title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Research on Environment Health and Population Activities (CREHPA), Kusunti, Lalitpur, Nepal.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Lamichhane
authors.forename: Tabetha
authors.initials: T
authors.lastname: Harken
authors.forename: Mahesh
authors.initials: M
authors.lastname: Puri
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
mesh_terms: D000028:Abortion, Induced; D001291:Attitude of Health Personnel; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D009390:Nepal; D010820:Physicians; D011247:Pregnancy; D036301:Qualitative Research; D012732:Sex Determination Analysis; D012737:Sex Factors