Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: evidence from nationally representative survey data

Abstract

ObjectivesTo quantify trends in changing sex ratios of births before and after the legalisation of abortion in Nepal. While sex-selective abortion is common in some Asian countries, it is not clear whether the legal status of abortion is associated with the prevalence of sex-selection when sex-selection is illegal. In this context, Nepal provides an interesting case study. Abortion was legalised in 2002 and prior to that, there was no evidence of sex-selective abortion. Changes in the sex ratio at birth since legalisation would suggest an association with legalisation, even though sex-selection is expressly prohibited.DesignAnalysis of data from four Demographic and Health Surveys, conducted in 1996, 2001, 2006 and 2011.SettingNepal.Participants31 842 women aged 15–49.Main outcome measureConditional sex ratios (CSRs) were calculated, specifically the CSR for second-born children where the first-born was female. This CSR is where the evidence of sex-selective abortion will be most visible. CSRs were looked at over time to assess the impact of legalisation as well as for population sub-groups in order to identify characteristics of women using sex-selection.ResultsFrom 2007 to 2010, the CSR for second-order births where the first-born was a girl was found to be 742 girls per 1000 boys (95% CI 599 to 913). Prior to legalisation of abortion (1998–2000), the same CSR was 1021 (906–1150). After legalisation, it dropped most among educated and richer women, especially in urban areas. Just 325 girls were born for every 1000 boys among the richest urban women.ConclusionsThe fall in CSRs witnessed post-legalisation indicates that sex-selective abortion is becoming more common. This change is very likely driven by both supply and demand factors. Falling fertility has intensified the need to bear a son sooner, while legal abortion services have reduced the costs and risks associated with obtaining an abortion.

Sex ratio at Birth in a Tertiary Care Hospital in Western Nepal are the Trends Changing?

“…Data revealed that women are more concerned about the sex of a child after fi rst birth 10 . This study also showed an increase in male birth with the rise in birth order.…”

Son Preference, Parity Progression and Contraceptive Use in South Asia

“…One thing to consider is whether the higher level of women's education in Bangladesh is partly responsible for the lower levels of reported son preference and son-preferring behaviours. However, there are also significant cultural differences to consider, and it should be remembered that more educated women in Nepal and India are more likely to have a sex-selective abortion (Jha, Kesler et al, 2011;Frost, Puri et al, 2013). Another consideration is differences in religion.…”

“…As fertility decreases and childbearing decisions are made more consciously, differential stopping behaviours become more prevalent. The potential culmination of this is sex-selective abortion which is currently seen in India and Nepal (Jha, Kesler et al, 2011;Frost, Puri et al, 2013), while current evidence suggests the practice is not common in Bangladesh (Kabeer, Huq et al, 2014), and the evidence on Afghanistan and Pakistan is scarce. As fertility falls, the need to bear a son at a lower parity increases, meaning that the manifest practices of son preference may tend to increase, and occur in parallel.…”

Fertility, household size and poverty in Nepal

“…This, however, does not appear to be the case (at parity one, at least). Using several rounds of DHS data, Frost et al (2013) find no evidence of sex selective abortion prior to 2002, except maybe at the border with India. More importantly, they find no evidence of sex selective abortion among the first-born even after the legalization.…”