Fifth Asian and Pacific Population Conference
(11-17 December 2002)
Bangkok
Nepal
Country Report
His Majesty's Government of Nepal
Ministry of Population and Environment
Kathmandu, Nepal
August 2002
Contents
Foreword ................................................................................................................... iii
Acronyms .................................................................................................................. iv
Executive Summary .................................................................................................. vi
I.
Overview of the Population and Development Situation in Nepal ...................... 1
1. Introduction ........................................................................................................... 1
2. Overview ............................................................................................................... 1
II. Poverty Reduction Strategy .................................................................................... 3
III. Dimensions of Population and Development ......................................................... 4
1. Fertility Levels, Trends and Implications ............................................................. 4
2. Mortality, Morbidity and Poverty ......................................................................... 6
3. Migration, Urbanization and Poverty .................................................................... 7
3.1 Internal Migration ......................................................................................... 7
3.2 International Migration ................................................................................. 8
3.3 Urbanization ................................................................................................. 9
4. Reproductive Health............................................................................................ 10
4.1 Family Planning .......................................................................................... 12
4.2 Adolescent Reproductive Health ................................................................ 13
4.3 Impact of HIV/AIDS .................................................................................. 14
5. Gender Equality and Development ...................................................................... 16
6. Ageing Population ............................................................................................... 18
7. Behavioral Change Communication and Advocacy and Information and
Communications Technology .............................................................................. 20
8. Data, Research and Training................................................................................ 22
9. Partnership and Resources ................................................................................... 25
10.Other Issues ......................................................................................................... 26
IV. Future Strategies ..................................................................................................... 28
Appendix I: Selected Population and Development Indicators, Nepal, 1991-2001. 31
Appendix II: Targets of the Ninth Five Year Plan and Beyond ............................... 32
Bibliography ............................................................................................................. 34
i
List of Table, Figures and Boxes
Table
S.N.
Title
Page
1.
Population Size and Growth in Nepal
2
2.
1995/96 Survey, Poverty Measures for Nepal
3
Figures
S.N.
Title
Page
1a.
Population Size of Nepal, 1911-2001
2
1b.
Population Growth Rate in Nepal, 1911-2001
2
2.
Trends in Total Fertility Rate, Nepal, 1986-2001
5
3a.
Population Pyramid Nepal, 1991
5
3b.
Population Pyramid Nepal, 2001
5
4.
Trends in Infant Mortality Rate
6
5.
Trends in Urban Population Growth
9
6.
Levels and Trend of Contraceptive Prevalence Rate, Nepal, 1976-2001
12
7.
Trends in Adolescent Population Growth
13
8.
Trends in Mean Age at Marriage
13
9.
Distribution of Population Aged 60 Years and Above, Nepal, 1952/54-2001
18
Boxes
S.N.
Title
Page
1.
Reproductive Health Package of Nepal
10
2.
Informal Population Education Camps
21
ii
Foreword
This Country Report has been prepared for the Fifth Asian and Pacific Population
Conference to be held in Bangkok during 11-17 December 2002 on the basis of
suggested guidelines. This report is based on sectoral plans and policies of the
government. The report focuses on population, poverty and sustainable development
issues in Nepal. Review of accomplishment, current status, priority issues and future
direction on different dimensions of population and poverty has been incorporated into
this report. The report has been prepared through extensive consultations with various
government, non-government agencies and professionals in the field of population,
poverty and development.
We would also like to express our thanks to the UNFPA/Nepal for their support in
preparation of the report.
August 2002
His Majesty's Government of Nepal
Ministry of Population and Environment
iii
Acronyms
ARI
ASDR
AIDS
ASFR
BCC
BPEP
-
Acute Respiratory Tract Infection
Age Specific Death Rate
Acquired Immune Deficiency Syndrome
Age Specific Fertility Rate
Behavioural Change Communication
Basic Primary Education Programme
CDPS/TU
CBOs
CBS
CDR
CEDA
CMR
-
Central Department for Population Studies, Tribhuvan University
Community Based Organizations
Central Bureau of Statistics
Crude Death Rate
Center for Economic Development and Administration
Child Mortality Rate
CPR
CREHPA
CST
CTEVT
DFID
DOH
FPAN
FSW
GDP
GOs
HIV
HMG/N
-
Contraceptive Prevalence Rate
Center for Research on Environment, Health and Population Activities
Country Support Team
Council for Technical Educational and Vocational Training
Department of
Department of Health
Family Planning Association of Nepal
Female Sex Workers
Gross Domestic Product
Government Organization
Human Immune Deficiency Virus
His Majesty's Government of Nepal
ICPD
IDU
IIDS
JICA
IMR
IEC
INGO
IDU
MMR
MoAC
MoES
MoH
-
International Conference on Population and Development
Injecting Drug User
Institute of Integrated Development Studies
Japanese International Cooperation Agency
Infant Mortality Rate
Information, Education and Communication
International Non Governmental Organization
Injecting Drug Users
Maternal Mortality Ratio
Ministry of Agriculture and Cooperatives
Ministry of Education and Sports
Ministry of Health
iv
MoICS
MoPE
MoWCSW
NDHS
NFFS
NFHS
NGO
NGOCC
NHEICC
NPC
POA
PRSP
PHC
RH
STD
TBA
TFR
UNDP
-
Ministry of Industries, commerce and Supplies
Ministry of Population and Environment
Ministry of Women, Children and Social Welfare
Nepal Demographic and Health Survey
Nepal Fertility and Family Planning Survey
Nepal Fertility, Family Planning and Health Status Survey
Non Governmental Organization
Non Government Organization Coordination Council
National Health Education, Information and Communication Centre
National Planning commission
Programme of Action
Poverty Reduction Strategies Paper
Primary Health Center
Reproductive Health
Sexually Transmitted Diseases
Traditional Births Attendant
Total Fertility Rate
United Nations Development Programme
UNFPA
UNHCR
UNICEF
USAID
VaRG
WFP
WHO
-
United Nations Population Found
United Nations High Commission for Refugees
United Nations Children Fund
United States Agency for International Development
Valley Research Group
World Food Programme
World Health Organization
v
Executive Summary
1. Prevalence of widespread poverty and higher population growth has been the
major challenge to Nepal's socio-economic development efforts. His Majesty's
Government of Nepal (HMG/N) has accorded high priority to implement the
resolutions of the Bali Conference, 1992 and recommendations of the
Programme of Actions adopted at the International Conference on Population
and Development held at Cairo in 1994. Since 1992 in Bali and 1994 in Cairo,
several efforts have been initiated to integrate population factors into
development planning. The efforts were aimed at improving access to quality
reproductive health services, empowerment of women, increased literacy status
and higher level of income. Some progress has been made in recent years in
reducing total fertility rate (TFR), maternal and infant mortality rates (MMR and
IMR) and increasing the life expectancy, contraceptive prevalence rate and the
educational status of the general populace.
2. The government of Nepal has set a long-term target of reducing fertility to the
replacement level by the end of the twelfth plan (2013-2017). In Nepal, women
of reproductive age experience high fertility at an early age. However, this trend
has been slowing down among women who are educated, employed and urban
based.
3. Nepal has achieved significant decline in mortality rate in recent years, mainly
due to increased access to basic health facilities. Faster decline in mortality and
slower decline in fertility has resulted in relatively higher rate of natural growth
of population. There has been a substantial increase in the life expectancy at birth
for both males and females. In fact, for the first time since the turn of the century,
female life expectancy seems to have surpassed that of males and more
importantly both sex achieved the life expectancy above 60 years. HMG/N has
further aimed at reducing mortality and morbidity by increasing accessibility,
availability and affordability of essential health services to the population.
4. The government has emphasized the need for reducing imbalance in the spatial
distribution of population in the country by promoting judicious socio-economic
development. Migration of rural population to major urban centres in the country
is creating tremendous pressure on the existing basic services. The government
has adopted the policy of regulating and managing both internal and international
migration.
vi
5. The steady increase of elderly people in total population of the country is
creating significant socio-economic implication in the country. The policy and
operational strategy adopted by the government is focussed towards the welfare
services for the elderly population in terms of economic benefit, social security,
health service facilities, honor, participation, education, and entertainment in
order to ensure their decent livelihood.
6. About 50 per cent of Nepalese women are in their reproductive age. HMG/N has
arranged a package of reproductive health services accessible at the community
level by mobilizing government, non-government, civil society, local body and
private organizations. Safe motherhood and family planning services have been
geared towards averting maternal mortality and preventing unwanted
pregnancies.
7.
HMG/N fully encourages couples and individuals to decide freely and
responsibly the number and spacing of their children and the means to do so. The
present level of CPR (39%) would increase to 67 per cent if existing unmet need
were to be met.
8.
has pursued National Adolescent Health and Development Strategy for
the adolescent population for providing educational and training opportunity,
knowledge on reproductive health and services, family and community
affiliation, socio-economic information and counseling and legal provisions.
HMG/N
9. The incidence of HIV/AIDS, even though low and recent, is increasing fast.
HMG/N is serious about preventing the disease and protecting against its
epidemic nature through the National Reproductive Health Strategy.
10. Gender discrimination is persistent in Nepal due to socio-cultural construct
together with high illiteracy, poor health and poverty. Provision of education,
health and employment are the prerequisites for empowering women and
enhancing their socio-economic and political status. Various multi -sectoral
interventions have been made for enhancing the status of Nepalese women.
11. The National RH/FP and IEC Strategy and The National Population Information,
Education and Communication Strategy have been launched to promote the
behavioral change communication and advocacy. Several government and nongovernment organizations have been implementing various information,
education and communication programmes to support small family norms, girls'
education, and reproductive health services including family planning.
12. Research on population dynamics and its interrelationship with development in
general and poverty in particular is in its incipient phase in Nepal. More research
vii
is needed to improve information for feeding into the planning process.
Government and non-government organizations, however, have actively involved
in providing training to stakeholders and target groups at the national and
regional level in the areas of reproductive health, empowerment, and gender
equity and equality.
13. In recent years, mutual co-operation between government and non-government
agencies has been promoted in the areas of policy formulation, programme
development, implementation, monitoring and resource sharing in a participatory
manner.
14. Maoist insurgency over the last six years has mostly disturbed the poor and
weaker sections of the society. As a result, providing quality of the health care,
education and other social services has been a major concern for accomplishing
the development objectives of the country.
15. HMG/N has already initiated to integrate population concerns into all aspects of
socio-economic development strategies of the country by means of a long-term
population perspective plan.
viii
I. Overview of the Population and Development Situation in Nepal
1. Introduction
Nepal is a landlocked country situated between India and China. It has a total population
of 231,51,423 in an area of 147,181 square kilometers with a density of 157 persons per
square kilometer. The country is divided into three ecological zones: mountain, hill and
Tarai (plains) and is inhabited by more than 100 caste and ethnic groups. About 80 per
cent Nepalese people are dependent on agriculture for their livelihood. However,
agriculture sector contributes only about 40 per cent of the GDP. The manufacturing
sector is still weak (about 10% of GDP) to contribute substantially to the GDP and
larger proportion of the GDP is being contributed through trade, tourism and service
sectors. The GDP per capita remains very low at US $ 236. Inequality of the means of
subsistence and income is widespread. A large segment of the people (38 %) lives below
absolute poverty line. The scale of poverty is higher in rural areas than in urban areas.
Widespread underemployment (33.2%) is considered as the principal cause of large-scale
poverty. Economic growth of the country has not improved markedly over time to
overtake population growth rate. Agricultural sector is still the backbone of the country's
rural economy on which rests the sustainability of people's livelihood.
Nepal adopted the policy of incorporating population issues into the development
process ever since the first plan launched in 1956. Population issues are being considered
with priority in the periodic plans of the country as an endeavour towards sustainable
development.
2. Overview
According to the Census 2001, total population of Nepal is 23.15 million with an annual
growth rate of 2.25 per cent between 1991 and 2001 (Table 1; Figures 1a, 1b). Almost
equal number of males and females is recorded in the census with a sex ratio of 99.8.
Population growth continues to be very high on account of the large size of female
population in the reproductive age group (49.2%) and high fertility rate (4.1 children per
woman) due to high-unmet demand for contraception (27.8%) and early marriage of girls
before the age of 18 years. In addition, the effect of population momentum created by the
young age population will contribute more to the population growth of the country. This
will be the major constraint for achieving accelerated socio-economic development
(Appendix I).
1
Table 1: Population Size and Growth in Nepal, 1911-2001
Census year
Population size
1911
1920
1930
1941
1952/54
1961
1971
1981
1991
2001
Absolute % change
%
Annual exponential
growth rate (%)
-1.2
-0.7
13.6
31.4
14.0
22.8
30.0
23.1
25.2
-0.13
-0.07
1.16
2.28
1.64
2.05
2.62
2.08
2.25
5,638,749
5,573,788
5,532,574
6,283,649
8,256,625
9,412,996
11,555,983
15,022,839
18,491,097
23,151,423
Figure 1a: Population Size of Nepal, 19112001
(Population in Million)
25
Figure 1b: Population Growth Rate in
Nepal, 1911-2001
3.0
23.2
2.62
2.28
2.5
20
15
8.3
10
5.6 5.5
9.4
1.0
6.3
0.5
5
0
-0.13 -0.07
0.0
2001
1991
1981
1971
1961
2001
1991
1981
1971
1961
1952-54
1941
1930
1952/54
1941
1930
1920
1911
-0.5
1920
0
1.16
1.5
11.6
2.25
1.64
2.0
15.0
2.08
2.05
18.5
During the last ten years, Nepal 's crude birth rate has reduced from 37.5 in 1991 to 33.1
per 1,000 population in 2001, while the crude death rate during the same period has been
reduced to 9.6 from 13.8. During the last ten years, some quantitative gains have been
achieved in lowering total fertility rate to 4.1 and increasing the contraceptive prevalence
rate (CPR) from 29 per cent to 39.3 per cent. Progress has also been made during the
last ten years (1991-2001) in lowering infant mortality rate from 102 to 64.4 per 1,000
live births and maternal mortality ratio from 850 to 539. The literacy rate for the
population 6 years and above has increased from 39.6 to 53.7 per cent, while the female
literacy of the same age increased from 25 per cent in 1991 to 42.5 per cent in 2001. A
noticeable gain in life expectancy has been revealed by the 2001 census as well by the
Demographic Health Survey of Nepal, 2001. Life expectancy for the total population
was recorded as 54.4 in 1991, while one of the recent estimates by Central Bureau of
Statistics has put life expectancy at birth for the total Nepalese population at 60.8 years.
2
From this estimate, it is also revealed that the life expectancy of females during the last
ten years increased from 53.4 to 61 years, while that of males increased from 55.9 to
60.6 years. This indicates that females started outliving males in Nepal since the
beginning of the new century. These accomplishments, by no means marginal, have not
been sufficient to overcome the persistent poverty and increase the quality of lives of the
Nepalese people. Successful implementation of government policies geared towards
slowing population growth, increasing per capita income in equitable manner and
developing quality human resources is prerequisite for poverty alleviation and
sustainable development.
II. Poverty Reduction Strategy
Prevalence of widespread poverty has been the major challenge to achieving desired
socio-economic benefit for the Nepalese people. During the Ninth Plan period (19972002) poverty level has been marginally reduced to 38 from 42 per cent (Table 2). But
due to inherent momentum of the broad base of population, there has been an increase in
the number of people living below absolute poverty line. High rate of under-employment
(32.3%), low productivity of land and labour, malnutrition, illiteracy (46.3%), low socioeconomic status of women and limited access to reproductive health and social services
have all contributed to higher population growth and low economic performance. In this
context, sustained economic growth is the necessary condition for sustainable
development. This can not be achieved, however, without a significant reduction in the
level of poverty in Nepal. Poverty alleviation was accorded as the foremost objective in
the preceding Eighth and Ninth plans of Nepal. Past experiences have clearly shown that
poverty alleviation can not be accomplished only by maintaining positive macroeconomic indicators. Tenth Plan Approach Paper and Interim Poverty Reduction
Strategy Paper have envisaged to expedite poverty alleviation by according high priority
to economic growth, good governance and social justice.
Table 2: 1995/96 Survey, Poverty Measures for Nepal (Poverty Line of NRs. 4,404
per Person Per Annum)
Head-count Index
(Population below the
poverty line)
Ecological Zone
Mountain
Hills
Tarai
Sector
Urban
Rural
National Average
Poverty-gap Index Squared-poverty-gap
Index
0.56
0.41
0.42
0.185
0.136
0.099
0.082
0.061
0.034
0.23
0.44
0.42
0.070
0.125
0.121
0.028
0.051
0.050
3
Poverty alleviation is going to be the major objective of the Tenth Plan (2003-2007) with
an aim of reducing the existing level of poverty from 38 to 30 per cent by the end of the
plan period and to 10 per cent by 2017. In order to accomplish this, a comprehensive and
long-term poverty alleviation package is to be vigorously implemented to meet the
millenium development goals. The major intervention strategies will have to be based on
reducing rapidly growing population, practicing good governance and promoting
economic opportunities. The ultimate goal will be to achieve sustained economic growth
in the context of sustainable development by raising the quality of life for all Nepalese
people through appropriate population and development policies and programmes. In
this context, fertility rate within next 15 years have to be contained within the
replacement level by encouraging general populace towards a small family norm.
The 10th Plan is being developed as the final PRSP. A long-term population perspective
plan is to be formulated and implemented from the start of the Tenth Plan with special
focus on relating population dynamics with poverty alleviation. Major objectives and
strategies for improve population health outlined in the I-PRSP.
III. Dimensions of Population and Development
The main thrust of the Nepalese population policy has been to enhance population
quality, reducing the growth rate of population and regulate internal and international
migration. Within the context of the Bali Declaration and ICPD, Nepal has attempted to
integrate population dynamics into development planning. An integrated and
comprehensive framework will have to be pursued for reinforcing the programmes
relating to population, poverty and development.
1. Fertility Levels, Trends and Implications
The current TFR of 4.1 in Nepal is one of the highest in South Asia. While urban Nepal
is approaching near replacement level fertility, rural Nepal has persistently high fertility
(4.4). This also indicates that fertility among poor people in rural areas is substantially
high. Affordability, accessibility, availability, knowledge and awareness of reproductive
health services including family planning have made a substantial difference between the
people living in rural and urban areas with regard to reproductive behaviour. The TFR in
the mountain (4.8) is highest among three ecological zones of Nepal followed by Tarai
(plain) (4.1) and hills (4.0). Prevalence of widespread poverty accompanied by
unemployment, underemployment low educational attainment and low status of women
all have contributed to high levels of fertility in the rural areas of Nepal (Figure 2).
4
Births per woman
Figure 2: Trends in Total Fertility Rate, Nepal, 19862001
6
5
4
3
2
1
0
5.1
4.8
1986
4.6
1991 Year
4.1
1996
2001
The population of Nepal is composed relatively of young people. More than 39 per cent
of its population is under 15 years of age (Figures 3a, 3b). About 50 per cent of women
are in their reproductive age. The age structure of Nepalese population is
overwhelmingly young characterized by high fertility and declining mortality. In
addition, early marriage and short spacing of birth among younger women make it
difficult to rapidly reduce MMR and IMR to the desired level.
Figure 3a: Population Pyramid Nepal, 1991
Age
Male %
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
20%
Figure 3b: Population Pyramid Nepal, 2001
Female %
Age
75 +
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
15%
10%
5%
0% 0%
5%
10%
15%
20%
20%
Female %
Male %
15%
10%
5%
0% 0%
5%
10%
15%
20%
His Majesty's Government of Nepal (HMG/N) has initiated several policy measures to
optimize its demographic trend in the context of socio-economic development of the
country. The measures include increase in income generating activities, improvement of
women's status, easy access to basic education and health care including reproductive
health and family planning services, with special focus in rural areas. In order to realize
the goal of attaining replacement level fertility by 2017, HMG/N has been focussing on
raising the age at marriage and increasing CPR along with the provision of employment
opportunity for females and raising the level of their education.
5
2. Mortality, Morbidity and Poverty
Mortality in Nepal has declined significantly over the past thirty years, mainly due to
increased access to essential health care services. However, rapid decline in mortality
and slow pace of fertility decline has resulted in relatively high rate of natural increase of
population. Steadily decreasing infant and child mortality rates have contributed to
reducing the over all mortality much faster than the reduction in TFR. Given increased
survival probability, it will take some more time for parents to take this as the motivating
factor to limit their family size in rural areas.
Crude death rates (CDR) in Nepal are declining over the years. The CDR was 37 in
1950s, which came down to 9.62 in 2001. There has been a significant drop in IMR over
the years. It was about 255 (per 1,000 live births) in 1950s, which has dropped to 64.4
per 1,000 live births in 2001 (Figure 4). Likewise, in 2001, CMR is 29 (per 1,000
children aged 1-4 years) and under 5 mortality is 91 (per 1,000 live births).
The maternal mortality ratio in Nepal is one of the highest in the region (539 per 100,000
live birth in 1996). The life expectancy at birth was 27.1 for males and 28.5 years for
females in 1954 and at present life expectancy at birth in Nepal is estimated at 60.8 years
for the total population with females out living (61.0) males (60.6) from the beginning of
the new century.
Deaths per 1000
live births
Figure 4: Trends in Infant Mortality Rate
150
100
108
102
79
50
64
0
1986
1991
1996
2001
Year
Nepalese people are susceptible to various diseases such as cholera and diarrhea,
pneumonia, tuberculosis, cancer, asthma and bronchitis and heart diseases among others.
It is becoming increasingly difficult to meet the growing demands of people for
improved access to education, health services, drinking water, sanitation and other basic
services that in turn become causes of morbidity and mortality in Nepal.
The body mass index (BMI) of women aged 15-19 years is 23 per cent, while it is 35 per
cent among women aged 45-49 years. It shows they are suffering from chronic energy
deficiency problem with the increase in their age. Women in rural areas suffer more from
malnutrition compared to their counterparts in urban areas (28% versus 17%).
6
The child nutritional status can be considered as one of the important indicators of
overall morbidity situation in a society. In Nepal a little more than 50 per cent of the
children under five years of age are found to be suffering from the long term
malnutrition.
HMG/N has aimed to reduce mortality and morbidity by increasing accessibility,
availability, acceptability and affordability of basic health care services. HMG/N has
been operationalizing various programmes designed to reduce mortality and morbidity
by means of awareness raising, decentralized health programmes and immunization
programmes to poor and underserved people. The government is also emphasizing on
nutrition and sanitation programmes to improve the quality of life. HMG/N's Second
Long-Term Health Plan and Tenth Plan Approach Paper and PRSP have emphasized on
focused and integrated programmes for improving mortality and morbidity situation in
Nepal Appendix II).
3. Migration, Urbanization and Poverty
3.1 Internal Migration
Migration has been an important component of population redistribution in Nepal.
People have been migrating from rural to urban areas in search of employment and
educational opportunities. Occasional natural calamities like floods and landslides have
also forced people to flee from their birthplace to other potential areas for their
livelihood. Internally displaced persons have remained in vulnerable situations expecting
urgent rescue and help. Important causes of internal migration in Nepal have been
poverty, inequitable distribution of income, unemployment, difficult livelihood and food
insecurity.
Internal migration has led to both positive and negative economic, social and
environmental implication for the place of origin and destination. Initially, low density
and economic potentialities in Tarai area prompted migration from the mountain and hill
to the Tarai. However, at present Tarai has less absorptive capacity to additional
population. Similarly, urban areas are overcrowded through rural to urban migration. To
circumvent this unequal distribution of population resulting from increasing rural to
urban and hill to Tarai migration, HMG/N has pursued the policy of regulating and
manageing the internal migration. The Tenth Plan Approach Paper and I-PRSP has
emphasized on more balanced spatial distribution of population by promoting socioeconomic factors both in the sending and receiving areas. In the mean time, displaced
people are being resettled in the potential areas by providing basic social services and
opportunities for income generating activities. Still new settlements are to be developed
with basic infrastructures, especially in hills and mountains, to facilitate and contain
balanced distribution of the population.
7
3.2 International Migration
International migration in Nepal is gaining increasing momentum. Job opportunities,
education and social security have been the major causes of international migration in
Nepal. Basically, search for employment and educational opportunities have been the
primary causes of emigration from Nepal. Considering both documented and
undocumented migrants, it is estimated that more than one million Nepalese have
migrated to India, Gulf and other countries. It is also estimated that every year
substantial amount is being remitted to Nepal through official and unofficial channel.
This has created substantial positive impact on the balance of payment and foreign
exchange reserve in the country. However, most young people going abroad belong to
unskilled status. This has led to hazardous and difficult life with less earning. As such,
HMG/N is making several efforts to enhance the status of Nepalese migrant workers.
The government has already started special skills development programmes and
financing schemes to enhance the quality of Nepalese youth going abroad for
employment. Necessary measures are yet to be taken to promote the welfare of
documented migrants and eliminate the discriminatory practices against them. In the
mean time, HMG/N has initiated necessary actions to reduce the number of
undocumented Nepalese migrants for their safety. The government will facilitate the
productive utilization and investment of the remittances from Nepalese emigrants.
Immigration to Nepal has been due to availability of employment and business
opportunities. It is known from the 2001 census that more than 600,000 foreign-born
migrants are living in Nepal. Since most of the foreign migrants are from India, the
system of open border with India has led to higher proportion of undocumented migrants
from India. Many of the Indian migrants having experience and skills on business and
entrepreneurship have contributed towards economic development of the country.
However, a continued migration from the southern neighbour may create excessive
pressure on available resources within the country. As such, the government will see the
possibilities of regulating the border with India to promote documented migrants in both
the countries. Future strategy of the country will be to regulate and manage the
international migration.
The presence of more than 100,000 refugees since last 12 years mainly from Bhutan has
been a major concern for Nepal. This has been creating many social, economic and
environmental problems in Nepal. The government with assistance from UNHCR and
other donors is providing food, shelter, health services, education and other services to
the refugees in collaboration with bilateral and multilateral donors. The limited
absorbing capacity of the country has been the prime concern for their continuous stay in
8
Nepal. HMG/N is making all possible efforts to work out solutions to the plight of
refugees residing in Nepal.
3.3 Urbanization
Nepal still has a low level of urbanization compared to many other countries in Asia.
The process of urbanization in Nepal is basically a function of increasing the number of
urban centres by combining the population of rural areas. For example, in 1971, Nepal
had only 16 government designated urban centres followed by 23 in 1981, 33 in 1991
and 58 in 2001 (Figure 5). Building infrastructure and providing basic urban services for
the rapidly designated urban centres is very difficult and slow. According to the 2001
census, Nepal has 86.1 per cent of the total population living in rural areas and 13.9 per
cent in 58 municipalities. Kathmandu, the Capital of the country has a population of
671,486 followed by four other sub-metropolitan cities, each with a population of over
100,000. The remaining 53 municipalities have been spread all over the country, ranging
in population from 10,000 to less than 100,000. There are also more than 120 settlements
functioning as urban market centres.
Percent of Total
Population
Figure 5: Trends in Urban Population Growth
15
13.9
10
9.2
5
6.4
4
0
1971
1981
1991
2001
Year
Nepal's increasing commercial ties and open border with India and high productivity of
the land have all contributed to the rapid urban growth in the Tarai during the last few
decades. The decrease in the scope of rural to rural migration from mountain and hill to
the Tarai in the future really means heavy influx of people from rural to urban areas. This
rural to urban stream of migration is bound to create imbalance in the spatial distribution
of economic benefits between the hill and the Tarai regions.
Keeping in view the possible implications, HMG/N is keen to strengthen complementary
relationship between urban and rural areas with increased employment opportunities.
Furthermore, HMG/N is encouraging growth of small urban and market centres along the
main highways to channel internal migration by promoting off farm employment
opportunities to disadvantaged groups, specially women. The government is planning to
discourage over crowding and environmental pollution in large urban centres. Besides
9
strengthening the urban management capacity of the local authorities, the government is
also attempting to provide more employment opportunities to migrants in urban centres
by establishing linkages between urbanization, migration and development. HMG/N is
striving for a balanced urbanization to minimize the negative effects of unplanned urban
growth.
4. Reproductive Health
HMG/N has endorsed the ICPD Programme of Action, 1994 as well as the WHO Global
Reproductive Health Strategy, 1995. Within this context, the government has recognized
that all couples and individuals have the basic right to decide freely and responsibly the
number and spacing of their children and to have the information, education and means
to do so. Nepalese women of reproductive age constitute 24.6 per cent of the total
population and 49.2 per cent of the total female population. About 18 per cent of
Nepalese women of reproductive age (15-49) have never married and 79 per cent are
currently married.
Nepal has got limitations in providing widest range of reproductive health services
because of too many varieties of complications arising out of early marriage, unsafe
abortion and negligence on antenatal and postnatal care.
HMG/N has arranged RH services in packaged forms and these services are being
promoted in a decentralized way through greater participation of partners at the
community and local level (Box 1). For ensuring reproductive rights and reproductive
health cares, at present HMG/N has pursued different components under reproductive
health services. Safe motherhood programme is very vital to ensure women's
reproductive rights. The government has embarked upon two major strategies for
improving maternal health. These are around the clock essential obstetric services and
the presence of skilled attendants at deliveries, especially at home. The government has
been emphasizing multisectoral approach to provide maternal health care services,
recognizing that majority of women do not have access to health services.
Box 1
Reproductive Health Package of Nepal








Family Planning
Safe Motherhood
Child Health
Prevention and Management of Complications of Abortion
RTI, STD, HIV/AIDS
Prevention and Management of sub-fertility
Adolescent Reproductive Health, and
Problems of Elderly women
10
In Nepal, one in two pregnant women receive antenatal care at least once with 28 per
cent receiving care from a doctor, nurses, auxiliary nurses or midwives. Most Nepalese
women receive antenatal care relatively at a late stage in their pregnancy and do not
make the minimum recommended number of four antenatal visits. Only one in seven
makes four or more visits during their entire pregnancy period. Institutional deliveries
are not common in Nepal. Trained medical professionals attend only 13 per cent of births
at delivery. And, Traditional Birth Attendant (TBAs) attends nearly one in four births.
About 89 per cent of births are delivered at home, compared with 9 per cent at health
facilities. Postnatal care is crucial for monitoring and treating complications within the
first two days after deliveries. Only 17 per cent of mothers receive postnatal care in
Nepal.
Women have practically no right over their own fertility regulation due to patriarchal
system of family formation. Husbands usually decide for her about when, how many and
how often she should get pregnant Prevailing high preference for sons has negative
relationship with women's reproductive health in Nepal. Sixty-six per cent of currently
married women either want no more children or want to postpone their next birth at least
for 2 years. Women with unwanted pregnancy are more likely to seek abortion and are at
high risk. In Nepal untrained personnel do most of the abortion in unsafe and unhygienic
condition.
Recently the parliament of Nepal has passed a bill legalizing abortion under the
following three conditions.
-
If the fetus is less than 12 weeks and with the consent of pregnant women,
-
If the fetus is less than 18 weeks and the pregnancy is due to rape or incest
and with the consent of pregnant women, and
-
If the pregnancy may cause health hazards to mother or/and child and with the
permission from authorized medical practitioners.
It is presumed that provision of family planning services together with legalization of
abortion will prevent unwanted pregnancies and avert maternal mortality due to
complication arising of unsafe abortion. Based on crucial importance of safer
motherhood to ensure reproductive rights, HMG/N has accorded high priority towards
easily available and accessible maternal and child health services such as promotion of
family planning, safe delivery and post natal care, breast feeding, infant and mother's
health care, prevention and care of infertility, abortion as specified by the law, treatment
of reproductive tract infections and sexually transmitted diseases.
11
4.1 Family Planning
CPR (%)
The
Family
Planning
Association of Nepal (FPAN) is
Figure 6: Levels and Trend of
the pioneer to initiate family
Contraceptive Prevalence Rate, Nepal,
planning services in the country
1976-2001
followed by the Nepal Family
Planning and Maternal and
50.0
39
Child Health Project in 1968 at
40.0
29
the government level. Family
24
30.0
15
planning services have been
20.0
8
3
10.0
expanded to cover all 75
0.0
districts of the country. Besides
1976 1981 1986 1991 1996 2001
government programmes, a
Year
number of NGOs and local
agencies are involved in the
delivery of family planning services at the grassroots level. The contraceptive prevalence
rate (CPR) among the currently married women in Nepal increased from 25.1 per cent in
1991 to 39.3 per cent in 2001 (Figure 6). The most widely used modern methods among
currently married women in Nepal are female sterilization (15%), injectables (8.4%) and
condom (2.9 %). There has been a threefold increase in the share of temporary methods
among all modern methods in the last decade and a decline in the share of permanent
methods. Almost all Nepalese women of reproductive age have heard of at least one
method of family planning. All these indicate positive contribution of family planning
services to reducing population growth rate in Nepal in the future.
Use of modern methods increases as women's participation in decision-making process
increases. Similarly, women in urban areas are freer to use family planning methods than
those in rural areas. The CPR of 62 per cent in urban areas as against 37 per cent in rural
areas clearly reflects this. The use condom is the most popular method among the
educated women, whereas female sterilization is most popular among the illiterate
women. Nepalese men and women are reluctant to use contraception mainly due to
infecundity and fear of side effects.
Electronic and print media have been extensively used for communicating messages
about family planning services. Nepal Demographic Health Survey, 2001 (NDHS 2001)
reveals that the majority of women (55%) and men (66%) have heard family planning
messages on radio, whereas only 22 per cent of women and 32 per cent of men have
heard of family planning messages on television. Two fifths of women and more than
one fourth of men had not been exposed to family planning messages through any media
source. Urban women and men are obviously more exposed to family planning messages
in any media. Family planning is being promoted in Nepal though service delivery as
well as behaviour change communication programmes including IEC and literacy
12
classes. Reproductive health programmes including family planning services will be
expanded in the future by providing a full range of quality health and other services to
reach the replacement level fertility at the end of Twelfth Plan. Family planning services
will be intensified as a national campaign through the participation and partnership
between governmental and non-governmental organizations.
4.2 Adolescent Reproductive Health
In Nepalese context, adolescents are particularly more vulnerable to reproductive health
because of lack of information and access to relevant services. The population census
2001 revealed that the adolescents aged 10-19 years constitute 23.6 per cent of the total
population (Figure 7).
Percent of Total
Population
Figure 7: Trends in Adolescent Population Growth
24
23
22
21
20
19
18
23.62
22.28
20.21
1981
1991
2001
Year
The singular mean age at marriage for female increased from 15.4 years in 1961 to 18.1
years in 1991 and to 19.5 years in 2001 (Figure 8). In the case of young girls of 10-24
years, 30 per cent were never married in 1961 but increased to 77 per cent in 2001. The
annual rate of births per 1,000 women aged 15-19 and 20-24 years showed a declining
trend during the last four decades.
Figure 8: Trends in Mean Age at Marriage
Age(years)
25
20
15
20.8
19.5
16.8
15.4
20.7
17.2
21.4
18.1
22.9
19.5
10
5
0
1961
Male
1971
Female
1981
Year
13
1991
2001
However, there has been still high fertility rate among adolescents. Over all, 21 per cent
of adolescent girls aged 15-19 are already mothers or are pregnant with their first child.
The Age Specific Fertility Rates (ASFR) in both urban and rural is the highest among
20-24-year age group.
The practice of early marriage is a major factor responsible for relatively high proportion
of adolescent child bearing in Nepal contributing to high maternal mortality. The
adolescent girls have tremendous nutritional deficiencies, which may affect their children
resulting in infants’ low-weight birth, disabilities or death. As they grow older, repeated
pregnancies, anemia, continued malnutrition and excessive workload can result in early
death. The use of modern contraceptives among currently married adolescent women 1519 and 20-24 years was 12 per cent and 23 per cent respectively in 2001. This indicates
that the use of contraceptives by these age groups has been very low. About one half of
currently married adolescents aged 15 years and about three fifths of 20-24 youths have
expressed their desire for contraceptives. Nearly half of the adolescent girls do not have
knowledge on HIV/AIDS. Higher percentage of HIV positive and AIDS were recorded
among 14-29 age groups.
The adolescent’s reproductive health programme is very recent in the government's
activities are mainly confined to awareness and prevention of early marriage, STIs, RTI
and HIV/AIDS. The government has developed Young People Development
Programme, 2002 and Adolescent Health and Development Strategy, 2000 which
includes educational and training opportunity, knowledge on reproductive health and
services, family and community affiliation, socio-economic information and counseling
and protective legal provisions. HMG/N has introduced population and reproductive
health education in public schools for the adolescents of grade 6 to 10 and also in
University curricula.
To enable the adolescents in dealing with their sexuality and reproductive health
positively and responsibly, they have to be provided with necessary information,
education and service needs. An information network of adolescent related reproductive
health activities will have to be developed in collaboration with different nongovernmental institutions and clubs in order to help adolescents to deal with their
reproductive and sexual health.
4.3 Impact of HIV/AIDS
The HIV/AIDS situation is relatively recent in Nepal with low to concentrated
prevalence. The first HIV/AIDS case in Nepal was identified in 1988. As of July 2002 a
total of 2,440 HIV positive cases were reported. Out of this, 601 were having AIDS, of
which 153 have already died. Actual number of HIV/AIDS positives in Nepal is
estimated many times higher than the recorded cases. WHO has estimated more than
50,000 cases. Estimated prevalence of HIV/AIDS is 0.29 per cent, but it is much higher
14
at risk groups. Lack of access to testing facilities and counseling, apprehension of being
exposed due to stigma and ignorance are the major factors for low reported cases of
HIV/AIDS. Nepal Demographic Health Survey (NDHS) 2001 states that knowledge of
AIDS is much higher among men (72%) than among women (50%). The increasing
number of HIV/AIDS cases in Nepal is largely due to commercial sex workers,
intravenous drug users, and high rate of STI due to low levels of condom use.
Among the total reported HIV/AIDS infection males comprise 72 per cent and females
comprise 28 per cent. The HIV scenario of Nepal reveals that 67 per cent of HIV cases
including AIDS is found among ages 14 to 29 years representing adolescents and youths.
Incidence of HIV/AIDS is more pronounced in urban areas and transportation routes
where high-risk sexual behavior is prevalent.
HIV/AIDS is having gradual significant demographic and socio-economic impact on the
poverty situation, in general and national development, in particular. The country might
experience the shortage of skilled and experienced manpower in the face of increasing
number of labour force being infected by the killer disease. The Second Long-Term
Health Plan (1997-2017) focuses on preventive aspect of all reproductive health services
including HIV/AIDS. It places greater emphasis on community involvement, increasing
access to PHC out-reach, Sub-health Posts, Health Posts and District Hospitals as well as
establishing a functional referral linkages between all levels for RTI, STI and HIV/AIDS
prevention and control. Efforts are being made to strengthen the integration of RTI, STI,
and HIV/AIDS in RH package. Following the Long Term Health Plan (1997-2017), the
National Reproductive Health Strategy of Nepal, 1998 has emphasized on prevention
and management of RTI, STI, HIV/AIDS and other reproductive health issues of
Nepalese people through integrated reproductive health package.
Similarly, the government formulated a National Adolescent Health and Development
Strategy in 2000. Major HIV/AIDS activities proposed in the document are to provide
adolescent friendly health service through existing outreach service outlets; initiate peer
counseling programmes in schools/clubs and at the workplace and to increase knowledge
on RTI, STI, HIV/AIDS; promote communication between parents and adolescents
regarding RTI, STI, HIV/AIDS education.
The approach paper of the Tenth Plan (2002-07) has realized an alarmingly growing
incidence of HIV/AIDS in Nepal. Greater emphasis is given on decentralization of health
activities at village level through enhanced management capabilities of sectoral agencies
at all levels, involvement of private sectors, NGOs, INGOs, and bilateral and multilateral
partners to implement RTI, STI, HIV/AIDS prevention control and management
programme. A comprehensive National HIV/AIDS Strategy is formulated in 2002, to
bring all sectors into mainstream. Similarly, National AIDS Council chaired by the Right
Hon'ble Prime Minister is also formed to demonstrate high level political commitment
and also to make a coordinated effort to fight against the HIV/AIDS epidemic.
15
The strategy is rights based approach with a specific focus on the rights of the people
infected and affected by HIV/AIDS, in particular, the rights to confidentiality. HIV
testing has encouraged as voluntary with guaranteed confidentiality and adequate pre and
posttest counseling in both public and private sectors. RTI, STI, HIV/AIDS prevention,
control and management strategy will give emphasis on prevention and control of STIs
and HIV infection among vulnerable people including female sex workers (FSWs) and
their clients, injecting drug users (IDUs), mobile populations, especially migrants to
India, homosexuals and prisoners.
HIV/AIDS prevention programmes is to be integrated in all line ministries and
development partners to control new HIV infections. Partnership programmes are to be
developed with national level NGOs, local governments and the private sector in this
direction. Possibilities of international support will be sought towards HIV/AIDS
prevention, control and management in Nepal.
5. Gender Equality and Development
Men, particularly husbands, in Nepal have dominant roles in decision-making. One in
two currently married women stated that her husband alone has a final say in her health
care. Likewise, two in five women have no say on the purchase of large household items.
One in three women can not visit family or relatives and can not make daily household
purchases without her husbands' permission.
Women in Nepalese perspective are considered as poorest of the poor but with larger
responsibilities in running the household. Much of their contribution is made invisible
even by the national accounting system. Ninety per cent of Nepalese women work in the
agricultural sector and majority of them is engaged in unpaid activities. More than one
fifth of working women do not have control over their own earnings. Most and worst
forms of violence against women are of domestic in nature and trafficking in girls for
commercial sexual exploitation. According to Census 2001, 55.2 per cent of Nepalese
women are economically active. About 17 per cent households have reported that female
members have ownership on land or on house or on livestock. This small magnitude of
ownership is inadequate to ascertain women's empowerment.
Substantial efforts have been made to reduce gender disparity in education through
special focused educational programmes since the Fifth Plan (1997-80). There still exists
a distinct gap between literacy rates of the two sexes. In 1971 male literacy was 23.59
per cent as against female literacy of only 3.91 per cent. After three decades, in 2001
male literacy has reached at 65.08 per cent as against 42.49 per cent female literacy.
The constitution of Nepal guarantees basic human rights to every citizen irrespective of
caste, class, sex, greed and colour. HMG/N is fully committed to adopt CEDAW and
ICPD, Programme of Action, 1994, Beijing Platform of Action, 1995 and the
16
Declaration and Programme of Action of the Word Summit for Social Development,
1995. By recognizing human rights of women as part of universal human rights, HMG/N
has initiated several measures for equal education, equal employment opportunities,
health services, and effective personal, political and property inheritance rights as the
initial interventions for the empowerment of women.
With a view to accelerating the gender equality and empowerment of women, some legal
provisions have been made in favour of women. In line with the constitution of Nepal,
the Local Self Governance Act (1999), the Civil Service (first amendment) Act 1998, the
Labour Act, 1991 and the Labour Regulations, 1993 and the Country Code (Eleventh
Amendments), 2002 are examples of government commitments in this direction. The
Ninth Plan of the country formulated triple objectives of gender mainstreaming,
eliminating gender inequality, and empowering women. The Agriculture Perspective
Plan has emphasized for the development and dissemination of women-friendly
technologies, encouragement to women’s groups in natural resource management,
agricultural inputs and extension services focused on the special needs of women, and
equal access to productive resources. The Ministry of Agriculture and Cooperatives
(MoAC) has prepared guidelines for gender-sensitive planning in local level agricultural
activities.
The Ministry of Education and Sports (MoES) has made mandatory for all primary
schools to have at least one female teacher. Many targeted programmes such as
alternative schooling, out-of-school programmes, incentives programme for girls and
disadvantaged children, and adult literacy promotion through formal and non-formal
education have been launched for women's education. Textbooks are being reviewed to
incorporate gender perspectives at all levels.
The Ministry of Labour and Transport Management (MoLTM) has been organizing
residential and mobile training programmes on women’s skill development with a view
to promote employment opportunities. The Ministry of Industries, Commerce and
Supplies (MoICS) has given priority on women's income generating activities through
the employable skills development process. The Ministry of Women, Children and
Social Welfare (MoWCSW) has introduced different schemes for socio-economic
upliftment of women including micro-credit schemes and Mahila Jagriti ( women’s
awareness) programmes. The Council for Technical Education and Vocational Training
(CTEVT) has been implementing technical education and vocational training for women.
Poor women have also been supported towards income generating activities through the
micro credit and other financial schemes. Likewise, many other governmental and nongovernmental organizations have been involved towards women's empowerment through
income generating activities and other socio-economic focused and prioratized
programmes.
17
Various interventions are being made for enhancing the health status of women through
family planning programmes, safe motherhood programme, prevention and management
of post-abortion complications, prevention of RTI, STD, HIV/AIDS prevention and
elderly care against reproductive cancers and nutrition programmes, under the umbrella
of reproductive health package. Similarly, abortion has been legalized in Nepal with full
caution that unsafe abortion is a major public health concern. Safe abortion has been
aimed to ensure women's ability for controlling their own fertility, to curb with sex
violence and to free from health hazards.
Nepal is committed towards women's upliftment. At the national level, three major plans
have been adopted; they are National Plan of Action (NPA) for the Implementation of
the Beijing Platform of Action, Second long-term Health Plan (1997-2017), and the
Tenth Plan (2002-2007) Approach Paper. The NPA sees women’s health in terms of life
cycle approach and aims at increasing their access to health services from womb to tomb.
Further, it is committed to provide basic health package to all citizens irrespective of
their ability to pay. Gender desegregated information system has also been initiated
through the Census 2001.
National Commission for Women has been newly established to provide guidance in
formulating gender-related policies and oversee and ensure effective implementation of
the programmes on gender equity, equality and women's empowerment. The Ministry of
Women, Children and Social Welfare in consultation with the National Commission for
Women and other relevant agencies is reviewing progressively on discriminatory laws
for gender equality and development. Similarly, many other proactive measures are also
being worked out to uplift the socio-economic status of the Nepalese women.
6. Ageing Population
In Nepal, the share of
Figure 9: Distribution of Population Aged 60 Years and
elderly persons (60
Over, Nepal, 1952/54 – 2001
years and above) was 5
1.6
1.48
per cent in 1952-54,
1.4
1.2
1.08
which increased to 5.8
1.0
0.86
per cent in 1991 and
0.8
0.65
0.49
0.6 0.41
6.5 per cent (1.48
0.4
million)
in
2001
0.2
0.0
.
(Figure 9). The elderly
1952/54
1961
1971
1981
1991
2001
population is estimated
to double by 2017. (Population in million)
Elderly
people
in
Nepal are found usually active and productive in their advancing years. They are
involved in childcare, cattle herding, handicrafts and simple farming activities. Elderly
18
females, in particular, mostly share responsibilities in household chores. However, heir
contribution and economic value have not been duly recognized.
The joint and extended family system is still extensive in Nepalese society. Whatever is
earned during the life of an elderly is spent already during his/her working days, and
hardly anything is left for transfer to the next generation. In Nepal, the property owned
by parents is generally transferred to their children on or before the death of parents.
Persons working in government services are entitled to receive pension and provident
fund upon their retirement. However, other non-government employees participating in
the formal sector in most of the cases are entitled to receive provident fund and gratuities
only.
Given the social structure of Nepalese society, the elderly have generally been able to
rely on the support of their children and the extended family to look after them. Older
persons, especially older women, are disproportionately represented amongst the poor,
with important implications on their nutritional status, medical care and physical well
being. Public health care services in Nepal are usually overcrowded, unevenly distributed
and over-strained due to shortage of funds for equipment, medicine and personnel, poor
maintenance of existing facilities and inadequate space. Unlike in most of the Asian
countries, Nepal has no health insurance coverage, either as a part of government social
security programme or private insurance policies.
In Nepal, ageing population has slowly started to exert pressure on the socio-economic
front. HMG/N is committed to support towards self-reliance, health care and socioeconomic security of the elderly people. HMG/N had initiated some policies and
programmes in this context during the Ninth Plan. The plan aimed at developing familybased security system to enable elderly to lead a life with dignity. Nepal has introduced
a national scheme of the monthly old age pension in 1994 that potentially provided direct
benefit to the elderly people. The scheme provides allowance at the rate of Rs. 1,200.00
per annum to helpless widow of over 60 years of age or aged people who have
completed 75 years.
A policy of collaboration among government and non-government organizations has
been adopted to enhance the socio-economic status of the elderly people and also to
eliminate any kind of violence and discrimination against them, with special attention to
the needs of the elderly women. The government runs one old age home for 215 familyousted and homeless elderly people. There are five other old age homes run by NGOs
with government support and 14 other homes run by welfare agencies. A total of 1,400
old aged persons have been benefited from such old age homes. Moreover, there are also
some day care centres for elderly persons, mostly in some urban centres of Nepal.
Moreover Rs. 1.7 million has been allocated during fiscal year 2002-3 to fifteen districts
for providing medical treatment to the elderly people. The poverty affected elderly
people are provided free medicine and treatment up to Rs. 2,000.00 at a time in a limited
19
area. However, these schemes have minimal coverage and government has no resources
to provide support and care for the elderly people who are in dire needs of assistance
from the public sector.
The Policy and Operational Strategy Towards Senior Citizens, 2001 is the key policy
document of the government towards elderly citizens of the country. It largely follows
the conventional welfare approach towards senior citizens and the government is trying
to incorporate older people's rights as their human rights. This policy has envisaged
incorporating economic benefit, social security, health service facilities and honor,
participation and involvement and education as well as entertainment aspects to support
the elderly people in having prestigious livelihood. Introducing different schemes will
materialize these operational policies. UNFPA has supported for the preparation of
country report as well as for participation of GO/NGO in Madrid for a policy strategy on
elderly. A clear strategic policy on elderly is yet to be formulated.
HMG/N is operationalizing different schemes to assist the elderly population by
providing economic support and medical care to specific target population such as: (a)
elderly people living alone, (b) disabled elderly, (c) others with specific health risk
including bed-ridden elderly. Geriatric ward in government hospital is to be set up at the
national level to provide treatment for the elderly. The existing hospitals in government
and private sectors at national and district levels will make arrangements for geriatric
wards. Medicines required for elderly on doctors’ prescription will be made available on
subsidized rates. Moreover, government will take every possible step for stopping
various types of violence against elderly. The elderly homes will be expanded further
through the partnership among the government and non-government sectors. Elderly
people will be encouraged to participate in the income generating activities based on
their skills, expertise and aptitudes. Necessary laws and regulations will be enacted to
make legal provisions conducive to the elderly people. Special provisions like, "Elderly
Citizen Counseling Services Centre" and "Social Security Fund" will be created for the
overall welfare of the elderly population. HMG/N is very keen to help the elderly people
by uplifting their socio-economic status. In this perspective, NGOs, CBOs, local bodies
and civil societies as well as private commercial organizations will be mobilized for
enhancing the self-reliance of the elderly people. This strategy has been clearly reflected
in the Tenth Plan Approach Paper and Poverty Reduction Strategy of the country.
7. Behavioral Change Communication and Advocacy and Information and
Communications Technology
Behavioral Change Communication (BCC) and Advocacy
In 1993, the National Health Education, Information and Communication Centre
(NHEICC) was established with a mandate to give high priority to communication in the
health sector, including family planning. The ICPD has broadened the scope of family
20
planning from primarily contraceptive method mix to include reproductive health. In line
with the ICPD Programme of Action, Beijing Declaration and Copenhagen World
Summit for Social Development Declaration, the Ministry of Health and The Ministry of
Population and Environment simultaneously developed the “The National RH/FP IEC
Strategy” (1997-2002) and “National Population Information, Education and
Communication Strategy” (1997-2001) respectively in 1997. These strategies have
recognized that effective information, education and communication for sustainable
human development and pave the way for attitudinal behavioral change.
Similarly, several other government and non-government organizations have been
carrying out various information, education and communication programmes to support
small family norm, girls' education, family planning and reproductive health
programmes. FPAN has developed its own Strategic Plan (2001-2005) focussed on
advocacy.
IEC materials developed and disseminated in Nepalese perspective consists of wide
range of communication channels. Education has been recognized as the prime factor for
behavioral change towards responsible reproductive behaviour and sustainable
development. Education is considered as the means, which links with demographic as
well as economic and social factors. For this purpose, both formal and informal
population education programmes are emphasized in Nepal. Tribhuvan University has
established a separate Central Department of Population Studies in 1988 with master's
degree programme leading to Ph.D. Similarly, population education has been
incorporated into school education since 1994. Informal population education
programme was initiated in 1981 through adult education. Afterwards non-formal
population education has been integrated into the skill development package of different
government and non-government organizations. Informal population education camps at
the village level have also been found effective to sensitize the rural mass on various
population issues (Box 2).
Box 2
Informal Population Education Camps
MOPE has initiated "Informal Population Education Camps" to educate the rural people on population
issues, who do not have easy access to the mass media. The camps are organized to disseminate
information on different dimensions of rural population by having informal and open interactions
among the targeted people concerning small family norms and better quality of life. These sorts of
camps are conducted conducted in close partnership with the local non-governmental organizations.
Ensuring greater women's participation in camps, population and RH-related issues are discussed by
using the posters specially designed for such camps.
21
The government has aimed to sensitize parliamentarians, decision-makers, media
representatives and intellectuals on population related issues. Advocacy is promoted
through consultative meetings, seminars, workshops, study tours, and web sites. Several
information kits and booklets are also distributed for IEC purposes. In addition,
substantial experience sharing visits, both internal and external, are conducted regularly.
HMG/N has pursued several channels of communication for promoting and
understanding the interrelationship between population and development. HMG/N's
sectoral policies emphasize on bringing behavioral changes in population and
development issues, specially in the areas of family welfare, reproductive health, gender
and socio-economic empowerment, especially of women.
Male involvement in responsible reproductive behaviour is an integral component of
BCC/IEC strategy. RH sub-components on family planning, safe motherhood,
prevention and control of HIV/AIDS all emphasize men’s role in promoting family
health and welfare.
Information and Communication Technology
The Ministry of Science and Technology has developed some programmes relating to
population and development issues. No specific attempts have been made so far with
regard to population issues through the private sector and NGOs based on ICT. This
demands for explicit policies and strategies related to ICT.
Keeping in view these issues, HMG/N is keen to bring about behavioral changes by
utilizing information and communication technology as the major tool for population and
development nexus. Information Technology Policy, 2000 and Technology Park are
recent initiatives to support the information technology accessible for population and
development purposes.
8. Data, Research and Training
Data
Reliable, timely and relevant demographic and health statistics have been considered
very essential to develop, implement, monitor and evaluate population and reproductive
health programmes of different government and nongovernment institutions. In Nepal,
various agencies have been involved in data collection and analysis, which include the
Ministry of Population and Environment, Ministry of Health, Central Bureau of
Statistics, Universities, NGOs and others.
Many gaps, however, remain with regard to quality and coverage of baseline information
concerning demographic and health statistics. They are enumerated as follows:
22

Collection and analysis of gender-desegregated data need to be strengthened in
order to increase status of women in social and demographic process.

Comprehensive and reliable data base need to be developed to examine linkages
between population, education, health, poverty, family well-being, environment
and development issues.

Timely and quality data need to generated in cost effective manner to meet the
millenium development goals, ICPD PoA and others.

Close coordination among various data collection agencies need to be
strengthened in order to avoid duplication and to minimize cost.

Research on both internal and international migration needs to be strengthened in
order to devise viable policy measures.

Data bank has to be geared down to ecological zones, development regions,
districts, villages and wards.

Vital registration system needs to be strengthened.

National level coordination mechanism has to be strengthened to integrate the
information collected by various agencies into a single system to optimize its use
and minimize errors.
Research
Findings of Research works are instrumental for the formulation of policy, monitoring
and evaluation of various population related programmes. Population and reproductive
health research works undertaken by government agencies are mainly carried out by the
Ministry of Population and Environment, Ministry of Health, Central Bureau of Statistics
and others. Central Department of Population Studies at Tribhuvan University has been
actively contributing to meet the research needs on migration, fertility, mortality,
employment and child labour. Centre for Economic Development and Administration of
Tribhuvan University has also been conducting research on population and environment,
mortality and the status of women. In addition, FPAN and many other NGOs such as
New Era, IIDS, CREHPA, VaRG etc. have also been working on reproductive health and
development related research. The following issues have been observed in Nepal for
undertaking research works on population and development.

Close coordination among research institutions need to be strengthened to avoid
duplication of research works.
23

Research on basic and applied biomedical, technological, clinical,
epidemiological, sexuality and gender roles will have to be carried out in
accordance with the national development strategies.

Wider dissemination of research findings needs to be encouraged for sharing
information and making use of research findings effectively.

Serious attention needs to be focused on the effective use of research
outcomes/recommendations for policy and programme development.

Socio-cultural and economic research needs to be built into population and
development programmes and strategies.

A national level information bank will have to be established to document
research findings carried out by various agencies.
Training
In the past, population training in Nepal was emphasized more on family planning
devices. In recent years, population training has been focussed on reproductive health,
gender equity, empowerment of women and integration of population into development
planning along with data collection, utilization and dissemination. In addition to
academic courses in population at the school and university level, several
formal/informal-training programmes in population have been initiated. Training
programmes on population and development are being undertaken by the Ministry of
Population and Environment, Ministry of Education and Sports, Central Department of
Population Studies at Tribhuvan University, Local Development Training Academy,
Department of Labour, Department of Cottage and Small Industries, Cooperative
Training Centre and Family Planning Association of Nepal and several NGOs, CBOs
and others.
Priority issues concerning population training in Nepal are the followings:

Assessment of population training programmes to ascertain its effectiveness.

Capability enhancement and usage of cost effective training approaches.

Extension of population training up to the local level.

Emphasis on participatory approach for training on population.

Involvement of more female participants.
HMG/N is keen to strengthen its data, research and training on population. Efforts will
be made to strengthen national data system on population and its networking to cater
different issues on population. Research works on population will be emphasized to fill
the research gaps and thereby conducting appropriate research to reinforce population
24
management programmes. Population training programmes will be made effective
through needs assessment and its extensions at the local levels.
9. Partnership and Resources
Partnership
In Nepal partnership between government and non-governmental sectors has emerged
very encourageingly in recent years. Government's direct role was considered
indispensable up to the 1980s. Increasing trend towards liberalization, globalization and
regionalization since 1990's have been the push factors to focus on more partnership
among government, donors and non-government agencies. The role of non-government,
community based organizations and private sectors' in population and development
activities are increasing in recent years. Non-governmental organizations are actively
involved in addressing pressing population, economic and social development concerns.
HMG/N has duly acknowledged the experiences, capabilities and expertise of nongovernment organizations in the field of reproductive health including family planning
services and women's empowerment.
International partnership has also been very supportive in Nepal's endeavour towards
integrating population into the development process. International cooperation has
proved beneficial both to the government and non-government agencies for the
implementation of population and development programmes. Mutual co-operations and
partnerships have been promoted in the areas of policy formulation, programme
development, monitoring and resource sharing.
It is clearly intended that the government have to play the facilitating role by creating
conducive environment for the non-government agencies to enhance their participatory
role. Greater participation of the civil society and non-governmental stakeholders are
being emphasized after the ICPD. The private sectors are also providing health care
services on a commercial basis.
Formation of the Non Government Organization Coordination Council (NGOCC) in
1994 representing the NGOs/INGOs has been a major breakthrough in developing
partnership. Representations of the non-government sectors in different government
forums and committees on population issues and vice versa have been encouraging. An
operational framework will have to be developed to promote the partnerships on a
sustainable basis.
Resources
In Nepal, resource constraint has been one of the major obstacles for accelerating
activities relating to population, poverty and development. Weak financial situation of
25
the country has been the prime cause for lesser allocation of resources for population
activities. Sufficient resources will be required to support health care and education
programmes and for improving the status of women. Nepal is in need of increasing
financial and technical support from the international community to urgently address the
problem of the most vulnerable group of poverty-stricken population, particularly in the
rural areas.
During fiscal year 2002/03, the government has earmarked about US $ 27 million for
reproductive health services, basic education, women's empowerment and other aspects
of population activities. This budget is about only 12 per cent of the total amount
allocated for social development. Of the total amount allocated for population activities,
84 per cent comes from the internal sources and 16 per cent from external sources.
FPAN will be spending US $ 2.1 million on family planning related programmes funded
most through donors. Likewise, there are several other non-government organizations
contributing financial resources to population activities. Most of the NGOs working on
population and development are excessively dependent on external sources. There is a
need for optimizing the mobilization and utilization of resources both internally and
externally. Current situation of the resource mobilization for population activities will be
improved through greater participation among all stakeholders at different levels. The
involvement of civil societies, CBOs and NGOs and local governments will be increased
through appropriate implementation strategies. Cost sharing approaches will be pursued
both in terms of human as well as financial resources.
HMG/N is aiming to promote partnerships among government, non-government
organizations, private sector, local communities and international community for
effectively utilizing the resources for population and development programme of the
country on a sustainable basis. Accountability, transparency and good governance will be
clearly emphasized in the process of shared responsibility for programme development
and implementation. To that end, government has recently brought foreign aid policy to
streamline donor coordination and focus on priority areas for sustainable development of
the country. Many donors like WHO, USAID, DFID, GTZ, UNAIDS, UNFPA, UNDP,
JICA and UNICEF are major contributors to population and reproductive health
programmes. They have shown strong support for implementing reproductive health
services in improving the quality of life.
10. Other Issues
Several crucial issues have affected socio-economic development of Nepal. There are
some other issues, which have exerted negative impact on the livelihood of Nepalese
people. Especially, poor people living in rural areas have been severely affected. Some of
the issues can be addressed as follows:
26
(i) Insurgency
Increased insurgency, especially over the last two years has disturbed the poor and the
weaker section of the society. Insurgency has led to the disruption in the delivery of
essential health services, education and other social services. Offices of the many of the
local governance bodies have been destroyed. It has also weakened the capacity of the
poor section of the society to seek for employment opportunities for their livelihood.
Curbing terrorism has been the over-riding concern in Nepal. It is hoped that Nepal will
soon succeed to overcome this crisis and resume the delivery of socio-economic services
to the poor and deprived people in a normal manner.
(ii) Essential Social Services
Quality of health care, education and other social services rendered has been a major
concern for accomplishing the development objectives of the country. Student population
has increased and the number of schools has been added but the diminishing the value of
quality education along with continuous drop out of students has been creating negative
effects on the over all quality of education in the country. Moreover, there exists a large
segment of poor people who can not yet afford to send their children to schools. Number
of health posts and health centres have been added, but the rural mass still lacks adequate
medicine and services of doctors and health workers. To overcome these shortcomings
and lapses, HMG/N is considering extended quality services to reach the targeted mass.
The issues discussed above are having crucial impact on poverty situation in the country.
HMG/N has aimed to achieve broad-based sustainable economic growth by best utilizing
the resources and means available in the country. HMG/N has initiated multidimensional strategies for bringing about qualitative reforms in the total development
process of Nepal.
(iii) Decentralization
Decentralization is being promoted in order to deliver the benefits of development
effectively especially in the rural communities. The Government commitment for
decentralization has been reflected in the local Self-Governance Act of 1999, which
seeks to delegate authority and responsibility to local bodies, empower local authorities
to collect taxes and develop plans and develop local administrative cadre.
Decentralization is an important mechanism for improving service delivery to local
communities and for enhancing effectiveness of public spending. Decentralization
process will be strengthened by (i) promoting transparency, accountability, and
responsiveness in the local institutions (ii) improving the technical capacity of local
bodies for identifying their needs, resource mobilization and planning, project and
27
programme preparation and implementation and accounting and expenditure reporting
(iii) clarifying the roles of both local bodies and line ministries.
Despite the importance attached to decentralization to promote accountability,
transparence and good governance and attain accelerated development, the capacity of
the local self-governance bodies is limited to plan, implement, supervise and monitor
development interventions. Insurgency and political instability are further weakening the
spirit of decentralization. Capacity of the local governance bodies needs to be further
strengthened to promote sustainable development at local level.
(iv) Environment
Though a number of efforts are made to maintain the biological and physiological
environment, however, a direct link between population and environment need to be
further strengthened. The policy documents of the government have not been able to
integrate population and environment concerns effectively. Much of initiatives on
environment ultimately have an impact on human health and the population at large. A
future strategy could therefore, be further enhancement in linking population, health and
environment issues more operationally.
IV. Future Strategies
HMG/N is committed to turn many of the ICPD recommendations into action. Nepal has
formulated and adjusted many national and sectoral polices following Programme of
Action of ICPD and recommendations adopted in other major international conferences.
Process has already been initiated to integrate population concerns into all aspects of
socio-economic plans and strategies of the country with a view to establish effective
interrelationships among population and development issues for achieving a better
livelihood, especially of poor people living in both urban and rural areas. All the efforts
of HMG/N are directed towards poverty reduction strategies in the context of sustainable
development. Several initiatives have been started at the central level and decentralized
process has also been emphasized to implement population programmes at the local
level. In addition to the government's initiatives, a conducive environment has been
crated to ensure greater participation of non-government organizations in the population
related programmes. It has been realized that additional financial resources will be
required from the public/private sectors, non-government organizations and the
international communities to implement the PoA of ICPD.
The establishment of the Ministry of Population and Environment (MoPE) in 1995 as the
umbrella organization in the field of population, development and environment is viewed
as the reflection of the strong government commitment to implement the
recommendations of ICPD and Bali Declaration. The Ministry is primarily responsible
for formulating population policies and programmes and monitoring and evaluating their
28
effective implementation. This Ministry in collaboration with the Ministry of Health,
Ministry of Women, Children and Social Welfare and Ministry of Education and Sports
is responsible for implementing the PoA recommended by the ICPD. It also functions as
the central coordinating agency to integrate population factors and gender concerns into
the development planning process. HMG/N has reconstituted the National Population
Committee composed of Ministers from various Ministries and chaired by the Right
Hon'ble Prime Minister to provide strong political leadership and guidance for
overseeing population and development activities in the country.
The Ministry of population and Environment is strongly committed to reinforce the
implementation of population and development activities in line with the
recommendations of ICDP. Under its leadership, the following strategies are put forth:

In consideration of the over all development goal of the country, a long term
population perspective plan will be developed and implemented for
integrating population issues into total planning process of the country in the
very near future.

Necessary intervention strategies will be worked out and implemented to
accomplish the immediate objectives of small and prosperous family by
ensuring qualitative essential health care services, education, gender equity
and social security systems.

Behavioral change communication process will be enhanced to intensify IEC
on population and development issues and advocacy for gender equity,
equality, women's empowerment and social security will be emphasized.

Population Pressure Index will be prepared to regulate and manage the
migration and urbanization process.

Participatory and partnership approach among governmental and nongovernmental organizations will be pursued for formulation, implementation
and coordination of the population and development policies and
programmes.

Decentralized procedure will be followed in the implementation of all
activities concerning population and development with special focus on
poverty reduction, reproductive health and other essential health care
services, basic education, enhancement of gender equity, equality and
women's empowerment, welfare to elderly citizens, behavioral change
communication and advocacy at the central, district and local level. Such a
29
process is expected to bring about a desired balance between population
dynamics and socio-economic development process in the country.

Cooperation from the international communities is very crucial for
strengthening national capacity including human resources development and
to cater to the essential needs to improve the quality of life of Nepalese
people.
30
Appendix I: Selected Population and Development Indicators, Nepal, 1991-2001
Indicators
Total area in Sq. Km.
Demographic Indicators
Population, 2001
Male
Female
Total
Annual population growth, 1991-2001
Urban Population
Rural Population
Total Population
Percentage urban
Population density (person per Sq. Km.)
Sex ratio (males/100 females)
Median age
Population distribution by broad age group (%)
0-14
15-59
60+
Dependency ratio
0-14
60+
Total
Percentage of Women aged 15-49 years to total female
population
Age at marriage
Median age at marriage
Male
Female
Socio-economic indicators
Economically active population (10+ years)
Male
Female
Total
GDP per capita (US $)
Growth of GDP (Per cent)
Literacy rate
Male
Female
Total
People living below poverty line (per cent)
Health indicators
Vital rates
Crude birth rate per 1,000 population
Crude death rate per 1,000 population
Total fertility rate
Fertility rate for urban
Fertility rate for rural
31
2001
147,181
11,563,921
11,587,502
23,151,423
2.25
3,227,879
19,923,544
23,151,423
13.9
157
99.8
20.1
39.36
54.14
6.5
72.69
12.00
84.69
49.24
22.9
19.5
71.7
55.3
63.4
236
4.6
65.1
42.5
53.7
38.0
33.1
9.6
4.1
2.1
4.4
Appendix I: Continued ………
Mortality
Life expectancy at birth (both sex)
Life expectancy at birth for male
Life expectancy at birth for female
Infant mortality rate
Under-5 mortality rate
Morbidity
Percentage of undernourished (stunted) children under 5years of age
Reproductive health indicators
Unmet need for family planning
For spacing
For limiting
Total unmet need
Family planning
CPR any method
CPR modern method
Sterilization
Female sterilization
Male sterilization
Injectable
Condom
Pills
others
Traditional method
Safe-motherhood
Percentage of mothers who received ANC from a health
professional
Percentage of women who received 2 + doses TT
vaccination
Percentage of delivery assistance from health professionals
Percentage of birth at health facility
Adolescent
Percentage adolescent who have begun childbearing
Percentage married among adolescent girls
HIV/AIDS
Percentage of women aged 15-49 years knowing at least
two ways of avoiding HIV
Male involvement in RH
Percentage of men family planning users among total
modern family planning users
Human Development Related Indices
HDI
GDI
GEM
HPI
32
2001
60.8
60.6
61.0
64.4
91.2
50.5
11.4
16.4
27.8
39.3
35.4
21.3
15
6.3
8.4
2.9
1.6
1.2
3.9
48.5
45
13
9.1
21.40
39.80
31.30
25.87
0.466
0.452
0.385
39.2
Appendix II: Targets of the Ninth Five Year Plan and Beyond
Status as
1996/97
Target
for
2001/02
74.7
61.5
118.0
102.3
3 Total fertility rate (per woman)
4.58
4.2
3.5
2.1
4 Average life expectancy at birth (in years)
56.1
59.7
62
68.7
5 Contraceptive prevalence rate (in %)
30.1
36.6
50
58.2
6 Delivery attended by trained personnel (in %)
31.5
50.0
55
95.0
7 Birth of infant below 2,500 gms. (in %)
-
23.0
12
8 Crude death rate (per 1,000 population)
11.5
9.6
6.0
9 Crude birth rate (per 1,000 population)
35.4
33.1
26.6
-
70.0
90.0
Population variables
1 Infant mortality rate (per 1,000)
2 Under-5 rate (per 1,000 live births)
10 Basic health services accessibility (% of people)
33
Target for
20 year
2006/07
target
(10th Plan) 1997-2017
45
34.4
62.5
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