This year marks the 30th year of International Conference on Population and Development 1994. Including ICPD, Nepal is committed to many conventions and protocols such as CEDAW, SDGs, Convention on Climate Change, etc, all of which affect people’s lives. The presentations that will be made by different subject matter authorities will be dealing in details with these commitments in relation to quality of life on Nepalese people. Given the time constraints, let me share with you the major achievements and concerns with respect to population and development in Nepal.
Today’s conference is entitled “National Conference on Population and Development” which suggests the interdependence between “population” and “development”. We are therefore concerned with how demographic variables such as population size, growth, distribution, migration – internal and international, age structure, etc affect the realization of development goals. On the other hand, it is also important to take into account how development policies and actions, influence population dynamics, directly or indirectly, positively or negatively. I will talk briefly about demography of Nepal but at the same time I will try to relate development efforts with demographic outcomes.
Pop growth
The rate of population growth is not a threat for Nepal anymore because the average annual growth rate has gone down drastically to 0.92 per cent per annum during the 2011-2021 decade.
However, annual population growth rates vary substantially among the 77 districts in the country. The number of districts with negative growth rates was 27 in 2011 and this increased to 34 districts in 2021 except that Mustang and Rasuwa which had negative growth in 2011 are now seen having positive growth in 2021. All these depopulated districts belong to the high mountain and hill districts.
During the last decade, the Mountain region experienced negative growth rate (-0.05%), the hill region very low growth rate (0.30%) while the Tarai showed very high growth rate of 1.54% per annum. Concentration of population in the Tarai has drastically used up farm land. Until the 1980s the Tarai was known as the bread-basket of the country but now the country depends on import of rice although still 62% of all households are involved in farming.
Pop size
The 2021 total population of 29.2 million will still be growing in absolute number until about mid 2050s reaching about 36 million and after that it will begin decelerating. Province wise projections show that all seven provinces will be growing in absolute terms until 2041 but thereafter the growth will decelerate at different times. Bagmati will achieve “0” growth earliest in 2041 (6.63 million) while Gandaki (2.99 million), Koshi (5.79 million) and Lumbini (6.03 million) provinces will achieve “0” growth in 2046; and Sudurpaschim (3.54 million) in 2051 and Karnali (2.8 million) and Madhes (9.09 million) only after 2061.
Factors responsible for population change
The recently observed low growth rate is primarily due to declining fertility and mortality and increasing out-migration in recent years. The total fertility rate has declined to 2.1 in 2022 attaining the replacement level of fertility.
Over the years the chance for survival has also improved – infant and child mortality have improved. Couples do not need to have many births to compensate for high infant and child mortality and as a result fertility aspiration has declined. Improving mortality has contributed to increasing life expectancy at birth in Nepal which has reached about 70 years in 2021 but this may be different if 2021 census data is used.
The demographic dividend
The demographic transition – shift from a relatively high fertility and mortality to a relatively low fertility and mortality, results in a change of the age structure of a population. These changes are seen in the population pyramids. The middle section of the pyramid of the current population of Nepal is broad which has two potential consequences. First, even if a rapid fertility decline occurs in the near future, there will still be a large number of births because of a high number of potential parents entering the age of childbearing. The population of Nepal will thus continue to grow in size, as I mentioned earlier. Second, as the working-age population increases at a faster rate than the total population, a change favourable to demographic development takes place. This is widely referred to as the “demographic window of opportunity”. This situation gives rise to the potential for a demographic dividend.
In Nepal, the demographic dividend for the total population began in 1996 and is likely to close in 2048. By gender, male demographic dividend began in 1997 and is likely to end in 2054 while the female demographic dividend commenced in 1995 and is predicted to end in 2044.
Nepal can reap this demographic dividend provided sufficient investment is made in health and education and employment opportunities are created.
Ageing
Population ageing is taking place rapidly. According to the population census of 1991, the proportion of population aged 60 and over was 5.8% and it grew to 6.5% by 2001, further to 8.1% by 2011 and the last census showed 10.2% aged 60 and over. The size of population aged 60 and over was 2.98 million in 2021 and majority (52%) of older persons are women. There are many negative perceptions about old age population in Nepal. We need to change our mindset and consider the opportunities this presents, while addressing the emerging needs for older people.
Absentee population
The size of absentee population is increasing rapidly in Nepal. The absentee population has increased from 2.7% in 1981 to 7.3% (1.92 million) in 2011 and further to 7.5% (2.19 million) in 2021. The 2021 census data shows increasing number of women leaving the country. Of the total absentee population, the proportion females were 12.4% in 2011 while it increased to 17.8% in 2021.
Contraception
Contraceptive prevalence rate has phenomenally increased from a mere 3% in 1976 to 31.5% in 1996 and by 2022 it further increased to 57%.
The NPC SDG target is for 74% of all women to have a met need for FP satisfied with modern methods by 2022 and 80% by 2030 and in Nairobi Conference in 2019, the Government of Nepal made commitment to bring down unmet need for family planning to “0”. However, 2022 data shows that the total demand for family planning that is satisfied is 55% by modern methods, that means the 2022 target is behind by 19% and among the currently married women the unmet need for FP was 21% in 2022 which is unlikely to be “0” by 2030. The data indicate that the Government has to strive hard to meet the targets set and commitment made in Nairobi.
The FP programme in Nepal is increasingly facing challenges. The main challenge is how to increase the users of modern methods of family planning because CPR of modern methods has remained constant at about 43% since 2006 while the use of traditional methods (periodic abstinence/ rhythm, withdrawal and other) has increased from 3.9% in 2001 to 15% by 2022 and of these traditional methods, withdrawal accounts for 90% and withdrawal is only 78 percent effective.
CPR of modern methods varies a great deal among the 7 provinces. Interestingly, the NDHS data of 2006, 2011, 2016 and 2022 consistently show the use of modern contraceptive methods much higher among women with no education compared to their educated counterparts. More research is needed to understand this phenomenon.
Gender
Nepal has made noteworthy progress in politics and legislation in terms of shifting norms in favour of female gender. This has been adhered to by the political parties.
In Nairobi in 2019, Nepal Government committed to ending violence against women and children. However, societal values and behaviour to females has not changed much. The proportion of women affected by physical violence has rather increased in the recent past. In 2016, 22% women aged 15-49 experienced physical violence since age 15 and this increased to 23% in 2022. Nepal, therefore, still needs legislative measures that can substantially reduce damaging sexual and gender norms. I am sure today’s presentation on gender and development will deal with in more details about these issues.
Harmful practices
The Government of Nepal is committed to ending, by 2030, harmful practices such as early marriage, forced marriage, chhaupadi, dowry, gender-biased sex selection and discriminatory practices related to religious rituals that affect women and adolescent girls seriously. Excluded, marginalized and poor communities are disproportionately impacted by these harmful practices.
Programmes need to be designed to address the harmful practices affecting SRH, gender and adolescent and youth wellbeing. The health system should provide quality family planning, expand adolescent-friendly health and other services, reduce unmet need for family planning, increase access to SBA and good maternal care, and promote child health. This in turn will help children grow healthy, join school and postpone marriage until they are old enough. Healthy mothers bring up healthy children.
In view of the bulge of adolescents in the total population there is an urgent need to provide proper and targeted CSE to students of grades 6-10 which in turn will contribute to late sexual initiation, late marriage, low school drop out in case of school students, enhanced negotiating skills and self-confidence. However, laws and policies need to be put in place to curb violence and eliminate discriminatory practices. All these put together can help the nation reap the benefit of demographic dividend.
Climate and population dynamics
Young geology, high mountains and difficult terrain are prone to natural disasters. Major types of natural disasters in Nepal include earthquakes and floods but fire, droughts, landslides, cold wave, avalanches, rainstorms, hailstorms have also occurred. Over 80 per cent of Nepal’s population is exposed to at least one of these hazards, with the poorest and most marginalized populations at greatest risk of being directly impacted by climate change.
Research on SRH and climate change is still nascent, but a growing body of evidence shows that climate change has direct negative impacts on maternal, newborn and child health, while climate-related disasters strain the capacity of health systems and hinder access to essential and lifesaving SRH services.
Nepal, from the first year of the 14th Development Plan (2016/17-2018/19), has begun implementing the 2015 Paris Agreement on Climate Change. Nepal needs to streamline Disaster Risk Reduction, Climate Change Adaptation, Gender and Social Inclusion issues in development planning, budgeting, implementation, monitoring and evaluation in an integrated way. The paper on climate and demographic dynamics will, I am sure, enlighten us on these issues.
Urbanization
Urbanization in Nepal was slow and steady until 2011 as the percentage of urban population increased from 9% in 1991 to 14% in 2001 and further to 17% by 2011. However, in 2014, the Government demarcated local politico-administrative units into 753 palika of which 293 were made urban municipalities and 460 as rural municipalities. Reallocating the population of 2011 census according to the new structure resulted in high proportion of population living in urban areas at 63.2%. Using the same criteria, the 2021 population census shows 66.2% urban. This whopping rise of urban population is unbelievable which is primarily due to reorganization of rural areas as urban areas. Experts on urbanization in Nepal had predicted that by 2026 only about 27% of the total population would be urban. In China, urbanization was steady and believable. For instance, the urban population grew from 11% in 1949 to 20% in 1981 and it took another 12 years for the urban population to reach 28%. The process of urbanization is defined in different ways in different countries but basically urbanization is the transformation process of the rural agricultural population who migrate to cities and towns and become an urban non-agricultural population. The government of Nepal is advised to review the criteria for urban areas.
Data and statistics
The republican system of governance demands for more and better data. Good governance requires data and evidence-based analysis rather than just assumptions. The National Statistics Office, only recently known as CBS, is responsible for the data ecosystem in Nepal. However, it needs capacity strengthening, including administrative data systems, especially at the lower levels of governance. All three tiers of the federal government need to be strengthened for data collection, processing, analysis and generation of indicators for inclusive planning and tracking of SDGs, ICPD and several other development targets.
International commitments
Nepal has shown strong leadership and commitment towards the implementation of ICPD PoA and SDGs, with most of the global and regional commitments localized in national policy and legislative frameworks. The SDG target 5.6 commits member states to ensure universal access to sexual and reproductive health and reproductive rights by 2030. The MOHP reiterates Rights to Health, Universal Health Coverage, Quality of Care, Midwifery Education and Free Health Care Program. The Constitution of Nepal 2015 enshrines safe motherhood and reproductive health rights, equity and inclusiveness.
Nepal is committed to “leaving no one behind” and “reaching the unreached” to accelerate the progress of increasing the number of additional users of family planning. With a special focus on meeting the family planning needs of adolescents and youth, Nepal will strive to increase the method mix with suitable FP methods of their choices.
Although the government of Nepal has committed to increase budget for the Ministry of Health and Population particularly RH services, the data do not support this. The Ministry of Health’s budget is too small to meet its needs. Low budget also affects programmes focusing on SRHR including FP.
In order to formulate policies and programmes to promote FP more effectively, comprehensive and nationally representative research studies need to be carried out to respond to the puzzles existing in FP and fertility inter-relationships. The research findings will certainly guide in designing effective FP programmes.
Quality population
Although population growth is not a problem anymore producing quality population is equally challenging. Therefore, the Government of Nepal should give equally high priority to population and development activities to develop quality population just as it gave high importance to reduce high growth of population in the past. Quality population is the bench mark for social justice and economic prosperity.
(Edited part of the working paper presented by former member of the National Planning Commission and demographer Dr. Karki at the National Conference on Population and Development 2080 organized by the Ministry of Health and Population and UNFPA)
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