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Falling Sex Ratios and Emerging Evidence of Sex-Selective Abortion in Nepal: Evidence From Nationally Representative Survey Data


Falling Sex Ratios and Emerging Evidence of Sex-Selective Abortion in Nepal: Evidence From Nationally Representative Survey Data

Melanie Dawn Frost et al. BMJ Open.


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.

Keywords: Public Health.


Figure 1
Figure 1
Conditional sex ratio of second order births where the first-born was female, by educational level of the mother, over time.
Figure 2
Figure 2
Conditional sex ratio of second order births where first born was female, by wealth tertile of the household in urban and rural areas, over time.

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