Assessment of Interventions on Sex-selection in Nepal: Literature Review

Abstract

The objectives of this review are to better understand how to respond to adverse sex ratios at birth in Nepal, first by synthesising at the country level what is known about levels, trends and factors underlying unbalanced sex ratios at birth, as well as initiatives with potential to reverse the trend; and secondly to examine, through primary research, the perspectives of stakeholders about the programmes that aim to empower girls to respond to adverse sex ratio at birth in selected settings, and assess the extent to which such a programme or initiative shows promise or may be scalable, if at all. Findings are expected to draw attention to gaps in evidence and outline areas of research that are needed to arrive at evidence-based recommendations for action, and to provide evidence-based guidance to help policy-makers and donors determine feasible and effective interventions that may hold promise. The review reveals that sex-selective abortion is an emerging issue in Nepal, very much connected to the easy accessibility to prenatal sex-determination technology, the religious and socio-economic value given to sons over daughters, pressure put on women to bear sons, and the dowry system prevalent in Nepal, all of which increase the likelihood of sex-selective abortion. The situation is further accentuated by the lack of focused policies and programs to address gender discrimination, and weak enforcement of law relating to dowry and sex determination practices, meaning that the demand for sex-selective abortion could increase. With declining fertility levels, couples are pressured to have fewer children of the desired sex which may aggravate abnormal sex ratios at births. Though very limited, studies indicated that the practice of sex selection is more prevalent among relatively rich, educated, urbanite women and in areas bordering with India. However, more research is needed to validate this information. The review also revealed that no separate Act or policy addressing the root causes of gender discrimination, son preference and conditional cash transfer programs for every girl child is present in Nepal. No special program exists for this, except a general program that supports parents for the education of their daughters. Nepal’s Interim Constitution of 2003 sets out that the State shall not discriminate against citizens on grounds of sex, religion, race, caste, tribe, sex, origin or language, but there are still several discriminatory provisions and schedules, mainly on nationality, marriage and family relations, sexual offences, and property rights, all of which run counter the rights of women and the girl child. A bill to address this is drafted and waiting for Cabinet approval. Gender and social inclusion, gender mainstreaming and women’s empowerment including gender-based budgeting have received prime importance in the national agenda, and the National Plan of Action for Gender Equality and Women’s Empowerment have been implemented by the government since 2004. However, no focused programs to address sex selection have been introduced as yet. The law strictly prohibits sex determination tests and sex-selective abortion, but enforcement is weak and unregulated. Rights-based civil society organisations, professionals and activists are confronted with two pronged issues when it comes to sex-selective abortion: firstly, how to preserve Nepalese women’s rights to safe and legal abortion, and secondly, how to prevent sex-selective abortion which is so deeply conjoined with entrenched gender-based discrimination, son preference and Nepali tradition and culture. The issue of sex selection will pose a greater challenge in the coming years as Nepali couples realise the social and economic advantages of a small family size. There is an urgency to establish new evidence on the determinants and motivating factors of sex-selective abortion practices, and to develop a national strategic plan for the country based on the evidence