Enforcement of laws related to abortions is virtually non-existent – no one has been convicted or fined to date. Authorities rarely monitor clinics proactively, and complaints are scarce due to social stigma and family pressure on women.
Despite Nepal’s progressive steps toward women’s empowerment and reproductive rights, a disturbing trend is emerging: the widespread practice of sex-selective abortions targeting female foetuses. Recent data from the ministry of health and population reveal a stark gender imbalance in births, with small private clinics in urban and semi-urban areas identified as the primary facilitators of this illegal activity.
In the fiscal year 2024-25, Nepal recorded 383,205 live births: 206,374 boys and 176,831 girls – a difference of nearly 30,000. This translates to boys outnumbering girls by 16.71 per cent, far exceeding the natural sex ratio at birth of approximately 105 boys per 100 girls. Experts warn that without urgent intervention, Nepal risks mirroring the severe gender imbalances seen in parts of India and China, leading to long-term social crises.
The disparities are most pronounced in certain provinces. Sudurpaschim Province recorded the highest gap, with boys outnumbering girls by around 25 per cent (20,344 boys versus 16,278 girls). Madhesh Province followed closely with over 24 per cent (48,117 boys versus 38,784 girls), while Karnali stood at 17.23 per cent. Even in more developed regions like Bagmati (including Kathmandu), the gap was 13.75 per cent. Gandaki Province had the smallest imbalance at 10.64 per cent, but no region was immune.
These figures point to unchecked sex-selective abortions, particularly in big cities and areas bordering India, where access to foetal sex determination is easier. Ultrasound technology, available after 12 weeks of pregnancy, allows radiologists to identify the foetus’s sex, often leading to abortions if it is female.
Son Preference Deeply Entrenched
Cultural son preference remains deeply entrenched in Nepali society. Sons are valued for carrying the family lineage, providing old-age support, performing religious rites such as lighting funeral pyres, and contributing economically. Daughters, on the other hand, are often seen as a financial burden due to marriage costs and perceptions of leaving the family. Late marriages, rising living expenses, and a shift toward smaller families exacerbate the issue: couples with a firstborn son may stop having children, while those with daughters continue pregnancies until a boy is born – or abort females.
Dr. Pawan Sharma, professor of Obstetrics and Gynaecology at Patan Hospital, described the situation as “more serious than many imagine.” He cautioned that Nepal could face consequences similar to neighbouring countries, including bride shortages and increased crime rates. Demographer Yogendra Bahadur Gurung from Tribhuvan University echoed this, noting reports of inter-state marriages in India and marriage difficulties in China due to skewed ratios.
The practice thrives in small private clinics, where approximately 300 radiologists and 200 gynaecologists operate outside the scrutiny of larger hospitals. These facilities, often in urban and semi-urban settings, offer discreet sex determination and abortions, which are more profitable than in government or major private institutions. Pharmacist Kabin Maleku highlighted that “these are the clinics where illegal sex-selective abortions take place,” adding that proper law enforcement could halt them immediately.
Dr. Swyam Prakash Pandit, a radiology professor, lamented that the greed of a few tarnishes the profession, calling for strict enforcement to protect honest practitioners.
Poor Enforcement of Laws
Nepal legalised abortion in 2002, a landmark reform that reduced unsafe procedures and maternal deaths. Last fiscal year, over 105,000 women accessed abortions at authorized facilities. However, sex determination and sex-selective abortion remain prohibited under the Safe Maternity and Reproductive Health Rights Act of 2018 and the National Criminal Code of 2017. Penalties include 1-5 years imprisonment and fines up to Rs 50,000 for both parents and providers.
Yet enforcement is virtually non-existent – no one has been convicted or fined to date. Authorities rarely monitor clinics proactively, and complaints are scarce due to social stigma and family pressure on women.
Health minister Sudha Gautam, a senior gynaecologist herself, is positioned to drive change. Experts urge her to prioritise regulation, monitoring, and awareness campaigns.
Activists stress that education alone has failed, as even urban, educated families exhibit patriarchal biases. Broader societal shifts – promoting gender equality, reducing discrimination against girls, and challenging cultural norms – are essential. If unchecked, the vanishing girls could trigger demographic disasters: a shrinking workforce, heightened violence, and social instability. As one editorial in the Kathmandu Post noted, Nepal stands at a crossroads – strict implementation of existing laws, coupled with cultural transformation, is imperative to safeguard future generations and ensure daughters are valued as much as sons.
Image: ChatGPT
