This article discusses ways to empower women in rural Nepal. Nepal needs to plan for the expected doubling of its population in the next 28 years. It is important that priorities be established in national development strategies. Nongovernmental organizations (NGOs) and the private sector will also play a role in development. Nepal is a multiethnic society with about 42% of its population living in poverty. About 42% are aged under 15 years. A major task of development is to engender a sense of hopefulness for young people, despite a deteriorating social situation. The government, the private sector, and NGOs must all act in a socially responsible manner by creating job opportunities and building infrastructure. Development should not concentrate on projects alone and should contribute to an equitable and just society, distributive justice, and sustainability. Economic growth is a lesser concern. Activism and intuition are necessary subjective approaches outside the realm of objective academic research. It is important to retain women's knowledge base of indigenous ways of doing things. Women are participating in NGOs in a variety of capacities. Although women's NGO participation may build important bridges of cooperation, their work remains invisible. NGOs are key players in exposing poor people's agenda in international forums. NGOs work with different ideologies and without political bases, which must be surmounted in building cooperation with the private sector. Elites must act responsibly to expose patriarchy and gender insubordination. Development interventions must be based on gender, economic, and social class relations.
This article synthesizes the Program of Action of the 1994 Cairo International Conference on Population and Development and identifies Nepal's programs in reproductive health. Nepal has family planning (FP), child survival, nutrition, and maternal health programs. New programs include the Safe Motherhood and Sexually Transmitted Diseases (STDs) (including AIDS) programs. These health programs are operated by several nongovernmental organizations (NGOs), such as the Family Planning Association of Nepal and the Nepal Red Cross Society. Most sexual and reproductive health care has a core of FP. Program expansion should include gender sensitive education and counseling on sexuality; pregnancy, delivery, and postpartum care; infant development and growth monitoring, especially among girl children; prevention and treatment of STDs and infertility; and prevention and management of unsafe abortion and provision of safe terminal pregnancy processes. FP becomes more acceptable when services are holistic and comprehensive throughout the life cycle and serve multiple health needs. A 1996 survey suggests that the number of modern FP acceptors would increase, if affordable services and information were available. Quality of care requires knowledgeable, skilled providers and trusting, health-seeking clients. Provider improvements are especially needed. Nepal has one of the highest maternal mortality rates in the world. It will take the concerted effort of government, NGOs, and the private sector to expand services, mobilize the community, and educate about health and reproduction.
This article discusses demand and unmet need for family planning (FP) in Nepal. In developing countries, unmet need for contraception is an estimated 1 in 5 married women of reproductive age. If needs were met, fertility would decline by an average of 18%. FP is needed by all men and women of reproductive ages who desire a stop to, or a spacing of, childbearing. FP programs usually focus only on married couples. Unmet need refers to the difference between an expressed fertility preference and actual lack of contraceptive use. The current unmet need for FP in Nepal, among currently married women aged 15-49 years, was 27.7% in 1991, and 31.4% in 1996. 22.7% in 1991, and 28.5% in 1996, had met the need for FP for spacing or limiting purposes. 21.5% in 1991, and 25.9% in 1996, had met the need for limiting childbearing. The total demand for spacing or limiting was estimated at 50.5% in 1991, and 59.9% in 1996. Unmet need during 1991-96 increased by 0.74%. Met need during 1991-96 increased by 1.16%. The total demand for FP increased by over 9 percentage points. Unmet need for limiting increases linearly with parity and increases in a U-shaped pattern with age. Unmet need varies inversely with education. Unmet need is attributed to weakly held fertility preferences, perception of low risk of conception, lack of contraceptive information, unacceptability of contraception, opposition from husband to contraceptive use or perceived costs, fear of side effects, and inadequate FP services. The importance of these factors may vary between settings.
This article features a discussion of Nepal's population dynamics and several major demographic issues for the future. The fertility rate in Nepal has declined, but insufficiently. There is a need to increase the contraceptive prevalence rate (CPR) from 29% to 40% over the next decade. CPR may be increased by improving functional literacy, increasing the length of schooling, awareness creation among subgroups, and improvement in the socioeconomic status of the population. Nepal has uncontrolled migration. There is a need to define appropriate international and internal migration policies and to improve regional development. There is also the need for nutrition programs targeted to malnourished children and pregnant mothers. Nepal is a country with a high birthrate of 37.5/1000, a declining death rate of 13.8/1000, high infant mortality of 97.5/1000 live births, high child mortality of 165/1000, and high total fertility of 5.5 children/woman. 42.7% of population are aged under 15 years. In 1991, the population growth rate was the highest in the terai region at 2.8%. Migration has increased population in the terai. The share of population in the hill and mountain regions has increased. The sex ratio of population was favorable to females in 1991. The sex ratio among persons aged 0-14 years and among those aged 45-60 and over favored males. The young and old populations continue to grow. The mean age of population was 18.8 years in 1991. The share of urban population was about 9.2% in 1991, but it is growing. Migration pressure arises at the destination due to social and political conflict, population pressure, land issues, and lack of social services.
This article discusses the future need to balance population growth with the food supply in Nepal. Current efforts to meet food needs are hampered by steadily deteriorating environmental conditions. Nepal is both an agricultural country and a food exporting country. The recent declines in food production make it a low-income, food deficit country. In 1994-95, there were 16 districts in the mountains, 33 districts in the hills, and 6 districts in the terai that had food deficits. 73.3% of the 75 districts had food deficits in 1994-95. Deficits are caused by low production and high growth of population in food growing districts. Population may reach 23.3 million persons by the year 2000. As population pressure increases, all potentially cultivable land may be brought under cultivation, including forested areas. Soil degradation and other environmental deficits in the natural resource base will be further exacerbated. In addition to stress on the natural resource base and population growth, an additional problem is malnutrition caused by insufficient food consumption. The most vulnerable groups affected by malnutrition and undernourishment are preschool children and pregnant or lactating women. The challenge is to increase food production without diminishing the available resources. By 2011, Nepal will need 5.6 tons of food, or an increase of 66% in food production. 3.3 million tons were produced in 1994-95. The old development strategies have not worked. New ones are needed that include multilevel planning. Integrated regional planning is included in the new 9th 5-Year Plan to increase food production and reduce population growth.
