Sabitri Thapa was 24 years old when she first had an abortion. In the next seven years, she would have undergone two more abortions. Sabitri, who asked her real name to be withheld, is now 42 years old and lives in Nepalgunj-5 in Banke.

All three of her abortions were the result of her family’s desire for a son. A mother of two teenage daughters and one son, Sabitri says she could not stand up to her family members alone without the support of her husband. “Sadly for me, my husband also wanted a son. During each pregnancy I was forced to get an ultrasound done to determine the sex of my foetus by my husband,” she said. “I was pregnant with a girl thrice but couldn’t keep them.”

Only after the birth of her son did her painful experiences with abortions end. “Three abortions in seven years had a great impact on my health,” she said. “I have recovered from the physical trauma my body suffered from frequent pregnancies and equally frequent abortions. But my mental health is still in shambles.”

Studies have shown frequent abortions have long-lasting implications on a woman’s reproductive health resulting in complications in future pregnancies or worse, says Jageshwar Gautam, consultant gynaecologist & obstetrician at Om Hospital and Research Centre.

The elective procedure also has a long-term effect on mental health especially if the woman goes for the procedure under duress, says Dr Prabhakar Pokharel, consultant psychiatrist at KIST hospital in Kathmandu.

“All that has happened to me was done to me by my family,’ said Sabitri. “I am happy with my daughters and did not harbour any desire to bear a son but I was under immense pressure to give birth to a boy.”

Sex-selective abortions are illegal in Nepal and carry a prison term for the guilty but the easy availability of pre-natal sex determination technologies make female foeticide a commonplace practice. Like several other countries in South Asia, Nepal has a visible preference for sons with many citing religious and socio-economic reasons.

“I have undergone abortion twice since my husband and his family wanted a son,” said Kavita BK, a 38-year-old woman from Nepalgunj sub metropolis. Kavita too asked her real name to be withheld for privacy reasons.

“They say that it’s a wife’s obligation to give birth to a son. They say sons are important in our society. They didn’t want to take a chance in case we had a baby girl so I was forced to undergo abortions after sex determination tests revealed I was carrying girls both times,” said Kavita.

As per The Right to Safe Motherhood and Reproductive Health Act, 2018, abortion is permitted up to 12 weeks of gestational age on the request of the pregnant woman, up to 18 weeks of gestational age in the case of rape or incest and at any gestational age if the pregnancy is detrimental to the woman’s health and life or if there is foetal impairment.

“Abortions should be done within the legal framework,” Durga Laxmi Shrestha, Nursing in-charge at Bheri Hospital told the Post. “We do the procedure for reasons such as if the health of the mother and her baby is compromised or in case of incest and rape.”

Basundhara Gyawali, a nurse in the maternity ward at the hospital, says the hospital doesn’t see a lot of first time prospective parents coming for abortions and it’s usually parents with daughters who come and seek abortions. “But we don’t entertain them and in fact, dissuade them from going for it. Some are not aware of the legal repercussions of sex-selective abortions,” she said.

Gyawali recounts incidents wherein new parents celebrate the birth of a son and get visibly upset if their newborn is a girl. “I think it boils down to social conditioning. In Nepal, boys are celebrated and the birth of a girl is bemoaned.”

Basanta Gautam, a human rights and gender equality activist based out of Banke, says sex-selective abortions are possible mostly because of easy access to such procedures through private clinics and lax monitoring of such clinics by the authorities.

“An increasing number of medical practitioners are found involved in illegal abortions in Banke,” he claimed. “Sex-selective abortions are happening in broad daylight but the authorities have not done much about it. Legal action is hardly taken against those who seek such illegal services and those who provide it,” he said.

Dr Ankur Bhandari, gynaecologist at Bheri Hospital, says sex-determination technology is a mark of advancement in the medical field but that the technology is being misused.

“Prenatal tests such as ultrasounds are important in pregnancies but since it can determine the sex of the foetus, this technology is being widely misused as a gateway for illegal abortions,” he said.

In the past year alone, 189 women visited Bheri Hospital seeking treatment for adverse health effects caused by unsafe abortions, said Bhandari.

The Safe Maternity and Reproductive Health Act, 2075, states pregnant women should not be coerced into identifying the sex of the foetus by intimidation or terror, or by improper influence and deception. The National Criminal Code, 2074, allows imprisonment to parents and service providers between one and five years, depending on the period of pregnancy and a penalty of Rs 10,000 to Rs 50,000.

However, no one has been sentenced or fined for committing such a crime in Nepal so far.

Head Constable Nabin Thapa at District Police Office in Banke, says the local police have not encountered cases of sex-selective abortions so far. “Many years ago a woman had filed a complaint against her family for forcing her to abort but she soon withdrew her statement and a formal case was never registered,” he said. “No one has come to us to report clinics engaged in illegal activities but if any victim comes to us to file a case, we will take action against the guilty as dictated by law.”

“Cases of forced abortions rarely come to light because of fear instilled in the women by their family members,” said Gautam. “The women share their stories only after the abortion is done. This could be the reason why Banke sees more births of sons than daughters.”

According to the data from Bheri Hospital last year, the number of newborn sons is higher than newborn girls in Banke. The hospital data shows 2,430 females and 2,742 males were born in the fiscal year 2019-2020. Likewise, 1,779 females and 2,060 males were born in Banke district in the fiscal year 2020-2021.

“Gender-based violence, religious bigotry behind gender identity and discrimination in power relations have made this issue very sensitive; we need to work towards raising awareness in society about the causative factors that lead to female foeticide,” said Kamala Pant, another human rights activist based out of Banke. “The discrimination girls face even when they are not yet born is what fuels the fire of gender violence and fails to create a safe environment for girls to live.”

“Only when the Nepali society begins to understand the importance of daughters and values their lives as much as that of sons, can we expect to see a decline in couples engaging in illegal sex-selective abortions,” said Pant.

Thirty-six-year old Sanju Dhungana from Nepalgunj-12, is still trying for a son. Sanju, who asked her real name to be withheld, is a mother to two daughters. A victim of forced abortions, she was forced to undergo sex-determination tests by her family twice. “Both times I was pregnant with girls and my family asked me to get an abortion,” she said. “They still want a son. The lack of awareness about gender equality and a desire for a male heir are some of the reasons why women like me have been forced to go through hell and live with guilt for the rest of our lives.”