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

Melanie Frost · Mahesh Chandra Puri

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Demographic Trends and Gender Preferences Reproductive Health and Contraception Global Maternal and Child Health

Abstract

OBJECTIVES: To 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. DESIGN: Analysis of data from four Demographic and Health Surveys, conducted in 1996, 2001, 2006 and 2011. SETTING: Nepal. PARTICIPANTS: 31 842 women aged 15-49. MAIN OUTCOME MEASURE: Conditional 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. RESULTS: From 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. CONCLUSIONS: The 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.

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References

1998Son Preference, the Family-building Process and Child Mortality in India 2006Low male-to-female sex ratio of children born in India: national survey of 1·1 million households 2009China's excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey 1997Fertility Decline and Increased Manifestation of Sex Bias in India 2011Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011 2003Birth control in China, 1949-2000: population policy and demographic development 2003Impact and Determinants of Sex Preference in Nepal 2002Gender Selection in China: Its Meanings and Implications

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