Baku, Azerbaijan - After giving birth to a baby girl, 24-year-old Shana knew what to expect the second time she became pregnant.

"When we found out that the second baby was going to be another girl, my husband said that he didn't want her and I was forced to have an abortion. It was already three months and 10 days. They anaesthetised me and cut the foetus out of me."

Shana's second daughter was one of thousands of girls aborted in Azerbaijan every year.

According to a 2012 report by the Guttmacher Institute, Azerbaijan has the highest total abortion rate in the world, with women having on average 2.3 abortions in their lifetimes. Between 2005 and 2009 almost 10 percent of potential female births in Armenia and Azerbaijan did not occur because of prenatal sex selection, another report found.

The oil-rich country has one of the world's worst records in sex-selective abortions, according to a report for the UN. In normal circumstances, 105 boys are born for every 100 girls. In Azerbaijan, the ratio in 2011-12 was 116 boys for every 100 girls. In some parts of the country, such as the Ganja region, the ratio is as high as 120 to 100.

It is not rare to hear of women who continue to have abortions until they give birth to a boy. Statistical trends also show that sex-selective abortions rose steeply when ultrasound testing became more common in the 1990s.

Shunned for having a girl



From a small women's shelter in the heart of Baku, Azerbaijan's capital, Shana told Al Jazeera in a soft voice how she had been happy and in love when she married her husband. But like others living at the shelter, she was rejected for not giving birth to a boy.

"My marriage was good until I became pregnant, and did not give in to the pressures of having an abortion because the baby was a girl. Then my husband sent me to my mother's house, and said he was going to take lovers to get a baby boy," she said. Shana's daughter, Leman - now a happy, piano-playing child - was ignored and disowned by her father and his parents from the time she was born.

I have seen men turning their heads and leaving the room without saying goodbye. Sometimes, if it is the first daughter, men are more or less ok, but when it is the second daughter, often he is not ok. - Tarana Hasanova, gynaecologist

The rejection often begins with an ultrasound taken at the 12th week of pregnancy. Tarana Hasanova, a gynaecologist at Baku's Policlinic Number 1, told Al Jazeera about the reactions she has seen after announcing that the foetus is a girl: "I have seen men turning their heads and leaving the room without saying goodbye. Sometimes, if it is the first daughter, men are more or less ok, but when it is the second daughter, often he is not ok."

Will new legislation help?

Walking though the wide, clean halls of Baku's main maternity ward, Faiza Aliyeva, the national coordinator for reproductive health in Azerbaijan, said she tries to change mindsets when she holds master classes for gynaecologists. "I tell them to react by saying something like, 'You are lucky! It's a great thing to have a girl. She will look after you in your old age.' That's what I told couples too as a practicing doctor."

India's solution to its own gender problem has been to ban testing for sex in the 12th-week ultrasound. But enforcement is difficult, says Dr Luis Mora of the United Nations Population Fund. Cheap kits make it possible to test for sex without a doctor's supervision. And some Azerbaijanis believe that withholding information about the gender of a baby would be a step too far. "It would be a violation of human rights," says Aliyeva.

Musa Guliyev, the deputy chairman of the Committee on Social Policy, told Al Jazeera that Azerbaijan's parliament plans to discuss a new legislative package on reproductive health this fall. Under the proposed legislation, any woman pursuing an abortion after the 12th week of pregnancy must have her case subjected to a medical commission that will decide whether the abortion has been sought on non-medical grounds, or for reasons related to the foetus' sex.

Guliyev believes such legislation is the only way to ensure that Azerbaijan's long-term demographics are not thrown out of kilter. The UNFPA has also warned of the consequences of a shortage of women, including the risk of human rights violations such as abduction, the trafficking and sale of women and girls for the purpose of marriage, and sexual exploitation.

The key, say reformers, is to take a holistic approach to the country's reproductive problems, rather than focusing solely on abortion. By teaching teenagers about sex and making contraceptives more readily available, Aliyeva argues, the government will cut the total number of abortions of foetuses of both genders.

Meanwhile, the case of South Korea has been commonly used as a successful example of how imbalanced sex ratios can be reversed.

By the mid-1990s, South Korea's sex ratio at birth was similar to Azerbaijan's today. But by 2007 it had declined to 107 males born per 100 females. South Korea based its strategy on a multidisciplinary approach: Legislation against prenatal sex detection was passed and effectively put into force; a mass media campaign called "Love your daughter" was launched; and new measures were passed to encourage gender equality. These new policies were aided by South Korea's economic boom, which helped women join the workforce and thereby achieve more autonomy.

Tradition trumps religion

It remains to be seen whether legislation will be able to change ingrained cultural prejudices in Azerbaijan. Legal systems in countries in the Caucasus region grant equal rights to men and women, but for many people of both genders, it is simply a matter of pride to have a son to perpetuate the family’s lineage. This preference runs so deep that not even Muslim and Christian teachings against abortion can limit the practice.

From his office in Baku, surrounded by piles of books, Islam expert Sahin Hesenli told Al Jazeera: "A daughter is the gift of God. The Quran states that a man that takes care of several daughters has a place in heaven."

But Shana tearfully recalls that her ex-husband's reaction was much different from what Hesenli would have expected. "After Leman was born, my husband did not want to give us money," she said. "He said that she wasn't his child and even asked to do a paternity test because he was sure that he could not have a girl. My mother-in-law also said that her son should have had a boy, not a girl."