2013/01/01 by Melanie Frost, Mahesh Puri, Peter Richard Andrew Hinde · 2 citations
Medicine · Social Sciences · #Abortion #Demographic Trends and Gender Preferences #Demography #Environmental health #Epidemiology #Falling (accident) #Family medicine #Global Maternal and Child Health #Internal medicine #Medicine #Pregnancy #Public health #Reproductive medicine #Sociopolitical Dynamics in Nepal
paper · pdf · doi:10.1136/bmjopen-2013-002612
openalex publication_date 2013/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
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.