=0.000) as indicated by the current study. Furthermore, the main motivation for son preference as stated by studied mothers was social gain (82.2%) followed by economic causes.
Akmam in 2002 noted that gender stratification in Nigeria society is related to Mothers' educational levels. High fertility and children has been favored in traditional Nepalese society, as reported by Adhikari in 2010, since they are considered a symbol of both social and economic well-being. Nepalese population thought that by having children, preferably sons, a woman raises her status in the family in addition to economic gains and old age security. It is viewed as, he added, a disgrace for a couple, particularly for the wife, not to have a lot of children. They believed in the Nepalese popular saying "May your progeny fill the hills and mountains".

Motivations Beyond Son Preference
Economic Motivation (17.8%) Social Motivation (82.2%) Similarly, Al-Ridhwany and Aljawadi in their cross-sectional study in 2018 have found that 26.3% of mothers thought that high parity would smoothen good socialization achieve social welfare by enjoying life of parents through "Filling the household", as they stated. Furthermore, they reported that financial deficit motivated 29.0% of mothers to prefer having high parity as a hope for monetary gain. They trust the public notion of "Having children especially sons, will decant into your own dish". Beside, another frequent public statement says that "Daughters are indoor workers and sons are outdoor workers."