Sex-selective abortion is not uncommon in Albania and other parts of the Balkans, driven by patriarchal norms that deem male offspring more desirable as well as significant rates of emigration, particularly by males.

According to the United Nations Population Fund, in societies where sex-selective abortion is practiced, sex-ratio imbalances have emerged; they include Albania, Montenegro, North Macedonia and Kosovo.

In 2023, Albania recorded a ratio of 107.4 boys per 100 girls, while a decade earlier some parts of the country were reporting coefficients as high as 111.7, well beyond what the World Health Organisation says can be expected – 103 to 107 boys for every 100 girls.

“Recent estimates suggest that there were 8000 missing female births due to prenatal sex selection in Armenia, Azerbaijan, Georgia, Albania and Montenegro from 2013–2017 alone,” the UNFPA said in a 2020 report.

In 2017, a BIRN investigation revealed a flourishing illegal market for genetic tests to determine foetal sex in Montenegro, driven by a societal preference for sons.

In Albania, the numbers point to a positive trend, but the imbalance remains; in the UNFPA report, Albania ranked among the top 15 countries globally for preference towards boys.

According to an online survey conducted in Albania and Bosnia and Herzegovina by Elbasanion and Fokus.ba respectively, public awareness of the phenomenon of sex-selective abortion is high, but so too is the stigma surrounding it.

“Yes, unfortunately I am familiar with such a case,” one respondent told Fokus.ba.

“It was a woman from a rural area pressured by her partner into having an abortion because he preferred not to have a female child; They already had a daughter, whom he barely accepted.”

‘Generational thing’

The UNFPA says that the selective abortion of female foetuses “is not only archaic, but also harmful to social and economic growth”.

In Bosnia, where the sex ratio is within the range expected by the WHO, roughly half of respondents to the Fokus.ba survey said they understood the concept and nine per cent reported knowledge of specific cases. 

In Albania, however, 72 per cent of respondents were familiar with the practice of sex-selective abortion and a quarter claimed knowledge of specific cases.

“It’s a generational thing,” said Manuela Bello, UNFPA head of office in Albania. 

“Today the ratio is 107.4 boys born to 100 girls, which means that we still have a gap between boys and girls in Albania.”

Rubena Moisiu, a professor of obstetrics and gynaecology in Tirana, concurred, saying that if the natural gender is surpassed, “there are reasons related to selective abortion”.

Demography expert Arjan Gjonça said the phenomenon was not limited to rural areas or the less educated; even educated women are known to abort female foetuses because of patriarchal pressures and economic factors, he said.

“Generally, according to studies, abortions do not come [only] from vulnerable sections or rural areas,” Gjonca said.

Olgert Alla, head of the Obstetric-Gynecological Hospital in Elbasan, noted improvements over the past decade but acknowledged that early gender-identification techniques had facilitated selective abortion practices. 

“When I started working 10 years ago, couples came who had abortions because of the sex of the child; couples who had two or three daughters were inclined to terminate the pregnancy if they had a daughter again,” he said, adding, however, that he had witnessed a decline in such cases more recently.

Questionable data

In Bosnia in 2022, the Agency for Statistics reported 105 boys born for every 100 girls, though the rate fluctuates from year to year.

In Bosnia, there is a dearth of reliable data on pregnancy terminations, despite a requirement that all public and private health bodies maintain such records and report them to the relevant authorities.

In the country’s two entities – the Federation and the Republika Srpska – the respective public health institutes possess some data, but its accuracy is questionable; the Federation institute, for example, lacks reports from three of the Federation’s 10 cantons.

According to the RegiZ database, where all health bodies are supposed to submit data on abortions performed, 2,406 pregnancies were terminated in the Federation between 2019 and 2023, including 730 in 2022 alone.

The real figure, however, is likely higher, possibly even double: for example, according to the Federation Institute for Public Health, 512 pregnancies were terminated in Sarajevo Canton between January 2019 and end-2022, yet the canton’s own Institute for Public Health gives a figure of 1,089.

In the Republika Srpska, the Institute of Public Health says that 1,343 pregnancies were terminated in 2022, in line with other years. Doubts persist, however, over the reliability of its figures.

In a 2019 analysis, experts of the Serbian SeConS Development Initiative Group in collaboration with the UNFPA wrote that while the official abortion rate in Bosnia is on a par with the EU average, “the quality of health statistics is questionable as there is [an] assumption that the majority of abortions are performed in private clinic and not reported to government institutions making BiH more prone to use of abortions as a means of family planning”.

None of the medical professionals interviewed by Fokus.ba reported patients seeking abortion solely based on foetal sex preference. 

However, in Bosnia, 42.3 percent of women make the sole decision to terminate a pregnancy, according to a 2023 study by the Sarajevo Open Centre.