Erased before birth: How gender bias fuels a silent war on unborn girls

Woman's palms pressed together and holding an embryo. [Courtesy/GettyImages] Imagine carrying a pregnancy with anticipation, enduring the emotional and physical transformations that come with it. But when the ultrasound reveals the fetus is female, fear sets in. In many South Asian countries, that fear is followed by a voluntary and forced abortion, not because of health complications, but because of gender. This harsh reality, well documented both anecdotally and in data, reflects one of the most chilling forms of gender-based violence: sex-selective abortion. Sex-selective abortion is a deeply rooted form of discrimination predominantly found in parts of the Global South, particularly in South Asia. Though illegal in most countries, this practice persists, fueled by a preference for male children, societal pressures and entrenched patriarchal norms. And it's only one part of a broader system of gender inequality that also includes menstrual discrimination, economic exclusion and restricted access to reproductive rights. According to the World Health Organisation (WHO), millions of female fetuses are aborted every year due to sex preference. In countries like India, China, Nepal and Pakistan, demographic data show skewed sex ratios, indicating widespread misuse of prenatal diagnostic tools to identify and terminate female fetuses. UNICEF data highlights that over 140 million women are "missing" globally-victims of gender-biased sex selection, infanticide, or neglect. In Pakistan, the sex ratio at birth is around 105 males for every 100 females, but in certain regions, it spikes to 109-112, suggesting active sex selection. "This is a significant regional concern," says Erfaan Hussein Babak, a Sexual and Reproductive Health Rights (SRHR) expert from Pakistan. "These numbers reflect the ongoing preference for sons who are seen as breadwinners and carriers of the family legacy, while daughters are viewed as economic liabilities." Hussein notes that in Pakistan, there is no legislation towards sex selective abortions, though abortion is considered illegal. Most of the children's homes have an 80 per cent rate of girls abandoned compared to boys. In India, despite legal prohibitions under the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, and subsequent legal amendments to ban and punish prenatal sex ratio screening and female foeticide, the practice continues. Poorvi Gupta, a 32-year-old independent journalist, confirms this. "In many Indian states, sex-selective abortion is still quietly practised. The government campaigns against it, and NGOs are active, but the societal mindset remains hard to change." Shivangi Pandey, 27, also a journalist based in India, adds, "Female infanticide and sex-selective abortions stem from the belief that girls are burdens. It starts with family conversations-how we speak about daughters versus sons. Until that changes, the bias remains." "Sex determination through ultrasounds and sonography in India is illegal," says Jaishree Kumar, 25-year-old independent journalist and documentary filmmaker based in New Delhi, India. "It is currently illegal in India to determine or disclose the sex of the foetus. There are underground centres that reveal the sex of the fetus to parents, and the government is trying to work on shutting them down. There are also instances of people flying out to countries where sex determination of the fetus is legal. Sex-selective abortions further promote the false belief that a girl child is a burden, and we must work together to end such perceptions." Nepal, too, faces similar challenges. While abortion is legal under certain conditions, including for pregnancies up to 12 weeks upon request and up to 28 weeks in cases of rape or incest, sex-selective abortion remains illegal. However, due to societal pressures and inadequate enforcement, the law is often circumvented. In contrast, Kenya's abortion laws are much stricter. Abortion is illegal except when the life or health of the mother is in danger, or in cases of emergency treatment. This restrictive stance often forces women to seek unsafe procedures. While sex-selective abortion is not widely documented in Kenya, the country still struggles with gender-based discrimination and inadequate access to sexual and reproductive health services. Sex-selective abortion is closely tied to menstrual discrimination-another expression of deep-rooted gender inequality. "In many countries, especially in the Global South, girl children are not valued, the discrimination of women begins long before birth and continues throughout life," says Dr Radha Paudel, a Nepalese activist and founder of Global South Coalition for Dignified Menstruation. "Menstrual discrimination is a daily reality for millions of women, particularly in the Global South." According to Dr Paudel, In families and communities which lack the technological or financial means to assess the sex of the fetus during pregnancy, discrimination begins at birth. In countries like Nepal, India and Pakistan, menstruation is shrouded in stigma and taboos. In some communities, menstruating girls and women are considered impure and are subjected to extreme restrictions. In rural Nepal, for instance, some women are still forced into isolation huts during their periods, a practice known as chhaupadi, despite it being outlawed. "In Brahmin communities," Dr Paudel explains during the Dignified Menstruation Media Fellowship 2025 that brought together journalists and activists from Nepal, India, Pakistan, Sri Lanka and Kenya, "women on their period are barred from entering kitchens, temples, or attending social functions. "These kind of practices are practised all over the globe in different names and forms, but are more visible in the Global South," she says. "These practices reinforce the belief that women are weak, unclean, and less capable," Dr Paudel says. This discrimination extends into economic life. "The gender pay gap is not just about wages," says Saumya, a journalist based in New Delhi. She adds that access to well-paying jobs is determined by multiple factors-mobility, safety, and healthcare, which are all limited for women in patriarchal societies. The concept of Dignified Menstruation advocates for a human-rights-based approach to menstrual health. It challenges the notion that menstruation is a private or impure matter and emphasises the need for education, access to hygiene products, and supportive environments for menstruating individuals. "This is not just about biology-it's about dignity," says Dr Paudel. "When we teach girls that their bodies are something to be ashamed of, we lay the foundation for lifelong discrimination." For decades, the government and other concerned organisations have implemented various activities to halt such discrimination. They include policies like affirmative action and interventions against SGBV. The mental health impact of these practices is also significant. From isolation during menstruation to the trauma of forced abortion, many women face depression, anxiety, and even suicidal ideation. "Until society begins to recognise menstrual discrimination as a serious human rights issue, the cycle will continue," says Saumya. "The silence must be broken-not just around menstruation, but around the value of women at every stage of life."

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