RUMA RAJBHANDARI WELCOME HOME: A newborn delivered at Bayalpata Hospital, Achham.

Wearing a red and green sari, a phuli in her nose, a fair, middle-aged woman timidly approached my desk in the Outpatient Department of Bayalpata Hospital, Accham.Averting her gaze from mine, she looked at the floor and spoke softly, not wanting anyone else in the room to hear.

"I have seven girls. I had one boy but he died when he was very young.?I've been to Dhangadi two times before but both times they were girls and I got rid of them."

On further questioning, she revealed that she had not menstruated in four months.She thought she could be pregnant again and wanted to know if it was a boy or a girl.If it was a boy, she would keep it.If it was a girl, she would abort.Her husband was an auxiliary health worker in a neighbouring village and was understanding; he loved his seven girls.But she was sick and tired of hearing the neighbours and her extended family suggesting she was a useless wife who could not produce sons. They'd even tell her husband he should marry another.

The year before, when she became pregnant, she and her husband had spent almost Rs 40,000 on medical treatment in the Indian-town of Paliya, which borders Dhangadi. She'd undergone three ultrasound examinations to determine the sex of the baby before it was finally confirmed that it was a girl.She then had a D&C (dilation and curettage) to abort the female fetus.

This time, she'd heard from people in her village that Bayalpata Hospital had a 'video x-ray' (the term for an ultrasound in these parts) and thought she would just come here to find out the sex of the baby, as she knew the hospital provided free services.

Her urine pregnancy test did turn out to be positive.But despite her protests, we had to tell her that we do not use ultrasound to tell patients the sex of their babies.If she wanted to keep the baby, whatever sex it was, we would provide her with appropriate antenatal care.If she did not want to keep the baby because she felt she had had enough children, we could provide her with comprehensive abortion care as long as the fetus was no more than 12 weeks old.

Despite an hour of counselling, she left saying she would now have to go to Dhangadi again for an ultrasound.

At Bayalpata Hospital, encounters like this are common.Many of the pregnant women that come to the hospital come knowing we have free ultrasound services, and hope that we can tell them the sex of their baby.Counselling such women seems futile in a society where the male child is so highly valued.Unless the status of women
as a whole improves throughout Achham, women who have the means will continue to make the long journey to Dhangadi and India.