Does son preference pay-off for the ailing and elderly in rural India?


Purpose: The purpose of this paper is to take a close look at factors that influence the choice and quality of healthcare received by ailing and elderly people in rural north India. The author is primarily interested in seeing what role is played by the presence of sons in the family, particularly co-residence with sons. In the absence of some broad-based social security arrangement in countries like India, older adults traditionally turn to living arrangement where the older adults are supported by their children or extended family. In a patriarchal society as India, such responsibility lies with the sons if one has son/s. Such dependence on sons explains preferential treatment towards younger sons as a justification for the care parents receive from sons in their advanced years. This culture of son preference behavior provides the context for this paper.

Design/methodology/approach: The empirical model is based on testing three inter-related research questions. First, the author asks whether having grown sons or living with son/s leads to up-front better quality of healthcare for parents. If the empirical analysis does not show support for this research question, the author broadens the research question to ask whether those with grown son/s or those that live with their son/s have a higher probability of seeing a trained medical professional as compared to some traditional healer. If the empirical analysis does not support the second question, the author further broadens the research question and asks whether those elderly who are sick are more likely to receive any healthcare (medical or traditional) if they have grown son/s or live with their son/s.

Findings: The results show that co-residence with a son does not have a statistically significant impact on the quality of healthcare received by the elderly individual. Additionally, not having a son also does not have a statistically significant impact on quality of healthcare received.

Research limitations/implications: For the purpose of the empirical analysis, the author utilizes World Bank's Living Standard Measurement Survey (LSMS) data collected from rural villages in Uttar Pradesh and Bihar in India in 1997-1998. The dataset may be somewhat dated, but it provides relevant information which transcends time. Additionally, with economic growth and modernization, more and more young people in India have migrated away from rural areas in the recent decade. Thus, surveys carried out in the last decade by the National Family Health Surveys in India show very little evidence of elderly parent in rural areas living with their adult children. This practice seemed to be much more prevalent at the time of the LSMS survey of 1997-1998.

Practical implications: Contrary to popular expectation, the results show that co-residing with a son has no statistically significant impact on healthcare received by parents. Additionally, not having sons does not matter either.

Originality/value: The author finds relatively fewer studies done on factors that determine the choice of healthcare for the elderly, particularly relating to those that are ailing (for reasons other than simply aging) and with reference to their living arrangement. The present paper addresses this void in the literature and is expected to make a meaningful contribution in bridging this gap in the literature.



Document Type





Agricultural economies, Developing countries, Development, Education, Gender, Health care

Publication Date


Journal Title

International Journal of Social Economics