Trial reportBMJ open2019
Determinants of imbalanced sex ratio at birth in Nepal: evidence from secondary analysis of a large hospital-based study and nationally-representative survey data.
Trial report in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02718222 (Studying the Impact and Performance of Institutionalizing Immediate Post-partum IUD Services as a Routine Part of Antenatal Counseling and Delivery Room Services in Nepal, Sri Lanka, Tanzania), which is not on this map. Cited by 11 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Studying the Impact and Performance of Institutionalizing Immediate Post-partum IUD Services as a Routine Part of Antenatal Counseling and Delivery Room Services in Nepal, Sri Lanka, Tanzania
Who cites it
11 citing papers in PubMed.
- Two decades of safe abortion policy evolution and reform in Nepal (2002-2025): progress, implementation, challenges, and opportunities.Archives of public health = Archives belges de sante publique · 2026Article
- Knowledge and attitudes towards abortion among young adults in Pahang, Malaysia: A descriptive cross-sectional study.Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia · 2026Article
- Extensive Uterine Necrosis and Peritonitis Following Clandestine Abortion Attempt: A Case Report.Clinical case reports · 2025Article
- Does mistreatment during institutional childbirth increase the likelihood of experiencing postpartum depressive symptoms? A prospective cohort study in Nepal.Global health action · 2024Article
- Maternal Folic Acid and Dietary Folate Intake in Relation to Sex Ratio at Birth and Sex-Specific Birth Weight in China.Nutrients · 2024Article
- Suspected illegal abortion and unsafe abortion leading to uterine rupture and incomplete abortion: A case report.Annals of medicine and surgery (2012) · 2022Article
- Gender, nutritional disparities, and child survival in Nepal.BMC nutrition · 2022Article
- Differences in maternal and early child nutritional status by offspring sex in lowland Nepal.American journal of human biology : the official journal of the Human Biology Council · 2022Article
- Estimation and probabilistic projection of levels and trends in the sex ratio at birth in seven provinces of Nepal from 1980 to 2050: a Bayesian modeling approach.BMC public health · 2022Article
- Girls start life on an uneven playing field: Evidence from lowland rural Nepal.Evolution, medicine, and public health · 2022Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo quantify sex ratios at births (SRBs) in hospital deliveries in Nepal, and understand the socio-demographic correlates of skewed SRB. Skewed SRBs in hospitals could be explained by sex selective abortion, and/or by decision to have a son delivered in a hospital-increased in -utero investments for male fetus. We use data on ultrasound use to quantify links between prenatal knowledge of sex, parity and skewed SRBs.
designSecondary analysis of: (1) de-identified data from a randomizedrandomised controlled trial, and (2) 2011 Nepal Demographic and Health Survey (NDHS).
settingNepal.
participants(1) 75 428 women who gave birth in study hospitals, (2) NDHS: 12 674 women aged 15-49 years. OUTCOME MEASURES: SRB, and conditional SRB of a second child given first born male or female were calculated.
resultsUsing data from 75 428 women who gave birth in six tertiary hospitals in Nepal between September 2015 and March 2017, we report skewed SRBs in these hospitals, with some hospitals registering deliveries of 121 male births per 100 female births. We find that a nationally representative survey (2011 NDHS) reveals no difference in the number of hospital delivery of male and female babies. Additionally, we find that: (1) estimated SRB of second-order births conditional on the first being a girl is significantly higher than the biological SRB in our study and (2) multiparous women are more likely to have prenatal knowledge of the sex of their fetus and to have male births than primiparous women with the differences increasing with increasing levels of education.
conclusionsOur analysis supports sex-selective abortion as the dominant cause of skewed SRBs in study hospitals. Comprehensive national policies that not only plan and enforce regulations against gender-biased abortions and, but also ameliorate the marginalizedmarginalised status of women in Nepal are urgently required to change this alarming manifestation of son preference. TRIAL REGISTRATION NUMBER: NCT02718222.
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