Selective Abortion Means Fewer Newborn Girls

SARLAHI, NEPAL — In the fourth month of her pregnancy, Indu found out she was carrying a girl. That night, she couldn’t sleep and kept crying. She chose to have an abortion, even though it’s illegal in Nepal to terminate a pregnancy after 12 weeks. If she were to have a seventh child, it needed to be a boy.

The desire to have a son is so strong in some parts of Nepal that it leads women like Indu to secretly terminate their pregnancies after finding out the sex of the fetus – either in a close-by town, or across the border in neighboring India. The decision is often one of economic necessity. Sons, especially in more rural regions, are considered financial assets who can contribute to a struggling family. But the illicit abortions, sometimes done in dangerous circumstances, often jeopardize the life of the woman. They’re also skewing the ratio of newborns, threatening to affect future population growth.

Indu, who asked to be identified only by her first name for fear of stigma, took a 1.5-hour long public bus journey to Sitamarhi in the Indian state of Bihar, where her brother and sister-in-law live. She went to a private clinic and aborted the child.

Preferring a son over a daughter is obvious, says Indu, who lives in the Terai region in the southern lowlands of Nepal. Each time she gave birth to one of her six girls, her husband made her work in the fields carrying a newborn. She wasn’t fed well, and every day a new taunt was hurled at her. She says she couldn’t let it happen again, but she didn’t want people around her to know about her decision.

Abortion pilgrimages across the border are common, says Bal Krishna Shrestha, project manager for Family Planning Association of Nepal, a reproductive health services advocacy organization in the municipality of Sarlahi, in the southeastern part of the country. The Terai region adjoins the Indian states of Bihar, Uttar Pradesh and West Bengal. The porous border between the two countries makes it easier for women to cross over to nearby Indian states where, even though sex-selective abortion is also illegal, it is legal to terminate a pregnancy until the 20th week.

As a result of this preference for sons, sex ratios of newborns in the Terai region are out of whack. Nepal’s 2001 census compared sex ratios in the country’s three ecological zones and found that, among the population below 1 year of age, there was a higher number of boys than girls in the Terai region (104.8 males per 100 females) compared to the hills (103.9) and the mountains (102.6). In the 2011 census, that number increased to 106.7 in both the Terai and hills.

SHILU MANANDHAR, GPJ NEPAL

Paswan, a mother who asked to be identified only by her last name for fear of stigma, holds hands with her youngest daughter in their neighborhood in Sarlahi, Nepal. The woman aborted a female fetus and had heavy bleeding after.

The natural expected sex ratio among newborns is between 95 and 105 males per 100 females, says Mahesh Puri, co-director of the Center for Research on Environment, Health and Population Activities, a Kathmandu-based consulting and research nonprofit. If it is above 105, Puri says it indicates something is happening. “For Nepal in general and these specific regions, the ratio indicates sex-selective abortion,” he says.

This will create long-term imbalances in Nepal, Puri says. “There will be a scarcity of females, which will affect the marriage market and fertility rate. There will also be an increase in violence against women and girls.”

The total fertility rate in Nepal also has fallen, from six children per woman in 1950 to less than two in 2022, according to the United Nations.

Similar imbalances already are affecting reproductive age groups in other countries, like China, South Korea and parts of India. In China, which had a state-backed one-child policy until 2016, the number of males now exceeds the number of females by 34.9 million, according to the country’s national statistics bureau. Officials encourage people to have two children to combat a population decline.

Cultural beliefs, particularly in the Terai region, shape these decisions. Meeting a “niputar,” or sonless woman, early in the morning can bring bad luck for the whole day. This attitude is also reflected in a popular proverb, “Dhilo hos, choro hos,” which roughly translates as “Let it be late, but let it be a son.”

Sons are seen as an economic as well as social asset in Nepal, while daughters are considered a financial burden for their parents, says Srijana Adhikari, executive president of Women Acting for Transformative Change, a nongovernmental organization that promotes women’s rights. That is because if a son marries, the family can demand money; but when daughters marry, they are obligated to give a dowry.

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The modern dowry system in South Asia, which started out with innocuous practices of gifting by well-wishers to the bride to contribute to her financial stability, has recently become a practice involving a substantial transfer of wealth from the bride’s family to the groom’s. In some cases, it has become a determinant of the value of the woman.

Indu is preparing for the wedding of her eldest daughter, who is 17. The groom’s family has demanded a dowry of 100,000 Nepalese rupees ($810), a motorbike and gold jewelry. “If I had a son, then I wouldn’t have to take a loan,” Indu says. “He would be earning money, supporting us, and taking care of us when we get old.”

She doesn’t regret the abortion, even though it caused her five days of bleeding and pain. Across Nepal, abortion-related complications, such as hemorrhaging, remain a leading cause of maternal death.

Abortions have been legal in Nepal since 2002 but are limited to the 12th week except for special circumstances, such as incest or rape, when they are allowed until the 28th week. Since the legalization, some harmful practices women used to end their pregnancies — such as swallowing ground glass or “paro” (mercury) or putting herbs in their vaginas — have plummeted. Puri, of the Kathmandu research nonprofit, estimates less than 2% of women now practice such methods.

But an estimated 58% of abortions remain clandestine procedures, provided by untrained or unapproved providers or induced by the pregnant woman herself, according to a 2016 study by the Center for Research on Environment, Health and Population Activities and the Guttmacher Institute, a United States-based research organization that studies reproductive health.

SHILU MANANDHAR, GPJ NEPAL

Rani, an expecting mother who asked to be identified only by her first name for fear of stigma, sits in her neighborhood in Sarlahi, Nepal. She refused to do an ultrasound to find out the sex of the fetus, despite the wishes of her in-laws and husband.

Abortions performed outside a qualified medical facility are of particular concern for Shrestha, from the Family Planning Association. “Unsafe abortions affect women’s health,” he says. “There are no efforts for inspection and checking from the government.”

The government has a large number of clinics across the country that it already monitors, says Dr. Sangeeta Kaushal Mishra, spokesperson for the Ministry of Health and Population. Monitoring all abortions in every setting is not possible, she says, and people aren’t likely to file formal complaints if the procedure is illegal.

As for Indu, a year after her abortion, she gave birth to a boy. She smiles as she talks about the treatment she received from her husband following the birth. “He was very happy, and treated me well,” Indu says. “He also fed me properly.”