Nepal remains a patriarchal society where the preference for sons is deeply ingrained across cultures and across the length and breadth of the country. The remotely hilly rural areas of Kalikot and the entire Karnali Province are no exception. This bias appears to have fueled a disturbing trend in Nepal, particularly in the rural hinterlands: women are undergoing fetal sex determination tests and terminating pregnancies when the fetus is found to be female. Doctors report a steady rise in such cases, particularly among women expecting a second or third daughter.
The story goes like this: expectant mothers undergo fetal sex determination in the first trimester. If the fetus is revealed to be another girl, the likelihood of terminating the pregnancy increases. And, if it is revealed to be the second or third daughter the likelihood of abortion increases by twofold, or three. A 28-year-old woman from Khadachakra Municipality, already a mother of two daughters, recently had her baby aborted after a test confirmed she was carrying another girl. This was her second abortion. Similarly, a 29-year-old woman from a nearby rural municipality, with three daughters already, is reported to have undergone multiple abortions for the same reason. According to a news report, one attempt at a local procedure nearly cost her life due to excessive bleeding. She was quickly rushed to well-equipped health facilities in Surkhet, and saved. Affluent women from Kalikot and other districts of the province increasingly travel to private hospitals in Surkhet and Nepalgunj for sex determination and abortion services. Many others, particularly those who cannot afford to pay for the expensive medical bills, first attempt unsafe, over-the-counter medications which often lead to severe complications, including life-threatening bleeding. Affluent women in Kalikot are, on the other hand, quietly traveling to private hospitals in Surkhet and Nepalgunj for these services. Others begin with unsafe over-the-counter abortion pills, which are readily available without prescription. These often lead to severe complications, including life-threatening hemorrhages.
Making abortion socially acceptable
Abortion was legalized in Nepal in 2002. As per the law, only licensed professionals can provide abortions at approved facilities. Women can independently choose to terminate a pregnancy within 12 weeks, and under certain conditions, up to 18 weeks. However, abortion based solely on fetal sex is illegal and punishable by law. Fetal sex determination was introduced in the 1950s for screening prenatal testing and has advanced significantly since. Today, it offers early insights into both gender and potential health concerns. The technology offers medical benefits, but it must be used responsibly. Misuse reinforces gender bias and overrides the ethical foundation of prenatal care. Last not the least, the misuse, if not arrested well in time, can ultimately also lead to demographic imbalance in a country which is already seeing a negative population growth. Yet, the issue cannot be tackled by legal enforcement alone. All three tiers of government – federal, provincial, and local – have a crucial role to play. While legal action against those involved is important, punitive measures must be paired with strategic awareness and education efforts. Expectant parents, especially mothers, must be informed, rather educated, about the ethical, legal, and health consequences of sex-selective abortion. Culturally sensitive public awareness campaigns could help reduce the demand for sex-based abortion. These initiatives should highlight the equal value of daughters and sons and promote safe, legal reproductive health practices. Prenatal screening is a medical breakthrough — one that should be used to protect lives, not to take them. Striking a balance between medical advancement and ethical responsibility is essential. After all, fetal sex determination is a boon, not a bane.
