India has reached the moon, built a fast-growing economy and made remarkable strides in technology and infrastructure. Yet, in many homes, particularly in rural India, many questions continue to weigh heavily on women: What if the child is a girl?
Will the family be happy? Will the mother-in-law ask when she plans to try again? Will relatives remind her that the family is still waiting for a son?
These may not always be spoken aloud. Sometimes the pressure comes through silence, disappointment, repeated questions or the expectation that another pregnancy will follow until a boy is born.
And that pressure can take a toll on mental health.
A recently published study, ‘Son preference, intergenerational household dynamics, and women’s mental health in India,’ based on fieldwork conducted between November 2023 and May 2024 among married women of reproductive age and their co-residing mothers-in-law in Jaunpur district of Uttar Pradesh, has brought this largely invisible burden into focus.
Published in the Journal of Development Economics, the study examined how son preference influences women's mental health and broader household dynamics. Researchers specifically studied women living with their mothers-in-law because the relationship between the two can play an important role in reproductive and family-planning decisions.
The study surveyed 1,572 daughter-in-law and mother-in-law pairs and collected socioeconomic and demographic information along with mental-health data using a screening tool for depression and anxiety.
The findings reveal an uncomfortable reality. Mothers-in-law whose daughters-in-law had a firstborn son had, on average, a 15% lower risk of depression or anxiety than those whose daughters-in-law had a firstborn daughter.
For daughters-in-law, the researchers did not find an overall mental-health effect. But when the women were divided by age, a different pattern emerged. Among older daughters-in-law, the mental-health consequences of not having a son became more pronounced as their reproductive years began to narrow.
In other words, for a younger woman, the family may believe there is still time to have a boy. For an older woman, the possibility becomes increasingly uncertain. The pressure can therefore become more intense.
The findings point to a problem that goes beyond son preference.
They show how deeply embedded social expectations can influence a woman's emotional well-being.
In many traditional families, sons are associated with carrying forward the family name, providing financial and social security in old age and performing family responsibilities after parents die. Daughters, despite contributing enormously to families, may still be viewed through a different social lens.
For women, this can turn pregnancy into a prolonged psychological test.
The question becomes not simply whether she wants another child, but whether she can give the family the child it expects.
And when the answer is repeatedly “no”, the consequences can extend into family relationships, reproductive choices and a woman's sense of self-worth.
The study also sheds light on an often overlooked part of the story.
In extended households, mothers-in-law can have considerable influence over daughters-in-law, including decisions around contraception and family planning. Researchers found that when a daughter-in-law had a firstborn son, mothers-in-law were more likely to approve the use of family planning and contraception.
The reason is not difficult to understand. Once the family believes its “fertility goal” has been achieved, pressure for another pregnancy can ease.
The researchers also found that mothers-in-law were more likely to provide childcare support in such circumstances. Among younger daughters-in-law, this support was linked to greater participation in the workforce and better economic opportunities.
That finding exposes another uncomfortable reality. A woman's ability to make reproductive choices or participate in paid work can sometimes depend on whether her family believes she has fulfilled its expectation of producing a son.
Her freedom, however, should not come with a gender condition.
Catalina Herrera-Almanza, assistant professor at the University of Illinois Urbana-Champaign and one of the study's authors, said mental health is shaped not only by individual characteristics but also by community conditions and social norms.
That is important because social pressure does not necessarily look like abuse.
A woman may never be openly threatened. She may simply be repeatedly reminded that the family needs a son. She may see other women celebrated after giving birth to boys while her own daughter's birth is met with muted reactions. Over time, such experiences can affect her emotional well-being.
The problem can become even more complicated when the same expectations are passed from one generation to another.
A mother-in-law who grew up believing that a son guarantees family security may unconsciously impose that belief on her daughter-in-law. The daughter-in-law then finds herself negotiating not only her own wishes but also the expectations of an entire household.
The researchers argue that interventions aimed at changing son preference should not focus only on young women. Mothers-in-law and wider household networks also need to be part of the conversation.
That approach could be particularly important in rural communities where household decision-making remains closely interconnected.
India already has programmes that engage mothers-in-law and communities in discussions around family planning. Such interventions could go further by challenging the belief that sons are essential for family security, lineage or social standing, said the authors.
The need is not merely to tell families that daughters are equal. It is to create circumstances in which women do not have to prove equality through their own suffering, they asserted.
Until that happens, the pressure surrounding childbirth will continue to be carried quietly by women, often behind closed doors, and sometimes at a considerable cost to their mental health.
