Albania risks gender imbalance
Tirana - "It's another girl," Roza said to the doctor, tears streaming down her pale face. "I cannot keep it, doctor, I already have three daughters," she implored.
The tiny, 28-year-old woman whose hair is already streaked with grey is more than four months pregnant - beyond the nation's legal abortion limit - but says she is ready to risk her life to make sure this baby is not born.
It is an all too frequent scene in Albania where the Council of Europe, the continent's 47-member state democracy and rights watchdog, warns that sex selective abortions have led to boys outnumbering girls 112 to 100 - out of sync with the biological standard sex ratio at birth of 104 - 106 males to every 100 females.
Sex selective abortions - and in earlier times infanticide - have been cited as an indicator for skewed sex ratios in some Asian nations where tradition prefers sons.
UN figures show China, India and Vietnam have the biggest imbalance, but the Council of Europe warns that the practice has spread to Europe - and has singled out Albania, Armenia, Azerbaijan and Georgia.
"Traditionally Albanian families have favoured boys over girls for two main reasons: The inheritance of the family name and the prospect of boys growing up to become breadwinners," a 2005 report by the UN Development Programme (UNDP) said.
"It is a mentality that has remained," said Aferdita Onuzi, a noted anthropologist here. "In certain regions a girl is sometimes seen as a heavy burden."
It is also a personal nightmare for women like Roza.
"Last time, my husband almost killed me, he became violent when he found out that I could not give him a son, and my mother-in-law also," the young woman said.
Her husband erupted in fury when he heard another girl was on its way, threatening to chase his wife and daughters from his home. "Are you sure?" he screamed at the doctor. "In our family we have only boys."
Albania legalised abortion on the eve of the communist regime's fall in the 1990s. It is allowed until the 12th week of pregnancy. After that, "therapeutic" abortions can only be performed if three different doctors have assessed a case and given the go-ahead.
While sex selection as a reason for abortion is expressly forbidden, there are no specific sanctions for breaching the law, local rights groups said. Since 2002, the availability of foetal sex screening has made it a frequent method for choosing the sex of one's child, according to these sources.
At only some €15 ($20), an ultrasound is within the reach of most budgets. And abortions, which cost around €150 in a private clinic, are much cheaper than going through an in vitro fertilisation process to sort sperm to ensure a male, which can run into thousands of euros.
In October, the parliamentary assembly of the Council of Europe (Pace) adopted a resolution stating that prenatal sex selection has reached "worrying proportions" in Albania.
World health agencies warn such imbalances cannot only affect marriage and fertility patterns but could cause unrest among young men unable to find partners.
The Council called on members Albania, as well as the former communist states of Armenia, Azerbaijan and Georgia, to investigate the reasons behind what it called their skewed sex ratios and to monitor birth rates to collect reliable date on the issue.
Tirana, however, rejects the Council's figures. The country, which hopes to become a candidate country for the EU, says that average data for the period 1998 - 2010 shows 99.99 females were born for every 100 males - within the biological norms.
Albania's Health Minister Petrit Vasili said that "everything is strictly controlled in the hospitals" and insisted a preference for boys in rural areas "has not had any influence on the Albanian population's demographics".
In the Pace report, parliamentarian Doris Stump of Switzerland said that the Albanian authorities "do not consider the skewed birth ratio as a nationwide problem but a sporadic phenomenon limited to some remote areas".
She also deplored the lack of sanctions against the sex-selective abortions, which Albanian health workers like Rubena Moisiu, the head of Tirana's Koco Glozheni hospital, said can circumvent the law.
"Some of these abortions are done in private clinics or by individuals who are not licensed to perform them," she noted.
For Moisiu, the solution is simple - stop foetal sex screening.
"It is an open debate even in countries more developed than Albania. The doctors should not reveal a child's sex, because what is important for parents is that the baby is in good health," she said.
"Yet now, the first question many Albanian women ask is: 'Is it a boy or a girl?', and not 'Is the baby healthy?'" she said.
"Some doctors come under enormous pressure from women to perform abortions when they see the foetus is female," she said. "It is that mentality that we have to change."