Evidence of Son Preference and Resulting Demographic and Health Outcomes in Pakistan

Abstract

Like much of South Asia, Pakistan has a highly patriarchal society. The desire for sons is a widely prevalent cultural value reinforced by feudal kinship systems, and is particularly prominent in rural areas because of agricultural work and the role of male inheritance in land ownership. In contrast, daughters are seen as an economic burden in both rural and urban areas; only a minority of women are active in the labour force, predominantly in urban areas. Such marked preference for sons can translate into sex-selective abortions and uneven sex ratios at birth (SRBs) when foetal sex determination technology is available and permitted. Moreover, as families begin to have fewer children, their desire to determine the gender of the child increases. This study consisted of an extensive literature review followed by an exploratory qualitative study in Karachi of the perceptions of reproductive healthcare providers regarding the demand- and supply-side practices that might indicate the occurrence or risk of prenatal sex selection. Its specific objectives were to gauge the prevalence and impact of son preference, the use of ultrasound technology to identify foetal sex, and the incidence of abortion (general and sex-selective), as well as to take stock of efforts to preempt such practices by enforcing the law on abortion, sensitizing healthcare providers to the risks, and elevating the position of daughters in society. The literature review produced very little evidence to suggest that son preference is leading to sex-selective abortions in the country; this was backed up by the exploratory study which revealed that sex-selective abortions are not perceived to be a common practice. The perceptions reported by healthcare providers indicate that willingness to abort female foetuses exists but not on a significant scale, and there is no observable trend of gender-biased sex selection at general health facilities. The fact that available ultrasound technology cannot detect the sex of the foetus in the first trimester, the difficulty of aborting at later stages, and the higher risks of obtaining illegal abortion services from unregulated providers are seen to be important barriers to sex-selective abortions. In summary, provider perspectives suggest that gender-biased sex selection and sex-selective abortion, while rare, are not entirely absent in Karachi. The pre-conditions for these practices exist: son preference persists, the small-family norm is prevalent, and the practice of disclosing the sex of the foetus, while discouraged by some, is widespread. As a largely illegal activity, abortion is a difficult area to investigate in Pakistan, but efforts must be made to better understand the current motivations of abortion clients and the perceptions of providers. A closer study of the incidence of abortions occurring after the second trimester would furnish a clearer picture of the extent to which son preference is currently affecting demographic outcomes