While poverty and under-education continue to dampen contraception use in Nepal, exacerbating the country's efforts to reduce maternal and child mortality rates, researchers say another, more surprising factor may be more intractable: Deeply held cultural preferences for sons over daughters.
Writing in the March 7, 2013 online International Journal of Gynecology and Obstetrics, scientists from the University of California, San Diego School of Medicine found that geography (urban versus rural), age and levels of education, wealth and social status all predictably influenced whether Nepalese women used birth control.
Young wives in Nepal were among those least likely to use contraceptives, 24 percent of wives ages 20-24 and just 14 percent of wives ages 15 to 19 years old. These low percentages, said first author Anita Raj, PhD, professor of medicine in the UC San Diego School of Medicine, were particularly notable among young wives who did not have any sons.
"Daughter aversion" reflects a profound, historical cultural bias in Nepal and in other central and south Asian countries, said Raj, an international authority on gender issues in the region. Part of the reason is financial, she said. Males traditionally enjoy greater economic opportunity.
"But tradition also says sons take care of parents," Raj said. "Daughters are supposed to leave the family and become the daughter of the in-laws, no longer the daughter of the parents. Practices like that are going to affect investment in your daughters."
Raj said son preference was worrisome for a couple of reasons. First, it persists even with improvements in education. Second, it remains strong among the youngest Nepalese wives.
She suggested the latter effect may be due, in part, to the influence of older generations.