Demographic transition and skewed SRB

Nepal has experienced a rapid demographic transition over the previous three decades, accompanied by increasingly skewed sex ratios at birth (SRB), marked by a disproportionate increase in the share of male births. The socioeconomic consequences of such gender selection, according to a growing body of literature, range from socioeconomic gender bias in hierarchical societies to reduced welfare due to a marriage market congestion externalities.

The phenomenon of skewed SRB gained prominence in specific Asian countries such as Korea, Hong Kong, Taiwan, China, and India during the 1980s. This trend was primarily attributed to preferences for male offspring, coupled with the development and accessibility of neonatal gender selection technologies that facilitated sex-selective fertility practices. Unlike neighboring China and India, Nepal exhibited normal SRBs during the 1980s and the 1990s, while a noticeable upswing emerged in the mid-2000s. This temporal shift in Nepal's demographic landscape accompanies one of the most rapid demographic transitions experienced by a country. The total fertility rate in Nepal declined gradually from 6 in 1960 to 5.2 in 1990. During the following three decades, this decline was so dramatic that it fell to a figure of just about 1.85 according to the 2021 population and housing census (Figure 1).

Son preference and sex selection

The intersection of falling fertility rates and a prevalent son preference, typical in male-dominated societies, may have significant socioeconomic implications. Indeed, a survey carried out in the early 1980s had identified Nepal as a country with an overwhelmingly high level of son preference. More than two-thirds of the respondents in the study wanted their next child to be a son; only 7 percent wanted a girl, and the rest reported being undecided. Among women with no children, these preferences were even stronger, with 71 percent reporting that they would like their next child to be a son, and a mere one percent wanting a daughter.

While such parental preferences could not have been practically translated into fertility outcomes earlier, the emergence and expansion of technologies to facilitate gender identification of fetuses have opened routes for gender selective fertility practices over recent years. While fertility trends may not provide strong 

evidence for gender-selective practices until the mid-2000s, with the share of boy births hovering around 51 percent, the latter half of the decade exhibits a discernible upward trend, indicative of recent surge in sex-selective fertility practices. Besides, the legalization and initiation of abortion services after the turn of the century might have played a largely facilitating factor. 

Such sex selection naturally becomes further intensified as birth parity rises, as shown by the proportion of male births for the first and second births, as well as for all third and fourth births reported in Figure 2. Consequently, the likelihood of gender-selective practices may be influenced by the existing gender mix of the couple's children. For example, consider a couple that has already had two girls and strongly desires a son. In such a scenario, they are more likely to opt for gender determination during pregnancy and, if a female gender is revealed, terminate the pregnancy, resulting in childbirth only if it is a boy. This dynamic leads to a higher proportion of boys in third births for parents who have had two girls in each of the first two births compared to parents who have at least one son. This observation is substantiated by the Nepali data presented in Figure 3, illustrating the likelihood of male births in the third pregnancy based on the genders of the first two children.

The divergence in the likelihood of male births at the third birth for families with two girls and those with at least one son follows the legalization of abortion in 2002. Although prenatal gender identification remains illegal, there is evidence suggesting that certain health service providers may not fully adhere to the regulations. As depicted in Figure 3, since the mid-1990s, parents with two daughters consistently exhibit a higher likelihood of a male birth during the third parity compared to parents with at least one son in the first two births, although the difference is not statistically significant for the earlier periods. For the more recent period, the difference has been starker.

Sex selective abortions and “missing women”

Nobel laureate Amartya Sen highlighted this high-tech sexism as one of seven disparate and interlinked forms of gender inequality prevalent in male-dominated societies with a strong preference for sons. He coined the term "missing women," referring to the gender-discriminating practices leading to the decline in female birth shares. Various researchers have estimated these figures to be in the tens of millions, particularly in countries like India and China.

The observed percentages of male births can be used to gauge the extent of gender selection and subsequently calculate the total number of implied abortions. In Nepal, gender selection has been on an upward trajectory in recent years, surpassing the 10% threshold in 2017, particularly during second and third birth parities. For example, the recorded boy-birth percentages for the third and fourth children, approximately 56% and 58% respectively, correspond to implied gender-selection probabilities of around 20% and 22% for third and fourth or higher births (Figure 4). These rates, combined with fertility data reported in the 2021 Census, translate to more than 200,000 "missing women" attributable to sex-selective abortions in the 2010-2019 period alone.

What we can do?

The potential future proliferation of gender determination technology may further amplify gender-selective practices if prevailing fertility dynamics and son preference persist. As gender identification technologies become increasingly accessible and affordable over time, there is concern that this may exacerbate the imbalance in SRB. These imbalances might manifest in the preponderance of male over female adults in the entire population, leading to serious socioeconomic consequences and welfare implications. Moreover, the disparity in gender ratios, with wealthier families tending to have more boys and poorer families relatively fewer girls, contributes to heightened gender inequality.

It might thus be essential to address the ethical, cultural, and socioeconomic dimensions associated with these technologies to prevent the potential exacerbation of gender imbalances in the future. Exploring heterogeneity in sex selection practices across different ethnic groups could contribute significantly to the development of targeted interventions and policies aimed at mitigating any disparities that may exist within the diverse landscape of Nepali society.