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Invited paper| Volume 21, ISSUE 3, SUPPLEMENT , S37-S41, May 2011

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Sex-Selective Abortion in Nepal: A Qualitative Study of Health Workers' Perspectives

      Abstract

      Background

      Sex-selective abortion is expressly prohibited in Nepal, but limited evidence suggests that it occurs nevertheless. Providers' perspectives on sex-selective abortion were examined as part of a larger study on legal abortion in the public sector in Nepal.

      Methods

      In-depth interviews were conducted with health care providers and administrators providing abortion services at four major hospitals (n = 35), two in the Kathmandu Valley and two in outlying rural areas. A grounded theory approach was used to code interview transcripts and to identify themes in the data.

      Results

      Most providers were aware of the ban on sex-selective abortion and, despite overall positive views of abortion legalization, saw sex selection as an increasing problem. Greater availability of abortion and ultrasonography, along with the high value placed on sons, were seen as contributing factors. Providers wanted to perform abortions for legal indications, but described challenges identifying sex-selection cases. Providers also believed that illegal sex-selective procedures contribute to serious abortion complications.

      Conclusion

      Sex-selective abortion complicates the provision of legal abortion services. In addition to the difficulty of determining which patients are seeking abortion for sex selection, health workers are aware of the pressures women face to bear sons and know they may seek unsafe services elsewhere when unable to obtain abortions in public hospitals. Legislative, advocacy, and social efforts aimed at promoting gender equality and women's human rights are needed to reduce the cultural and economic pressures for sex-selective abortion, because providers alone cannot prevent the practice.
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      Biography

      Prabhat Lamichhane, MSc, is a Research Associate at Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal. His work focuses on maternal and reproductive health and gender-based violence research.

      Biography

      Tabetha Harken, MD, MPH, is an Assistant Professor in the Department of Obstetrics & Gynecology at the University of California, Irvine. Her most recent work focuses on increasing the use of long-acting reversible contraception in adolescents.

      Biography

      Mahesh Puri, PhD, is Associate Director at the Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal. His recent research focuses on reproductive health and rights.

      Biography

      Philip Darney, MD, MSc, is a Distinguished Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the School of Medicine at University of California, San Francisco, and a founding director of the Bixby Center for Global Reproductive Health.

      Biography

      Maya Blum, MPH, is a Project Director at the UCSF Bixby Center for Global Reproductive Health. She has extensive experience designing and implementing reproductive health research studies in the United States and internationally.

      Biography

      Cynthia C. Harper, PhD, is an Associate Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the School of Medicine at University of California, San Francisco, and a faculty member of the Bixby Center for Global Reproductive Health. Her research focuses on the impact of health policies and individual behaviors on reproductive health outcomes, specifically in the areas of contraception and sexually transmitted infections (STIs), including HIV.

      Biography

      Jillian Henderson, PhD, MPH, is an Assistant Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the School of Medicine at University of California, San Francisco, and a faculty member of the Bixby Center for Global Reproductive Health. She conducts research on women's access to health care, contraception, and reproductive health.