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This report on gender-biased sex selection in Kosovo (UNSCR 1244) originates from a wider concern about potential sex imbalances at birth in several countries in Eastern Europe. It follows the United Nations interagency statement released in 2011 on sex selection (OHCHR, UNFPA, UNICEF, UN Women and WHO, 2011), the report of the Parliamentary Assembly of the Council of Europe (Council of Europe, 2011) on the Caucasus and Southeast Europe, and the report of UNFPA (2015b). These documents called for a larger mobilization by government organizations and international agencies to gather more evidence on the phenomenon in Eastern Europe and this report represents the first attempt at examining prenatal sex selection in Kosovo.

Sex selection has emerged since the early 1990s as a widespread harmful practice in several Asian countries. It is lesser known that prenatal sex selection has also been put into practice in parts of Europe. This report starts with a brief overview of the world situation, in which we identify two regional clusters of countries in the South Caucasus and in Southeast Europe, with clear signs of potential prenatal sex selection. The sex ratio at birth (i.e. the number of male births per 100 female births), fluctuating normally around 105, has indeed increased to levels between 110 and 115 in these countries. This artificial rise in the proportion of male births began in most countries around 1990, a period marked by political and economic transformations in Eastern Europe.

In this report, we use both qualitative and quantitative data to document the nature and intensity of son preference. Discussions and interviews make it clear that most families always look for a son. We further demonstrate that gender bias influences reproductive decisions and that subsequent fertility can be twice as frequent when families do not have any sons. This quest for a son can be observed across all regions, social categories, and ethnicities of Kosovo.

A separate chapter has been devoted to the exploration of the demographic consequences of skewed levels of sex ratio at birth. The major implication is the gradual buildup of a male surplus in Kosovo’s adult population. This demographic surplus might after some years distort the marriage system and international migration would then become a natural solution for men to escape the growing local sex imbalance.

Our last chapter sums up our findings and their implications. We must emphasize that higher fertility and restriction to reproductive technologies are unlikely to have any impact in Kosovo’s modern demographic regime. The gradual disappearance of gender bias is a prerequisite for prenatal sex selection to subside in Kosovo. We conclude this report with a set of recommendations about Kosovo.