Discrimination isn’t just hurtful — for hundreds of thousands of girls in India, it’s deadly.

Approximately 239,000 Indian girls under the age of 5 die every year due to neglect related to gender bias, according to a new study published in the global health journal The Lancet. Researchers found that the widespread preference for boys in India encourages many families to prioritize food, educational opportunities, and medical attention for boys over girls.

The study focuses on causes of “excess female mortality” rate — the premature death rate — among girls under the age of 5 in India. Analyzing the death of female children across 35 states, the report found 29 states had significant excess mortality rates.

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Researchers examined the impacts of sexist attitudes on the health and life outcomes of girls born in India, but noted that the preference for male children also leads many women to abort female fetuses. In fact, at least 11 million fewer girls were born in the last 28 years than predicted due to sex-selective abortion, according to the Population Research Institute.

“Gender-based discrimination towards girls doesn’t simply prevent them from being born, it may also precipitate the death of those who are born,” Christophe Guilmoto, one of the study’s co-authors, said in a statement. “Gender equity is not only about rights to education, employment, or political representation. It is also about care, vaccination, and nutrition of girls, and ultimately survival.”

Gender discriminatory attitudes are so pervasive in India, even health practitioners are guilty of providing a lower standard of care and less attention to young girls than boys.

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The study ultimately found that 22% of deaths among young girls in India can be attributed to gender bias, meaning that many of those deaths could have been prevented. In order to prevent future unnecessary deaths of girls under the age of 5, the researchers argue, cultural norms and attitudes that consider girls less valuable than their male counterparts must change. Girls must be seen as an equal and integral part of society, and female children must be valued for their capabilities and contributions, rather than viewed as a financial or social burden.

"Discrimination towards the girl child is not justified,” Nandita Saikia, another of the study’s co-authors, said in a statement. “Rather than discriminating against [girls],] it is necessary to raise their value through education and self-dependence."

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