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Prenatal Son Selection Disastrous for Nepal

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Prenatal son selection in Nepal has created disasterous gender imbalance, says a study by UNFPA.


Majority of Nepalis prefer sons over daughters, and the latter suffer many social and cultural stigmas.

The UNFPA (the United Nations Population Fund) study recommends implementing national policies and programmes that can contribute to promoting gender equity, diminish socio-cultural and religious practices that manifest gender discrimination, and protect the reproductive rights of every Nepalese woman. The study also suggests initiating advocacy activities to reform the existing discriminatory laws, and initiating a public dialogue on the ethics of sex selection.


Sex Selection: Pervasiveness and preparedness in Nepal
Executive Summary
This study is aimed at identifying the incidences, causes and determinants of pre-natal sex selection in four of the eight districts of Nepal (as well as Kathmandu) that had high sex ratios for the population below 1 year of age in the 2001 census. In addition, the study examined the situation in three border routes connecting Nepal with major towns in India. Analysis indicates that the practice of pre-natal sex determination and sex-selective abortion is low in the study population. Only 3 per cent (74 women) of the ever-pregnant women had sought pre-natal sex-determination tests. The study also found that more than half of the married women in the survey (54 per cent) had no preference for any sex during the first pregnancy, though son preference in the first pregnancy was found to be higher among women in the Tarai than in the hill districts.

At the same time, however, among those who had a daughter as their first child, the vast majority (81 per cent) reported preferring to bear a son during the next pregnancy. Indeed, daughters are still widely perceived to be of less economic value, because tradition continues to demand that women’s families give dowry at the time of marriage; in addition, women almost always live in their husband’s home after marriage, thus disallowing them
from helping their birth parents on any sustained basis. Sons, on the other hand, are perceived to be future sources of economic support (including in bringing home dowry) and old-age security, while religion allows only sons to perform last rites.

Women from the Tarai have relatively easy access to sex-determination clinics in Indian border towns. The study showed that 57 per cent of married women are aware of prenatal sex-determination technologies, and know where to obtain such services. One-fifth of the women who ever had pre-natal sex-determination tests had visited India to do so. The study identified 72 clinics located in 10 border towns and cities along the three studied border
routes in India that provide sex-selection services to Nepalese women.


Key conclusions
• Sex selection is not a major concern now; however, it is likely that demand could increase in future due to son preference and availability of technology;
• Proximity to India has impacted knowledge of and access to sex-selection services

Way forward
• Train all medical practitioners on gender issues and long-term consequences of sex selection;
• Stringent measures need to be instituted to prevent the misuse of ultrasound;
• Educate public against practice of dowry, especially in the Tarai.
• Ensure equitable care of women particularly after giving birth to girls, to reduce risk of uterine prolapse ;
• Initiate programmes to benefit girl child such as scholarships and incentives;
• In future censuses, collect data related to sex ratio at birth.


Study Summary
In Nepal, as in many Asian countries, son preference is very strong, due to the country’s longstanding patriarchal social structure. According to the 2001 census, sex ratios (computed as the number of males per 100 females) for those younger than 1 year of age were over 106 in seven districts in the Tarai plains and one hill district. This study subsequently aimed to identify the incidences, causes and determinants of pre-natal sex selection in four of these eight districts. Three of the four districts (Dhanusha, Parsa, Kapilbastu) lie in the Tarai belt bordering India, while the fourth district (Gorkha) lies in the central hills. In addition, the study examined the situation in three border routes connecting Nepal with major towns in India, and in Kathmandu Metropolitan City, to assess the availability and accessibility of pre-natal sex-selection technologies in these areas.

A combination of qualitative and quantitative research methodologies was used in the study. Semi-structured interviews were held with health providers and other key informants, and focus-group discussions were held with husbands, mothers-in-law and married women. The locations of clinics offering pre-natal sex-selection services were mapped, and in-depth interviews were carried out with women who had undergone pre-natal sex selection. The survey of 2,644 married women age 15-49 was based on a multi-staged modified cluster sampling technique (see appendix).Data collection was carried out between July and early August 2007.

The evidence gathered by the study established that the majority of survey respondents (57 per cent) were aware of ultrasound technology, and knew where to obtain such tests. Women who were aware about ultrasound technology were about twice as likely to seek pre-natal sex determination as those who were unaware of such technology. In Nepal, ultrasound services are largely concentrated in Kathmandu city, but are also quite accessible in the urban areas within the four study districts and their adjoining districts. Such services are also available in Indian border towns, even though pre-natal sex selection is illegal in India.

The qualitative research findings identified culturally defined folklore that glorifies sons and disfavours daughters. For the most part, daughters were said to be necessary only to perform household chores. Sons, on the other hand, were said to be prized for continuing the family lineage, for providing economic support and old-age security, and for performing their parents’ last rites. The study found that there are great pressures on young married women to give birth to a son.

Those women who have given birth to two or more daughters consecutively are under particularly high pressure, often in the form of threats from their mothers-in-law and husbands. Such women have no choice but to become pregnant repeatedly until a son is born. Statistically, the practice of pre-natal sex determination and sex-selective abortion was found to be very low in the study population. Only 3 percent (74 women) of the ever-pregnant , women who have been pregnant irrespective of the outcome of the pregnancy; women had ever sought pre-natal sex-determination tests; and only 14 per cent of the women who had ever had an induced abortion had done so after pre-natal sex determination. The study subsequently points to pre-natal sex selection currently being at a
preliminary stage in Nepal, in contrast to India and China, where it is a widespread phenomenon.

However, it is well known that legal sanctions against sex selection have not stopped medical practitioners and ultrasound operators in Nepal from providing these services. As such, this study recommends implementing national policies and programmes that can contribute to promoting gender equity, diminish socio-cultural and religious practices that manifest gender discrimination, and protect the reproductive rights of every Nepalese woman. The study also suggests initiating advocacy activities to reform the existing discriminatory laws, and initiating a public dialogue on the ethics of sex selection.

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To read the full 40-page study, click here (PDF version).

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CPA
Brihát Śhānti Sámjhautā, 2006
(Comprehensive Peace Agreement)








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