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BMJ Open. 2013 May 14;3(5). pii: e002612. doi: 10.1136/bmjopen-2013-002612.

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

Author information

  • 1Independent researcher, Southampton, Hants, UK.

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.

KEYWORDS:

Public Health

PMID:
23674444
[PubMed]
PMCID:
PMC3657664
Free PMC Article
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