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

Melanie Dawn Frost, Mahesh Puri, Peter Richard Andrew Hinde

Research output: Contribution to journalArticlepeer-review

38 Citations (SciVal)


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.


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.

Original languageEnglish
JournalBMJ Open
Issue number5
Publication statusPublished - 14 May 2013


  • Journal Article


Dive into the research topics of 'Falling sex ratios and emerging evidence of sex-selective abortion in Nepal: evidence from nationally representative survey data'. Together they form a unique fingerprint.

Cite this