TY - JOUR
T1 - Prevalence and correlates of sex-selective abortions and missing girls in Nepal
T2 - Evidence from the 2011 Population Census and 2016 Demographic and Health Survey
AU - Channon, Melanie Dawn
AU - Puri, Mahesh
AU - Gietel-Basten, Stuart
AU - Stone, Lucy Williams
AU - Channon, A.
N1 - Funding Information:
Funding This work was supported by the Birth Control Trust of the Galton Institute, grant number R37295/GA001.
Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/3/16
Y1 - 2021/3/16
N2 - Objectives These were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena. Design Observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016. Setting Nepal. Participants (1) 2 567 963 children age 0-4 in the 2011 population census and (2) 27 329 births recorded in DHSs. Primary and secondary outcomes We estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth. Results We find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts. DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups. Conclusions It is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion.
AB - Objectives These were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena. Design Observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016. Setting Nepal. Participants (1) 2 567 963 children age 0-4 in the 2011 population census and (2) 27 329 births recorded in DHSs. Primary and secondary outcomes We estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth. Results We find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts. DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups. Conclusions It is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion.
KW - demography
KW - health policy
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85102864409&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-042542
DO - 10.1136/bmjopen-2020-042542
M3 - Article
C2 - 33727264
AN - SCOPUS:85102864409
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e042542
ER -
