Drita, 31, covers her face with trembling hands. She just learned that after giving birth to three daughters in four years she is pregnant again with a girl, an unforgivable crime in the patriarchal Balkans that clearly prefers boys.
She tries to mutter a few words, but her mother-in-law, Sanije, silences her with a hard stare.
"A fourth one is a curse... either she will abort or there is no place for her with us," she says, handing a bundle of bank notes to a doctor at a private clinic in downtown Tirana.
Selective abortions are common practice in Albania and some other Balkan countries where an imbalance between boys and girls at birth is blamed on a preference for boys.
"Prenatal sex selection continues to be a persistent practice in Albania although the legislation specifically bans it," said Rubena Moisiu, head of an obstetrics hospital in Tirana.
It gradually leads to a demographic masculinisation of society, already visible among young children.
In countries such as Albania, Kosovo, Montenegro and in western Macedonia there some 110 male per 100 female births," Christophe Guilmoto of the French Research Institute for Development, who specialises in gender imbalances, told AFP.
This figure is higher than the average biological sex ratio at birth of 105 boys to 100 girls. And the regularity of the 110-100 ratio over the years attests to the imbalance.
According to the national statistics bureau, on January 1 there were 31,000 fewer women than men in Albania's population of 2.8 million.
Albania is among the few European countries where men outnumber women, and this despite a very strong emigration for economic reasons over the past two decades, mainly by men.
- Traditional society-
"Such a trend exists also in Montenegro, a traditional society where (prenatal) sex selection is a common practise," says Maja Raicevic of the Women's Rights Centre in Podgorica.
"In recent years for every 8,000 births there were about 800 more boys than girls, an imbalance that is far from normal," said Olivera Miljanovic, head of the National Medical Genetics Center.
As a result, Montenegro lacks some 3,000 women of reproductive age, she said.
In the Balkans "boys are more desired than girls," explained anthropologist Aferdita Onuzi from Tirana.
"Women are under strong pressure to give birth to a male successor at any price."
In Kosovo, Montenegro, but also in some Macedonian regions, traditional thinking that favours boys over girls is said to be the main cause of this phenomenon.
Experts stress that a woman is perceived only as a "burden" and a man as a "pillar of the family".
- 'Missing women' -
Abortion in the Balkans region is legal until the 10th or in some cases 12th week of pregnancy, before a baby's sex can be determined.
To circumvent the law, however, many selective abortions are carried out in private clinics or even by individuals who are not authorised to perform such a medical procedure.
"Although there have been cases when women died, everyone remains silent, fearing repercussions. A lot of money is at stake," said Fetije Këpuska a Pristina gynaecologist.
In Montenegro, many women prefer to go to hospitals in neighbouring countries to determine the baby's sex before abortion.
"I know a woman who aborted twice under pressure from her husband's family after learning she was pregnant with girls. Eventually, she gave birth to a boy," Milica, a professor in Podgorica who did not want to give her family name, told AFP.
"The missing women, eliminated before birth because of their gender, weigh heavily on the society and economy of all the countries concerned," said Elsona Agolli, a gender issue expert with the United Nations Population Fund in Tirana.
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