Posted by Dan Schwarz
“I have seven girls. I had one boy but he died when he was very young. I’ve been to Dhangadi two times before [for ultrasound diagnostics] but both times they were girls and I got rid of them.”
-Excerpted from Dr. Ruma Rajbhandari’s new article in The Nepali Times
In the United States, gender inequality is commonly discussed in the context of interpersonal relations, job promotions, or even the types of clothing that are socially acceptable. But in many other countries and cultures throughout the world, gender inequalities can be a literal determinant of life and death.
Unfortunately, despite its significant ramifications for gender discrimination, sex selection has been notably neglected in much of the recent international development and human rights discourse. Sex selection is the practice of determining the sex of a fetus early on in pregnancy (most commonly using ultrasound imaging technology), and selectively aborting “less desirable” female fetuses, in exchange for the opportunity to “try again” for a “more desirable” male child.
In Far Western Nepal, where Nyaya works, among many other instances of gender inequality, our staff regularly encounter mothers, fathers, and extended family members who come to Bayalpata Hospital, seeking ultrasound imaging early on in pregnancy, so that they can make decisions about which pregnancies they wish to pursue, about which pregnancies are worth more than others. Girl children, because of their eventual marriage into another family, are frequently viewed as another family’s property from the time of their birth. Boy children, in contrast, are viewed in the context of their future contributions to work in the family fields, and their eventual care for their parents as they age. Consequently, boy children are often seen as more valuable than girl children, and are selected for accordingly.
Mothers in Nepal face significant cultural and gender biases, exemplified by the practice of sex selection, in which mothers opt to terminate female pregnancies so as to save their resources for "more valuable" male pregnancies.
Pregnant women and their families regularly travel to Dhangadi (about ten hours travel and an enormous economic burden for an area with an average daily income of less than $0.50 USD) or even across the border to India to pursue “video X-ray” (ultrasound) during their first trimester, hoping to avoid having “yet another” daughter. Given the relative devaluation of girl children versus boy children, families in Achham who are struggling with poverty, unemployment, and poor health, will frequently opt for the expensive up-front costs of sex selection (and subsequent termination) rather than the long-term costs of raising the less valuable girl child.
Recently, having struggled with these issues while working at Bayalpata Hospital, Dr. Ruma Rajbhandari MD, MPH (from The Brigham and Women’s Hospital in Boston) wrote about her experiences in the Nepali Times. Detailing the case of a pregnant woman with seven daughters but no sons, Dr. Rajbhandari highlights the societal and cultural pressures facing women in Achham, and attempts to reconcile her role as a physician and advocate for her patient, while also attempting to challenge the cultural biases which lead to practices such as sex selection. Bayalpata Hospital has strict guidelines against performing ultrasound imaging for sex determination, but the patients continue to request it. When they are unsuccessful in getting the ultrasound, they move on to other clinics or hospitals who will give them sex-specific imaging information.
You can read Dr. Rajbhandari’s article in the Nepali Times here.
Sex selection affects not only the health of the mother and unborn fetus, but that of society as a whole. In the future, we will continue to struggle for not only equity in access to healthcare, but more broadly, for gender equity and human rights. Please join us in this struggle and continue to support our work; the very life and death of the people of Achham depend on it.
“Unless the status of women as a whole improves throughout Achham, women who have the means will continue to make the long journey to Dhangadi and India.”
-Dr. Ruma Rajbhandari