When Rights Become Access: Abortion Reform and Missing Girls in Nepal

Reforms that expand reproductive rights change behavior only when they change effective access. We study Nepal, which legalized abortion in 2002 to reduce unsafe procedures, and ask when and where legal access affected the sex composition of births in a society with son preference. We combine quasirandom variation in firstborn sex with the staged rollout of abortion services and predetermined connectivity to city services in a triple-difference design. The rollout separates two margins. During the initial first-trimester rollout, later-birth hazards declined where services were reachable, but the male- and female-birth responses were not statistically distinguishable, and the sex composition of births did not change. Once access expanded to include second-trimester services, medication abortion, and midlevel providers, the annual probability of a female birth fell while male births did not decline detectably. Nationally, the firstborn-girl differential in the annual female-birth probability fell by 0.49 percentage points. The response was concentrated within two hours of a city: relative to locations beyond two hours, the female-birth probability declined by an additional 1.30 percentage points. Back-of-the-envelope calculation maps the national composition estimate to an annual flow equivalent of about 11,900 missing girls at birth, or 1.91 percent of all births.