Although the false incidence (children born with neural tube defects or NTD) and true incidence (foetuses with NTD) of spina bifida is on the decline in the developed world, the same cannot be said of spina bifida in developing countries. In a country like India, the socioeconomic consequences of this malformation are devastating. Because of their high incidence, problems related to antenatal diagnosis and abortion, the quality of life decisions involved, lack of social support structures, neglect of the girl child, lack of defined ethical guidelines and a paucity of multidisciplinary clinics, NTDs pose some of the greatest ethical challenges to the paediatric surgeon in India.Some years ago, I was shocked to know that the parents of my patient - a third girl child with meningomyelocele - had officially named her "Nakoshi" which means "unwanted".