Sex Ratio at Birth (SRB) is defined as the number of male births to 100 female births. The natural sex ratio at birth is not random; in fact, it occurs with regularity, at around 105 boys to 100 girls. This applies almost universally when there is no discrimination against either of the sexes.

It is prenatal sex selection, also known as gender-biased sex selection, that leads to a distorted or skewed sex ratio at birth. Although India and China are known for their notoriously skewed SRBs, it is equally prevalent in other countries in South and East Asia, such as South Korea and Vietnam, and also in South-east Europe. In 2010, the sex ratio at birth ranged between 110 and 120 male births in many countries.

Data suggests that parents are often indifferent to gender at the time of the birth of their first child. The gender imperative for the next child, however, becomes stronger in the absence of a child of the preferred sex. When fertility is high, parents are ready to repeat births indefinitely in their quest for a boy. But low fertility in many Asian countries and declining fertility in the case of Nepal means that parents now have only one or two chances to give birth to a child of the preferred sex.  

Skewed SRBs

Nepal is also witnessing an emerging trend in skewed SRBs, which should be a cause for concern. Recent studies have shown clear evidence of a substantial increase in gender-biased sex selection since 2002, after abortion was legalised in Nepal even though gender-biased sex selection is strictly prohibited. The sex ratio for second and third-born children, when previous births were females, has decreased substantially in almost all regions of Nepal, indicating an increased practice of gender-biased sex selection. Women who are wealthier, better educated and living in urban areas are more likely to use prenatal sex selection. For example, data suggests that there were just 325 girls born for every 1,000 boys among the richest urban women. The fall in the child sex ratio witnessed post-2002 indicates that gender-biased sex selection is becoming more common.

Such results might prompt a linking of abortion rights to gender-biased sex selection. However, it is very important not to conflate these two issues, ie, to simply attribute the sudden increase in gender-biased sex selection to the abortion law. A critical factor leading to the liberalisation of Nepal’s restrictive abortion law was unsafe abortions, which were significant contributors to Nepal’s high maternal mortality and morbidity. One of the intentions of the safe abortion law was to reduce the Maternal Mortality Rate. This was also one of the Millennium Development Goals.

Abortion and the male

According to Nepal’s 2002 Abortion Law, pregnancy termination is available under special circumstances—up to 12 weeks gestation for any indication by request; up to 18 weeks gestation in the case of rape or incest; at any time during pregnancy if the mental/physical health or life of the pregnant woman is at risk; and at any time during pregnancy if the fetus is deformed and incompatible with life. All this hinges on the approval of a medical practitioner. Moreover, only providers certified in safe abortion care are eligible to provide induced abortion services. A pregnant woman alone has the right to choose to continue or discontinue with a pregnancy. In the case of minors (under 16 years of age) or mental incompetence, a legal guardian must give consent. Pregnancy termination on the basis of sex selection is prohibited. Anyone found performing (or facilitating) an abortion on this basis can be punished with a year’s imprisonment.

One accurate way to predict whether you’re having a boy or a girl is to undergo an ultrasound, which is usually done between 18-20 weeks of pregnancy. Since this is the most common way of learning a child’s sex in Nepal, the negative SRB indicates that women are terminating pregnancies after 12 weeks and therefore, illegally. Recently, more advanced methods available in industrialised western countries, such as a blood test, can reveal the baby’s sex as early as seven weeks into a pregnancy. The simple test analyses fetal DNA in the mother’s blood, looking for traces of the male ‘Y’ chromosome. However, because of their high cost, these tests are only used in specialised laboratories and are not available commercially.

Gender-biased sex selection is a discriminatory practice against girls which is a result of a complex web of socioeconomic and cultural factors, including patriarchal mindsets, a rapid decline in fertility, the desire for a small family with one or more boys and the misuse of modern technology. In recent times, it has been perpetuated by the illegal use of diagnostic technologies coupled with unethical medical practices.

A common factor in many countries for skewed child sex ratio is the preference for a son. This manifests not only in the pre-natal period but also in practices that discriminate against females after birth. The preference for a son is directly related to the status of women. Nepal still has cultural traditions that maintain women in an inferior position: a patriarchal system, patrilineal families and patrilocal residential systems, along with inheritance rules for family assets that favour sons and socialisation processes that encourage women to be submissive. Daughters are still seen as liabilities. Women feel compelled to produce sons due to family and social pressure because of the high value placed on sons.

Halting the trend

Adverse SRBs have been observed in many Asian countries for several decades and the resulting shortage of women/surplus of men is an unprecedented demographic situation in the documented history of human populations. The repercussions are serious.  Research in China and India have shown that a rise in male bachelorhood and childlessness can create individual dissatisfaction leading to growing dissensions between male groups (married against unmarried), the loss of social cohesion and increased violence against women in the form of sexual harassment, rapes and trafficking for marriage and prostitution.

A number of policy interventions may have been instrumental in the turnaround observed in some parts of India and China—the implementation of a ban of gender-biased sex selection; girl child friendly schemes like laadli in India; active campaigning; increased control of prenatal facilities, which limits the frequency of gender-biased sex selective practices; and a change in the gender preference system, characterised by a reduction in the bias against daughters.

In Nepal, we have to confront the many forms of denial and ignorance regarding gender-biased sex selection. Gathering evidence through quantitative and qualitative research and projecting future scenarios, strong advocacy and behavioural change initiatives are urgently needed. Raising awareness through educational campaigns about gender equity, Nepal’s safe abortion policies as well as the dire consequences of gender-biased sex selection are also crucial.

Kharel is a sociologist