Kathmandu’s narrow alleys and bustling boulevards mask a troubling trend that threatens Nepal’s future: small private clinics quietly fueling illegal sex selection and female foeticide, skewing the nation’s sex ratio at birth and exposing deep-rooted gender inequality in Nepal (gender bias, daughter devaluation, and son preference are still potent forces in Nepali society). Despite abortion being legal and prenatal sex determination banned, the accessibility of ultrasound services and lax enforcement in Kathmandu and semi-urban areas have created a shadow network of clinics where expectant parents can determine a foetus’s sex and, if it’s a girl, seek a termination. Sex-selective abortion clinics in Kathmandu are now at the center of an urgent public health and human rights debate, as data shows more boys being born than girls and experts warn of long-term social consequences if the trend continues.
In the fiscal year 2024-25, Nepal’s Ministry of Health and Population recorded 383,205 births, with 206,374 boys and 176,831 girls—a disparity of nearly 30,000 that far exceeds the natural biological norm of about 105 boys per 100 girls and suggests clandestine sex-selective abortions are a major factor behind the imbalance. Radiologists and gynaecologists working in tiny private facilities dotting Kathmandu and other urban hubs are identified by public health specialists as the main enablers of these illegal practices. These clinics provide the means to confirm the sex of an embryo after the 12-week threshold when such tests are possible, and then, if parents so choose, to terminate pregnancies.
Under Nepal’s Safe Maternity and Reproductive Health Act, 2018, both sex determination and sex-selective abortion are explicitly prohibited; violators face one to five years in prison and fines under the National Criminal Code, 2017. Yet, in practice, no clinic owner, technician, or parent has ever been prosecuted or fined for engaging in sex selection, reflecting a yawning gap between law and enforcement. Independent doctors and pharmacists lament that the greed of a few practitioners tarnishes the reputation of the medical profession and fuels a perilous practice that undermines women’s rights and reproductive autonomy.
The cultural currents driving this phenomenon run deep. In many Nepali families, especially within patriarchal structures (often influenced by socio-economic norms that see sons as carriers of the family name, providers of old-age security, and performers of key ancestral rites), having a boy is widely perceived as a blessing. Girls (‘chhori’) are still seen by some as an economic burden due to dowry expectations and marriage expenses, while boys (‘putra’) are viewed as assets who will support aging parents and inherit property. These ingrained beliefs can transform the joy of pregnancy into agonizing decisions about a child’s sex and whether a girl has a future in her own family.
Activists note that even with rising female education and women’s empowerment, the preference for sons persists, in part because broader gender inequality remains entrenched in Nepalese society. Discrimination against girls—beginning long before birth—reinforces the notion that daughters are less desirable, increasing the emotional pressure on pregnant women who are often at the mercy of family expectations. Women may be coerced by husbands, mothers-in-law, or extended family to seek sex determination and, subsequently, a termination if the unborn child is female.
The availability of cheap and frequent ultrasound scans in the city—once heralded as a boon for maternal health—has inadvertently facilitated gender-biased decisions. Studies from before show that widespread use of these technologies without strict oversight can lead to a rise in prenatal sex determination for non-medical reasons, and Nepal is no exception. Echoing patterns seen in neighboring countries where legal bans failed to curb sex selection, ultrasound clinics can quietly provide the information parents want, and abortion clinics complete the grim transaction.
The consequences of Kathmandu’s small clinics offering these services go beyond skewed birth statistics. A widening gender gap can destabilize communities, with long-term risks that include increased violence, trafficking, and social instability as the pool of women of marriageable age shrinks relative to men. Experts argue that Nepal’s efforts to enforce existing laws must be paired with broader cultural change: tackling patriarchal norms, elevating the status of girls, and strengthening women’s economic and social power in every corner of the Federal Democratic Republic of Nepal. Only by confronting both the legal and cultural roots of sex-selective abortion can Nepal hope to reverse this trend and ensure that every child—boy or girl—is welcomed and protected.
Spicy Auntie here, lighting a cigarette I don’t smoke and staring very hard at Kathmandu’s ultrasound machines. Because Auntie has seen this movie before, and trust me, it never ends well. It starts quietly, politely, with phrases like “just checking,” “family pressure,” “one last try for a son.” It ends with missing girls, exhausted women, and a society pretending it has no idea how it got there.
Let’s be very clear, because Auntie does not dance around the truth: sex selection is not a “women’s choice” problem. It is a patriarchy-with-a-receipt problem. When daughters are treated like temporary guests and sons like lifetime investments, technology doesn’t liberate women—it just gives misogyny better tools. An ultrasound does not hate girls. People do.
I hear the whispers already. “But abortion is legal in Nepal.” Yes, it is, and that matters. Safe abortion saves lives. But legality without accountability is like giving a drunk uncle car keys and hoping for the best. When tiny clinics quietly tell families what they are “having,” everyone knows what comes next. The woman pays the price, with her body, her conscience, and often her silence. Meanwhile, the men go home feeling very satisfied with their lineage.
Auntie has traveled enough in South and Southeast Asia to recognize the pattern. First, girls disappear from birth statistics. Then brides become scarce. Then trafficking, forced marriages, and violence against women rise like clockwork. And suddenly everyone is shocked. “How could this happen?” they ask, clutching their pearls. Auntie would like to point at the spreadsheets, the clinics, and the family dining tables where daughters were discussed like bad investments.
And let’s not romanticize culture while we’re at it. Culture is not a fossil. Culture is what people choose to keep doing. Sons lighting funeral pyres, daughters marrying out, inheritance flowing in one direction—these are traditions that can change. They have changed elsewhere. They change when girls are valued not for what they bring to men, but for who they are as human beings.
What makes Auntie angriest is not the technology. It’s the cowardice. Laws exist, but enforcement politely looks the other way. Clinics make money. Families save face. Women absorb the trauma. And society shrugs, as if this were weather.
So here’s Auntie’s unsolicited advice: stop pretending this is a private choice. It’s a public disaster in the making. Protect abortion access fiercely, yes—but crack down hard on sex selection, name son preference for what it is, and start celebrating daughters loudly, publicly, unapologetically.
Because when girls vanish before they’re even born, the future doesn’t just tilt male. It tilts cruel. And Auntie has zero patience for societies that manufacture their own heartbreak and call it tradition.