nepal population report 2011
Nepal Population Report
2011
Nepal Population Report 2011
Published by:
Government of Nepal
Minstry of Health and Population
Population Division
Ramshahpath, Kathmandu, Nepal
Tel No.: 01- 4262987
600 pcs
Website: www.mohp.gov.np/population
Government of Nepal
Ministry of Health and Population
Population Division
Ramshahpath, Kathmandu, Nepal
Nepal Population Report 2011 - 1
Printed by:
Saugat Printing Press
Anamnagar, Kathmandu.
Phone: 4233474
2 - Nepal Population Report 2011
Preface
Acronyms
This report is an analytic version of the demographic situation, structures; trends related with socio-economic and cultural aspects and are prepared on the information based on population census 2001 and other related surveys, reports, plan/policies and estimations of population and reproductive health.
On behalf of the Ministry of Health and Population, I would like to thank
Centre for Social Sciences Studies (COSSS) for undertaking the status review task and preparing this report. Likewise, I would like to thank all those individuals and organizations who extended their support and provided us relevant information. I would also like to thank my colleagues of Population
Division.
I hope this report will be of great value to researchers, policy makers, students, teachers, various institutions and the public at large.
Padam Raj Bhatta
Chief
Population Division
Nepal Population Report 2011 - 3
ARI
ASDR
AIDS
ASFR
BCC
CDPS/TU
-
CBOs
CBS
CDR
CMR
CPR
CTEVT
DOHS
FPAN
GDP
GOs
HIV
ICPD
IDU
IMR
IEC
INGO
IDU
LLPM
MMR
MoHP
NDHS
NFFS
NFHS
NGO
NHEICC
-
NPC
POA
PPP
PRSP
PHC
RH
STD
TBA
TFR
The high rate of population growth in Nepal has affected both social and economic aspect of Nepalese people in general. Excessive population growth has caused increased pressure on limited resources available in the country.
This Nepal Population Report presents a status review of the population and its dimensions in Nepal. The report also includes the population policies and programmes that are implemented by different government and other agencies in Nepal.
-
Acute Respiratory Tract Infection
Age Specific Death Rate
Acquired Immune Deficiency Syndrome
Age Specific Fertility Rate
Behavioral Change Communication
Central Department for Population Studies, Tribhuvan
University
Community Based Organizations
Central Bureau of Statistics
Crude Death Rate
Child Mortality Rate
Contraceptive Prevalence Rate
Council for Technical Educational and Vocational Training
Department of Health Services
Family Planning Association of Nepal
Gross Domestic Product
Government Organization
Human Immune Deficiency Virus
International Conference on Population and Development
Injecting Drug User
Infant Mortality Rate
Information, Education and Communication
International Non Governmental Organization
Injecting Drug Users
Local Level Population Management
Maternal Mortality Ratio
Ministry of Health and Population
Nepal Demographic and Health Survey
Nepal Fertility and Family Planning Survey
Nepal Fertility, Family Planning and Health Status Survey
Non Governmental Organization
National Health Education, Information and Communication
Centre
National Planning commission
Programme of Action
Population Perspective Plan
Poverty Reduction Strategies Paper
Primary Health Centre
Reproductive Health
Sexually Transmitted Diseases
Traditional Births Attendant
Total Fertility Rate
4 - Nepal Population Report 2011
Table of Contents
Chapter 1
Demographic Situation
1
Chapter 2
Fertility and its Proximate Determinants
19
Chapter 3
Mortality
34
Chapter 4
Migration
43
Chapter 5
Urbanization
49
Chapter 6
Education, Language, Religion and Ethnicity
54
Chapter 7
National Health Policies and Programs
62
Chapter 8
Women Empowerment
86
Chapter 9
Ageing
91
Chapter 10
Economically Active Population
102
Chapter 11
Sources of Demographic Data
109
Chapter 12
Population Policies and Programmes
115
Chapter 13
International Conferences
132
Chapter 14
Millennium Development Goals
138
Chapter 15
Poverty in Nepal
143
Chapter 16
Population Projections for Nepal 2001 – 2021
154
Chapter 17
Social Exclusion, Population and Conflict
160
Nepal Population Report 2011 - 5
6 - Nepal Population Report 2011
Chapter 1
Demographic Situation
These population growth figures for the world as a whole suggest that the rate of growth of population was quite low during earlier years when fertility and mortality were quite high. The growth rate slowly started to increase as mortality started to decline.
1.1 What is Population?
Years to Add Each Billion to
World Population
The word “Population” usually denotes all the inhabitants of a specified geographical area at a given time. This is concerned with its size, its structure and characteristics, its distribution and the changes taking places due to the interaction of fertility, mortality and migration.
The study of human population can be encompassed into two types of demography: formal demography and Population studies. Donald Bogue, in his book entitled
“Principles of Demography” defines “demography as the statistical and mathematical study of the size, composition and spatial distribution of human population, and of changes over time in these aspects through the operation of the five processes of fertility, mortality, marriage, migration and social mobility. Although it maintains a continuous description and comparative analysis of trends, in each of these process and their net result, its long run goal is to develop a body of theory to explain the events that it charts and compares(1969).However, population studies is concerned with population compositions and changes from substantive viewpoints anchored in another discipline. By definition, population studies are interdisciplinary, bordering between formal demography and a substantive discipline that is often, but not necessarily, a social science.
1.2 Population Situation of the world and SAARC region
It is important to study the history of world’s population growth rate to find out how the growth of population varies in different parts of the world. The world's population was estimated at about 300 million in the year A.D. 1, which increased to about 500-800 million by 1750 A.D. The average annual growth rate of population during the period 1 A.D. to 1750 A.D was around 0.56 per
1000 per year, while the growth rate for the period 1750 to 1800 was th estimated around 4.4 per 1000 per year. In the beginning of the 19 century world population was estimated to be around one billion. By 1850 the population has already increased by 300 million i.e. world population in 1850 was estimated to be 1.3 billion. By 1920 the population reached 2 billion, which was estimated to be 3 billion by 1960 (Coale 1974). The next billion in world’s population was added by 1975. World reached a population of 5 billion in 1987. It was estimated that the population of the world reached six billion in October 12, 1999.
Table 1. 1: World Population (in Millions)
Year
Population
1750
791
1800
978
1850
1262
1900
1650
1950
2521
1999
5978
Source : PRB datasheet 2010.
Nepal Population Report 2011 - 1
First
(1800)
All of Human History
Second
130 years (1930)
Third
30 years (1960)
Fourth
14 years (1974)
Fifth
13 years (1987)
Sixth
12 years (1999)
Seventh
12 years (2011)
Eighth
13 years (2024)
Sources: UN Population Division and Population Reference Bureau.
© 2010 Population Reference Bureau. All rights reserved. www.prb.org
Figure 1. 1:Years to Add Each Billion to World Population
At some point around 1800, after untold millennia of human history, global population reached its first billion. The world’s population now grows by 1 billion about every 12 years. The 20th century began with 1.6 billion and, at the end of that century; those two numbers had simply reversed to 6.1 billion.
If birth rates continue to decline in developing countries, the increase to 8 billion could take slightly longer (PRB 2010). It is estimated that world population has reached 7 billion in 2011.
Table 1. 2: Selected Demographic Indicators of World,2010
Indicators
Midyear Population
(million) 2010
Rate of Natural
Increase
Projected Population
(million) 2025
Projected Population
(millions) 2050
Crude Birth Rate
Crude Death Rate
2050 Population as a multiple of 2010
Urban Population
(percent)
Infant Mortality Rate
World
Less
Developed
Regions
5656
Least
Developed
Asia
Nepal
6892
More
Developed
Regions
1237
857
4157
28
1.2
0.2
1.4
2.3
1.2
1.9
8108
1290
6819
1172
4845
35.7
9485
1326
8159
1710
5424
46.1
20
8
1.4
11
10
1.1
22
8
1.4
35
12
2
19
7
1.3
28
8
1.6
50
75
44
27
43
17
46
6
50
81
41
48
2 - Nepal Population Report 2011
Life
Expectancy
at birth Male
Female
Total
Total Fertility Rate
Population under Age
15 Years (%)
Population Aged 65 years above (%)
Contraceptive
Prevalence Rate
Any method
Modern Method
Population with
HIV/AIDS among the population aged 1559 years (%)
Male
Female
67
74
66
55
69
64
71
69
2.5
27
81
77
1.7
17
68
67
2.7
30
57
56
4.5
41
74
72
2.2
26
65
64
3
37
8
16
6
3
7
4
USA
Indonesia
Brazil
Pakistan
Bangladesh
Nigeria
Russia
Japan
310
235
193
185
164
158
142
127
USA
Pakistan
Nigeria
Indonesia
Bangladesh
Brazil
Ethiopia
Congo, Dem. Rep.
423
335
326
309
222
215
174
166
Source : PRB datasheet 2010
62
55
71
60
60
54
29
23
66
60
48
44
0.8
0.7
0.9
1.9
0.3
0.7
0.9
0.3
1.1
2.7
0.2
0.3
Population Density
(per sq. miles)
51
23
68
41
130
191
GNP Per capita (2008 in US$)
Mobile Phone
Subscribers per 100
Inhabitants
10030
32370
5150
1240
6000
1120
60
109
49
21
49
15
Table 1. 4: Selected Demographic Indicators of the SAARC regions, ,2010I
Source : PRB datasheet 2010.
By 1950, nearly one third of the world's population lived in the developed countries, but this proportion is declining over the years as the growth rate of population in less developed countries are substantially higher than that in developed one. The average growth rate of the world population has been estimated at 1.2 percent per annum. In the less developed regions this rate is around 1.5 percent while it is much lower in more developed regions. It has been projected that the world’s population will reach 9.5 billion by 2050.
Some demographic indicators of the world have been presented in Table 1.2
Table 1.3 shows the most populous ten countries in the world in the year
2010 and projected for 2050. India will be most populous country in 2050. In
2050, three countries from SAARC will reached at most ten populous countries. Table 1. 3: Ten most populous countries in the world
Country
China
India
The following Table shows the comparative demographic situation in the
SAARC region. India is the most populous country followed by Pakistan. Total fertility rate is highest in Afghanistan and other demographic indicators also show the worse situation in the country.
2010
Population (million) Country
1338
India
1189
China
2050
Population (million)
1748
1437
Nepal Population Report 2011 - 3
Indicators
Mid year
Population
(million) 2010
Projected
Population
(million) 2025
Crude Birth
Rate
Crude Death
Rate
Urban
Population
(percent)
Infant Mortality
Rate
Life
Male
Expect Female ancy at Total birth Total Fertility
Rate
Population under
Age 15 Years (%)
Contraceptive
Prevalence Rate
Any method
Modern Method
Srilanka India Pakistan Afgha nistan 20.7 1188.8 184.8
29.1
23.2
1444.5 246.3
Bhutan
0.7
Bangl Maldiv adesh es
164.4
0.3
Ne pal 28
39.4
0.9
195
0.4
35.
7
19
19
30
39
25
39
22
28
7
6
7
18
8
18
3
8
15
29
35
22
32
25
35
17
15
53
64
155
40
45
12
48
72
76
74
63
65
64
66
67
66
44
44
44
67
68
68
65
67
66
72
74
73
64
65
64
2.4
2.6
4.
5.7
3.1
2.4
2.5
3.0
26
32
38
44
31
32
30
37
68
53
56
49
30
22
19
16
31
31
56
48
35
27
48
44
Source : PRB datasheet 2010
4 - Nepal Population Report 2011
Population Clock, 2010
Table 1.5 describes the current population change with the form of population clock. Implicit in the classical demographic transition theory is the concept of modernization and development, which brings about changes in mortality and fertility. Initially decline in mortality takes place and fertility decline is the response to this decline in mortality. Timing of fertility response depends on the levels of development and modernization in the countries concerned.
Table 1. 5: Population Clock 2010
WORL D
6,892,319,000
Population
Births per
Year
Day
Minute
More Developed
Countries
1,236,646,000
Less Developed
Countries
5,655,673,000
140,184,169
384,066
267
14,215,211
38,946
27
125,968,959
345,120
240
56,907,606
155,911
108
12,125,055
33,219
23
44,782,552
122,692
85
83,276,563
228,155
158
2,090,156
5,726
4
81,186,407
222,429
154
6,383,531
17,489
12
80,133
220
0.2
6,303,398
17,270
12
Deaths per
Year
Day
Minute
Natural increase (birthsdeaths) per
Year
Day
Minute
Infant deaths per
Year
Day
Minute
However, this explanation of fertility and mortality decline was challenged by new information obtained from the European Fertility Project, which found no evidences of association between socio-economic development and demographic change (Knodel and van de Walle (1979). Caldwell provided further critique to demographic transition theory by stressing the importance of western values regarding nuclear families. In another words, western values were more important than the level of development (Caldwell1976).
Caldwell’s argument has also been challenged by different studies, which have cited the presence of nuclear families before the demographic transition
(Smith 1982). In a similar manner, although there has been a remarkable decline in fertility in Taiwan, extended family system is still in place thereby indicating that nuclear family (westernization) is not the prerequisite for fertility decline (Sun et. al.1978).
Stage 1
Stage 2
Stage 4
Birth rate
Natural
increase
1.3 Demographic Transition
Demographic transition is a description of the observed long-term trends in fertility and mortality and a model, which attempts to explain them. Demeny
(1972) has summarized it very succinctly “In traditional societies both the fertility and mortality are high and in modern society both the fertility and mortality is low. In between, there is a demographic transition”.
Death rate
First proponents of demographic transition theory were Thompson (1929),
Davis (1945) and Notestein (1945). Three basic elements of the transition can be obtained from their writings;
a) It describes the changes that have taken place in fertility and mortality over time.
b) It attempts to construct theoretical causal models to explain the changes that have taken place.
c)
Stage 3
Prediction for the changes, which might occur especially in the developing countries in the light of the experience of the developed countries. Nepal Population Report 2011 - 5
Time
Figure 1. 2: Demographic Transition Model
Although there is still some controversy over the demographic transition theory, it is still an important theory commonly discussed to explain the demographic changes, which are taking place around the world. Basically it can be described in four stages (Fig 1.2). The first stage of demographic change is the time when both the fertility and mortality fluctuate and are quite high. This is the period when the natural growth rate of population is quite low.
6 - Nepal Population Report 2011
The second stage of transition is when the mortality starts to decline while fertility remains more or less constant. This is the period when the growth rate starts to increase and reaches the maximum just before the decline in fertility starts to take place. At the third stage, fertility also starts to decline as a response to declining mortality. Finally the fourth stage is when fertility and mortality are quite close and fertility is close to replacement and fluctuates according to different environmental conditions.
As we will see later, mortality in Nepal started to decline since the late fifties and the pace of mortality decline has become faster since the 1990s. If one looks at the fertility transition in Nepal one would find that fertility started to decline much later and at much slower speed than mortality. For example, fertility in Nepal was more or less constant till early eighties and started to decline thereafter. Thus it can be argued that Nepal is in the third phase of demographic transition where both the fertility and mortality are declining.
1.4 Size and Growth Rate of Population of Nepal.
Geographically Nepal is situated between China and India. These two neighbours are the most populous countries in the world with both having more than one billion people. Nepal’s population of 28 million (projected for
2010) is very small compared to its neighbours. Although the size of the
Nepalese population compared to its neighbours is quite small, its high rate of population growth has been a matter of great concern for the country.
Census operation started in Nepal since 1911. Initial censuses till 1952 were more or less head count based on household level information. The first census of Nepal (1911) yielded a population size of 5.6 million. Since then, census count has been conducted more or less at ten-year intervals. In the census of 1952/54, technical assistance in conducting the census was obtained from United Nations and in fact this census can be regarded as the first scientific census ever conducted in Nepal. Because of different reasons, this census was carried out at two points in time. For example, eastern part of the country was enumerated in 1952, while the western half was enumerated in 1954. Because the enumeration was carried out in two points in time, the
1961 census is generally accepted as the first scientific census in terms of international standard and comparisons.
According to the latest census of 2001, Nepal’s population was 23,151,423 as of June 2001. The average annual growth rate of population during the last decade i.e. 1991-2001 was 2.25 percent (CBS 2002). The census also revealed that the sex ratio i.e. males per 100 females was 99.8. In other words 49.95 percent of the total population was male, while the females comprised 50.05 percent of the population. The total population obtained in different censuses of Nepal, corresponding growth rates and times to double the population have been presented in Table 1.6. It should be noted that during the 2001 census, some of the districts could not be fully covered because of security reasons. Based on household level form and estimation
Nepal Population Report 2011 - 7
total population of Nepal were 23,151,423. Individual information (form-2) was filled in for only 22,736,934 individuals. Thus detailed data are available only for this number of persons.
Table 1. 6: Population size, growth rate and doubling time, Nepal,1911 – 2001
Census
year
1911
1920
1930
1941
1952-54
1961
1971
1981
1991
2001
Total
Population
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
Population
Change
- 64,961
41,214
7,51,075
19,72,976
11,56,371
21,42,987
34,66,856
34,68,258
46,60,326
Annual Growth Rate
(Exponential)
-0.13
-0.07
1.16
2.27
1.64
2.05
2.62
2.08
2.25
Doubling
Time
60
31
42
34
26
33
31
Source; CBS 2002
Fluctuations in the annual growth rate of population mostly relate to the quality of data obtained in the census notably the coverage and undercount and possibly over-count in different censuses. The Table shows that the rate of population growth in Nepal is still quite high (2.25percent). This high rate of growth of population has affected almost every aspect of life, both social as well as economic. It has caused increased pressure on limited land resource as more and more marginal land is being cultivated. The population growth has also led to shortages of food at places. Because of the need to farm marginal land for food production, forests are being depleted, which have resulted in frequent landslides, floods as well as soil erosion. High rate of population growth also warrants increased spending on the social services such as education, health, drinking water and other basic needs. It has increasingly been difficult to meet the growing demands of people for these services. 1.5 Population Distribution
1.5.1 Spatial Distribution
Nepal has three distinct ecological regions. These are mountains, which are defined as area that lies between the altitude of 4877 and 8848 meters comprise 35 percent of land area, while hills are defined as area that lies between the altitude from 610 to 4876 meters and comprises 42 percent of land area. Altogether these regions comprise about 77 percent of the total area and have about 52 percent of the total population in 2001. The Terai region lies below the elevation of 610 meters. It comprises of 23 percent of the total land area and contains nearly 48 percent of the population. The data in Table 1.7 also clearly show that the proportion of population living in Terai
8 - Nepal Population Report 2011
is increasing, while the proportion of people living in the hill and mountain is declining over the years. This disproportionate distribution of population among ecological regions of Nepal is most probably due to many reasons.
Some of these reasons could be
a)
b)
c)
d)
e)
f)
Unequal distribution of resources
Availability of productive land in Terai,
Difficult topography of Hill and Mountain
Disparity in socio-economic development and
The lack of basic facilities and infrastructure in these regions.
Lack of access to information.
Table 1. 8: Population Growth Rate by Ecological Region, Nepal, 1961/71 –
1991/2001
Geographic region Inter-census period
Average Annual Growth Rate
1971/81
1981/91
1.35
1.02
1.65
1.61
4.11
2.75
2.66
2.08
1961/71
Mountain
Hill
Terai
Total
1.85
2.39
2.05
1991/01
1.57
1.97
2.62
2.25
Source: CBS, 1995 CBS 2002.
Table 1. 7: Population Distribution by Ecological Zones Nepal .1952/54 - 2001.
Census yrs.
1952/54
Mountain
-
Hill
-
1961
-
-
1971
1138610
(9.9)
1302896
(8.7)
1443130
(7.8)
1687859
(7.3)
6071407
(52.5)
7163115
(45.5)
8419889
(45.5)
10251111
(44.3)
1981
1991
2001
Mountain & Hill
5349988
(64.8)
5991297
(63.6)
7210017
(62.4)
8466011
(56.4)
9863019
(53.3)
11938970
(51.6)
Terai
2906637
(35.2)
3421699
(36.4)
4345966
(37.6)
6556828
(43.6)
8628078
(46.7)
11212453
(48.4)
Total
8256625
9412996
11555983
15022839
18491097
23151423
1.6 Population Distribution by Development Region
If one looks at the Nepal’s population by development regions, one would find that the highest proportion of population is in the Central Development Region and Far-Western Development Region has the lowest proportion of population. During 1981-91, the population growth rate has gone down in all the development regions as compared to previous decades. The decrease in growth rate was highest in the Eastern Development Region. It should be noted that this deceleration in population growth could also be the result of the undercounting and over-counting of population in different censuses concerned. Table 1. 9: Population Distribution and Growth by Development Regions Nepal,
1981 – 2001
Note: The figures in Parenthesis indicate percentages.
Source: CBS 1995, 2002
Development
Region
These factors have led to increased migration to the Terai area from hills and mountains and at the same time flow of immigrants from the bordering country have played crucial role in the increased population living in the Terai region.
Eastern
1.5.2 Population growth rate by ecological region
Central
The rate of increase of population is higher in the Terai compared to the hills and mountains. During the decade of 1971-81, population in the Terai has increased by 4.1 per cent. However, the population growth rate has gone down during 1981-91, in all the three geographical regions. During the period
1991-2001 rate of population growth has increased in the hills and mountains but has slightly decreased in the Terai. Still the growth rate of population in the Terai is much higher than that of the hills or mountains.
Western
Mid-West
Far-West
Total
Distribution of Population(%)
1981
1991
2001
3708923
(24.49)
4909357
(32.68)
3128859
(20.83)
1955611
(13.02)
1320089
(8.78)
15022839
(100)
4446749
(24.05)
6183955
(33.44)
3770678
(20.39)
2410414
(13.04)
1679301
(9.08)
18491097
(100)
Source : CBS 2002, 2003
Nepal Population Report 2011 - 9
10 - Nepal Population Report 2011
Average Annual Growth Rate (%)
1971-81 1981-91
19912001
5344476
2.86
1.83
1.84
(23.09)
8031629
2.42
2.33
2.61
(34.09)
4571013
2.49
1.88
1.92
(19.74)
3012975
2.77
2.11
2.26
(13.01)
2191330
3.25
2.44
2.26
(9.47)
23151423
2.66
2.08
2.25
(100)
Eastern development region had a growth rate of 2.86 per cent per year in
1971-81 decade, which decreased 1.83 percent in 1981-91 decade. However, the growth rate of Central Development Region came down merely to 2.33 percent from 2.42 percent per year. During the decade 1991 to 2001 highest growth rate was recorded for Far-Western Development Region
(2.66percent), while the second highest rate of growth was recorded for
Central Development Region (2.61percent).
1.7 Growth rate and distribution of population by districts
The distribution and the growth rate of population by districts over the census years are presented in Table 1.6. Kathmandu district has the largest population as indicated by the different censuses of Nepal. The census of
2001 showed a population of 1081845 in the Kathmandu district. The smallest population was recorded in the Manang district. The census of 2001 showed that the population in the Manang district was 9587. The Table 1.10 also provides area of the districts as well as population density per square kilometer. Kathmandu district has the highest density with 2739 persons per square kilometer. The lowest population density was observed for the Dolpa district with 3.7 persons per square kilometer.
120780
153746
178356
479743
534692
344594
129781
92454
129414
192689
88245
137640
212571
159805
379055
375358
432569
361054
398766
183705
161445
134698
202056
282806
688109
843220
625633
166479
113111
159203
203018
107686
156702
231385
287689
570282
572399
671364
553481
635701
279821
212408
1241
1703
1606
1855
1257
891
679
3480
1507
3312
1074
1591
2063
1363
1188
1180
1002
1259
2491
1546
162.8
166.1
428.5
454.6
497.7
186.8
166.6
45.7
134.7
32.5
145.9
145.4
139.5
418.4
481.8
569.0
552.4
504.9
112.3
137.4
Average
Annual
Growth
Rate19912001
120053
175206
229214
593737
674823
463481
146386
102870
141903
198784
97200
139457
215965
221256
465668
460746
543672
440146
492798
223900
188064
Population
Density
per sq km
2001
Taplejung
Panchthar
Ilam
Jhapa
Morang
Sunsari
Dhankuta
Terhathum
Sankhuwasabha
Bhojpur
Solukhumbu
Okhaldhunga
Khotang
Udayapur
Saptari
Siraha
Dhanusha
Mahottari
Sarlahi
Sindhuli
Ramechhap
1991
District
1981
Population
Area in sq. Kms.
Table 1. 10: Distribution and the Growth Rate of Population by Districts, Nepal 1981-2001
1.43
2.10
1.48
2.23
3.00
1.29
0.95
1.15
0.21
1.02
1.17
0.69
2.63
2.03
2.17
2.11
2.29
2.55
2.23
1.22
Nepal Population Report 2011 - 11
Dolakha
Sindhupalchok
Kavrepalanchowk
Lalitpur
Bhaktapur
Kathmandu
Nuwakot
Rasuwa
Dhading
Makawanpur
Rautahat
Bara
Parsa
Chitawan
Gorkha
Lamjung
Tanahun
Syangja
Kaski
Manang
Mustang
Myagdi
Parwat
Baglung
Gulmi
Palpa
Nawalparasi
Rupandehi
Kapilvastu
Arghakhanchi
Pyuthan
Rolpa
Rukum
Salyan
Dang
Banke
Bardiya
Surkhet
Dailekh
Jajarkot
Dolpa
Jumla
Kalikot
Mugu
Humla
148510
234919
307150
199688
144420
426281
210549
30241
236647
243411
332526
318957
284338
259571
231294
152720
223438
271824
221272
7021
12930
96904
128400
215228
238113
214442
308828
379096
270045
157304
157669
168166
132432
160734
266393
197152
198544
167111
165612
99312
22043
68797
79736
35287
28721
173236
261025
324329
257086
172952
675341
245260
36744
278068
314599
414005
415718
372524
354488
252524
153697
268073
293526
292945
5363
14292
100552
143547
232486
266331
236313
436217
522150
371778
180884
175469
179621
153554
181785
354413
285604
290313
225768
187400
113958
25013
75964
88805
36364
34383
12 - Nepal Population Report 2011
204229
305857
385672
337785
225461
1081845
288478
44731
338658
392604
545132
559135
497219
472048
288134
177149
315237
317320
380527
9587
14981
114447
157826
268937
296654
268558
562870
708419
481976
208391
212484
210004
188438
213500
462380
385840
382649
288527
225201
134868
29545
89427
105580
43937
40595
2191
2542
1396
385
119
395
1121
1544
1926
2426
1126
1190
1353
2218
3610
1692
1546
1164
2017
2246
3573
2297
494
1784
1149
1373
2163
1360
1738
1193
1309
1879
2877
1462
2955
2337
2025
2451
1502
2230
7889
2531
1741
3535
5655
93.2
120.3
273.6
877.4
1894.6
2738.8
257.3
29.0
175.8
161.8
484.1
469.9
367.5
212.8
79.8
104.7
203.9
272.6
188.7
4.3
4.2
49.8
319.5
150.7
258.2
195.6
260.2
520.9
277.3
174.7
162.3
111.8
65.5
146.0
156.5
165.1
189.0
117.7
149.9
60.5
3.7
35.3
60.6
12.4
7.2
1.65
1.59
1.73
2.73
2.65
4.71
1.62
1.97
1.97
2.22
2.75
2.96
2.89
2.86
1.32
1.42
1.62
0.78
2.62
5.81
0.47
1.29
0.95
1.46
1.08
1.28
2.55
3.05
2.60
1.42
1.91
1.56
1.92
1.61
2.66
3.01
2.76
2.45
1.84
1.68
1.67
1.63
1.73
1.89
1.91
Bajura
81801
92010 108781
2188
49.7
Bajhang
124010 139092 167026
3422
48.8
Achham
185962 198188 231285
1680
137.7
Doti
153135 167168 207066
2025
102.3
Kailali
257905 417891 616697
3235
190.6
Kanchanpur
168971 257906 377899
1610
234.7
Dadeldhura
86853 104647 126162
1538
82.0
Baitadi
179136 200716 234418
1519
154.3
Darchula
90218 101683 121996
2322
52.5
Note: These are adjusted figures and take into account the boundary changes districts. 1.67
1.83
1.54
2.14
3.89
3.82
1.87
1.55
1.82 of the
Source: CBS 1995, CBS 2002.
1.8 Population Density
Ecologically, Nepal is divided into 3 regions; mountain, hill and Terai. As these three regions differ from each other in climate and topography, population distribution is also different in these regions. Data obtained from different censuses indicate that population density has increased in all three regions over the years, with Terai witnessing a much higher density than Mountains and Hills.
Table 1. 11: Population density (person per sq. km.) by ecological zones & development regions, Nepal, 1981-2001.
Zones/Regions
Mountain
Eastern Central Western Mid Western Far Western Total
6277
5819
21351
7932
51817
1981
32.41
65.82
3.43
11.35
36.42
25.14
1991
34.40
75.03
3.37
12.20
41.95
27.85
2001
Hill
Area sq.km. 10438
38.47
88.39
4.22
14.48
50.15
6762
116.94 178.60 117.41
76.03
89.37
116.76
1991
132.95 226.98 132.15
88.95
99.18
The sex ratio at birth is around 105 male births for every 100 female births and existing higher risk of death among females than males in the country, low sex ratio can only be explained by the possibility of a large volume of temporary male emigration.
152.87 300.10 152.47
107.44
118.15
167.11
7317
4845
34024
Table 1.12 shows that females have slightly outnumbered males, mainly because adult males used to go abroad in search of livelihood.
Table 1. 12: Sex Ratio by Ecological Regions, Nepal,1952/54 – 2001
Sex Ratio
Ecological Regions
1952/54
1961
1971
94.26
102.14
97.05
100.79
98.02
106.39
101.37
1981
1991
2001
98.43
95.34
103.85
99.47
98.39
95.84
103.77
99.80
137.25
2001
Area sq.km. 7269
9328
5260
1981
290.70 255.97 182.11
91.67
88.23
192.71
1991
365.72 325.18 252.87
127.14
139.62
253.58
2001
Total
The sex composition of a population is indicated by sex ratio. It is calculated as a ratio of total number of males to that of females multiplied by 100. Thus it shows the number of males per 100 females. In normal populations sex ratio of 103-105 is obtained at birth. This indicates that for every 100 female babies born nearly 105 male babies are born. As the age increases i.e. by the age of five, the sex ratio is considered to be more or less equal as infant and child mortality is higher for male babies. As the age increases, sex ratio gets in favor of females as mortality for males are higher than females.
61345
Area sq.km. 10749 11805 18319
1981
Terai
1.9 Sex Ratio
32.57
13710
Table 1.11 presents population density for Nepal by ecological and development regions. In 1981 population density for Nepal was 102 persons per square kilometer, which is increased to 157 in a period of 20 years. In
1981 only 193 persons per square kilometer resided in Terai region, which increased to 330 in 2001. Mountain region had 25 persons per square kilometer in 1981, which increased to only 33 after 20 years in 2001. In the
Hill region it reached 167 from 117 in the same 20 year period. Among development regions, the lowest population density is observed for MidWestern Development Region (71), while it is the highest in the Central
Development Region (293) in 2001.
453.93 421.75 333.32
168.22
205.28
42378
19539
147181
67.56
102.01
95.95
100.10
96.80
104.71
102.14
108.33
105.02
329.59
Area sq.km. 28456 27410 29398
Mountain
Hills
Terai
Nepal
1981
130.32 179.10 106.43
46.14
1991
156.25 225.61 128.26
56.87
85.95
125.63
2001
187.82 293.02 155.49
71.10
112.15
157.30
Source: CBS 2002.
Nepal Population Report 2011 - 13
Source : CBS, 1995,2002.
However, in the censuses of 1971 and 1981 more males were counted than females. The censuses of 1991 and 2001 yielded more females than males and as a consequence overall sex ratio was less than 100. This sharp decline in sex ratio during 1981-1991 periods is unexplained, because there is no authentic evidence to explain such changes in the sex ratio. Only exodus of male population for work outside the country, can be speculated, again a large
14 - Nepal Population Report 2011
exodus could be hardly possible. Table 1.13 shows sex ratio of population by ecological and development regions from 1981 to 2001.
Table 1. 13: Sex ratio of population by ecological & development regions, Nepal,
1981-2001.
Development Regions
Ecological
Zones
Year
Mountain
1981
102
107
108
107
102
105
1991
96
100
109
103
94
98
2001
97
99
116
103
96
98
Hill
Eastern
Central Western Mid Western Far-western
Total
101
106
100
100
92
102
97
102
88
96
92
95
2001
Terai
1981
1991
97
103
87
97
94
96
108
107
109
107
116
108
103
106
103
102
101
104
2001
Nepal
1981
1991
102
107
102
101
103
Table 1. 14: Percentage Distribution of Population by Five-year age groups,
Nepal, 1981-2001
Age
Groups
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65+
Male
15.5
14.5
11.9
9.0
8.3
7.4
6.1
6.0
4.9
4.3
3.8
2.4
2.5
3.4
1981
Female
15.3
14.6
10.8
8.6
9.5
8.1
6.9
5.9
5.1
3.9
3.4
2.2
2.4
3.1
Male
14.9
15.5
13.1
9.5
7.9
7.0
6.0
5.6
4.5
4.1
3.3
2.7
2.3
3.6
1991
Female
14.4
14.8
12.1
9.9
9.3
7.8
6.5
5.5
4.7
3.9
3.1
2.3
2.3
3.4
Male
12.29
14.38
13.50
10.44
8.33
7.23
6.39
5.73
4.75
4.13
3.46
2.80
2.31
4.26
2001
Female
11.95
13.87
12.73
10.57
9.40
7.95
6.71
5.79
4.82
3.99
3.28
2.49
2.27
4.16
Total
12.12
14.12
13.11
10.51
8.87
7.59
6.55
5.76
4.79
4.06
3.37
2.65
2.29
4.20
104
1981
105
107
103
103
105
1991
100
104
93
99
96
105
99
2001
100
105
93
99
98
100
1.10 Age Structure
Whether a population is young or old, or getting older or younger depends on the proportion of people at different age groups. In general, a population with more than 35 percent under age 15 is considered young and population with more than 10 percent aged 65 and above is considered old. Age structure is affected by the fertility, mortality and migration. However, under normal situation, the affect of mortality and migration is smaller and proportion of population at each age group is mainly affected by fertility. Distribution of population by five year age group is shown for males and females based on census data in Table 1.14.
Source : CBS, 1995,2002.
The present age structure suggests that a large share of resources have to be spent on basic facilities such as education, nutrition and health of young people just to maintain a status quo. It also suggests that because of young nature of Nepalese population, population momentum for Nepal is still very high, indicating that Nepal’s population will continue to grow for quite some time even if the fertility were to reach replacement level today.
From the Table it can be seen that percentage of 5-9 age group population is highest in the census periods except 1981. Under normal situation age group
0-4 should have the largest population. Usually children under 5 year of age are undercounted especially children under one years of age therefore age group 5-9 shows the largest population in different censuses of Nepal. After the age group 5-9, the proportion decreases with age, following more or less the expected pattern. The age structure of the population in the census year
2001 is shown in the figure 1.3.
The Table 1.14 shows that the population of Nepal is composed primarily of young people and since 1960s it has remained young. More than 39 percent of its present population is under 15 years of age. Similarly, more than half of the population is in the age group 15-59. This age structure indicates approximately one person is in the working ages (15-59 years) for every person less than 15 years old and aged 60 years or more. This age structure of Nepalese population is mainly due to high fertility and declining mortality in all ages, particularly in younger ages.
Nepal Population Report 2011 - 15
16 - Nepal Population Report 2011
If one were to look for the proportionate share of population in these groups, one would find that adolescents in Nepal cover 23.62 percent of the total population i.e. nearly a quarter of the population. It should be noted that for a period of nearly three decades this group of the population will be in the reproductive age and will be bearing children. If we were to look at the proportion of population in the youth category we would find that 19.38 percent i.e. nearly a fifth of the total population is in this group. It should be noted that this group is already in the reproductive age group and already contributing to population growth. If we are to control the rate of population growth through addressing fertility then these groups need to be targeted for the population related programmes. In general, young people (10-24 years) constitute of almost 33 % of the total population of Nepal.
75+
70-74
65-69
60-64
55-59
50-54
Male
Female
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
1.12 Distribution of Women aged 15-49, by five year age groups.
5-9
16
14
12
10
8
6
4
2
0
0
2
4
6
8
10
12
14
16
0-4
Percent
2001
Figure 1. 3: Population Pyramid of Nepal, 2001
Source: CBS, 2002
1.11 Adolescents and Youth
Adolescence is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological (i.e. pubertal), social, and psychological changes, though the biological or physiological ones are the easiest to measure objectively.
Historically, puberty has been heavily associated with teenagers and the onset of adolescent development. Adolescence is the second decade of life and it is a period of rapid development, major physical change take place and differences between boys and girls are emphasized. Adolescents are often thought of as a healthy group. Nevertheless, many of them do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either prevenTable or treaTable. In addition, many serious diseases in adulthood have their roots in adolescence. For example, tobacco use, sexually transmitted infections including HIV, lack of nutrition and exercise habits, lead to illness or premature death later in life (WHO).
As discussed earlier, the rate of population growth is highly affected by fertility. If there are more women in the reproductive age group then a larger number of births will take place given a fixed fertility rate. As the age group of women increases, the proportion of women in each group decreases.
However, in the 1981 census the number of women in the age group 20-24 was greater than the number of women in the age group 15-19. This could be due to age misreporting in the censuses of Nepal.
Among women, about 49 percent are in the reproductive age. In a likewise manner, of the total population about 24.6 percent of the population is in the reproductive age. In Nepal, female marriage takes place early and almost every woman marries. Thus higher proportion of married women coupled with higher fertility levels contributes to high rate of population growth.
The proportion of women in the reproductive age group has increased slightly over the last 10 years. This could be mainly due to declining fertility whereby the proportion of younger population less than 10 year of age has declined.
For example, among males it was 30.4 percent in 1991, which decreased to
26.7 by the year 2001. Corresponding figures for females are 29.2 percent and 25.8 percent respectively.
Youth is the time where a person's life is in between childhood and adulthood.
The majority (almost 85%) of the world’s youth live in developing countries, with approximately 60 percent in Asia alone. A remaining 23 percent live in the developing regions of Africa, and Latin America and the Caribbean. By
2025, the number of youth living in developing countries will grow to 89.5%.
Therefore, it is necessary to take youth issues into considerations in the development agenda and policies of each country.
Nepal Population Report 2011 - 17
18 - Nepal Population Report 2011
Chapter 2
Fertility and its Proximate Determinants
2.1 Fertility
The major three demographic processes that determine the structure, distribution and growth of any population are: fertility, mortality and migration.
Among these factors, fertility is one of the main factors in determining the age structure of a population. As Compared to other demographic processes, the study of fertility is more complex because it is affected by host of factors including biological as well as other behavioral.
Fertility refers to the number of live births per women in the population. It represents the actual performance and should not be confused with the ability of capacity to reproduce, which is termed as fecundity. The inability of reproduce is called sterility.
Only a section of the population namely women in the reproductive age group (1549) which is biologically identified as between menarche and menopause.
population and other available demographic parameters for the estimation of fertility and mortality indicators. Once the survey data are available, direct method of fertility estimates are commonly used. Demographic surveys carried out before 1991 have indicated some problems of data quality, especially omission and displacement of vital events. Because of this till 1986 different censuses and surveys provided fertility estimates based on indirect method [i.e. sTable population estimates or different versions of P/F ratio methods. P/F ratio may be defined as the ratio of present vs. past (cumulative fertility). Table 2.1 provides estimates of CBR over time for Nepal. It indicates that
CBR in Nepal was high till the mid eighties. After the mid-eighties, CBR has been gradually declining.
The Nepal Demographic and Health Survey, 2006 has indicated that the CBR is around 28 per thousand in Nepal. Although, this means a decrease of 4 points during the last 5 years, this CBR is still considered to be quite high.
Table 2. 1 :Crude Birth Rate by various sources, Nepal, 1952/54 - 2005
Sources
The demographic literature offers many measures of fertility. There are broadly two ways of approaching the study of fertility: period and cohort. Period analysis looks at fertility cross-sectional that is at births occurring in a specific period of time, normally one year. Cohort Analysis on the other hand looks over time, at their reproductive history. In spite of the general theoretical preference for cohort measures, the literature suggests that period influences tend to be more powerful than cohort influences in explaining fertility behavior.
Demographers have developed different measures of fertility for its analysis.
In this report, we will mainly focus on four indicators namely Crude Birth Rate
(CBR), Age Specific Fertility Rate (ASFR), Children Ever Born (CEB) and
Total Fertility Rate (TFR).
2.1.1 Crude Birth Rate
The Crude Birth Rate is defined as the number of live births per thousand persons in a given area for a particular year. Although, simple to calculate and easy to understand, it is a crude measure, because it uses persons from all age groups and both the sexes involve in the denominator. Age/sex structure of the population has an important bearing on the Crude Birth Rate, it is ignored altogether. For example, even if two countries have the same agespecific fertility rates, their crude birth rates may be substantially different if their age/sex compositions are different. Despite being a crude measure, it is one of the most commonly used summary measures for level and trend analysis of fertility.
Fertility measures including CBR are calculated either through indirect methods or through direct methods. In the absence of vital registration and survey data, indirect method of fertility estimation is usually used. These methods are based on sTable population, which utilizes the age-structure of
Nepal Population Report 2011 - 19
United Nations, ESCAP
Vaidhyanathan and Gaige
Krotki and Thakur
CBS(Census data)
Nepal Fertility Survey, MOH
CBS(Census data)
Nepal FP/MCH Project, MOH
CBS Demographic Sample Survey
CBS(Census data)
Nepal Family Health Survey, 1996
Nepal Demographic Health Survey, 2001
Nepal Demographic Health Survey, 2006
Years
1952-54
1954
1961
1971
1976
1981
1981
1986
1991
1994-96
1998-2000
2003-2005
Crude birth rates
(per 1000 population)
45.0
48.7
47.0
42.0
45.5
44.0
42.9
40.7
41.6
37.0
33.5
28
Source : CBS 1995, MOH, 1997,2002a and 2006
2.1.2 Age Specific Fertility Rates (ASFRs)
Age Specific Fertility Rates (ASFRs) are defined as the ratio of children born to a specific age group of women to the number of women in the risk of bearing children. These are more refined a measure of fertility as the age/sex structure of a population is taken into account.
Thus, international comparisons of ASFRs can easily be made while CBR described earlier should not be compared internationally unless standardized for the age/sex structure of the population. For the calculation of ASFRs, usually a five-year age groups are considered.
There is an inverted U-shaped relationship between fertility and the age of women. In other words, during early part of reproductive life fertility is low. It
20 - Nepal Population Report 2011
increases to a maximum value during the twenties and then declines women get older. Table 2.2 presents ASFRs for Nepalese women aged 15 to 49 from
1971 to 2003-2005.
The age pattern of fertility indicates that Nepalese women have the highest fertility in the early part of childbearing period. For example, in 2003-2005, of the one thousand women in the age range 20-24, 234 women give births in a given year while the corresponding figure for women in the age range 35-39 is only 48. If the age specific fertility rates for the period 1998-2000 and 20032005 are compared, we find that fertility has declined for all the ages during the last five-year period.
Table 2. 2 : Age Specific Fertility Rates, Nepal, 1971-2000
Age
group
1971
1976
15-19
0.074
0.145
20-24
0.267
0.290
25-29
0.310
30-34
0.261
35-39
1981
198486*
198991*
1994-
0.066
0.099
0.101
0.127
0.110
0.098
0.230
0.261
0.263
0.266
0.248
0.234
0.295
0.266
0.230
0.230
0.229
0.205
0.144
0.269
0.245
0.200
0.169
0.160
0.136
0.084
0.196
0.169
0.206
0.114
0.117
0.094
0.081
0.048
40-44
0.109
0.075
0.142
0.068
0.055
0.037
0.034
0.016
45-49
0.043
0.023
0.099
0.049
0.026
0.015
0.007
0.002
96*
19982000*
20032005
*ASFRs are based on births that occurred three years prior to the survey
Source : CBS 1995; MOH 1997; MOH 2002.
The figure 2.1 presented below provides the comparison of ASFR for the period 1998-2000 and 2003-2005.
2.1.3 Total Fertility Rate (TFR)
Another measure commonly used to describe the level of fertility is Total
Fertility Rate (TFR). Verbally TFR is defined as the number of children of a woman would bear during her childbearing period under prevailing age specific fertility rates (i.e. ASFRs). The TFR is calculated as the sum of
ASFRs. As we have used ASFR for 5 year age groups, the sum of ASFRs need to be multiplied by 5 to obtain the TFR. Although, defined as a cohort measure, in fact, it is a synthetic cohort measure based on period data. It is the most commonly used summary measure of fertility as it is free from age distribution of a population. This measure is also widely understood and used by policy makers and planners. Table 2.3 provides the different estimates of
TFR from 1971 to 2005.
Table 2. 3 : Total Fertility Rate Nepal, 1971-2000
Data Source
CBS Census, 1971
Nepal Fertility Survey 1976, MOH
Nepal Contraceptive Prevalence Survey 1981,
MOH
Nepal Fertility and Family Planning Survey
1986, MOH
Nepal Fertility Family Planning and Health
Survey 1991, MOH
Nepal Family Health Survey 1996, MOH
Nepal Demographic and Health Survey 2001,
MOH
Nepal Demographic and Health Survey, 2006
Year
1971
1975-1976
1980-1981
Total Fertility Rate
6.3
6.33
6.27
1984-86
5.1
1989-91
4.8
1993-95
1998-2000
4.6
4.1
2003-2005
3.1
*These rates are based on births occurring 3 years preceding the survey and are direct estimates. Source : CBS 1995; MOH 1997; MOH 2002a, MOHP, 2006.
0.3
0.2
0.1
0
15 - 19
20 - 24
25 - 29
30 - 34
Age
2003 - 2005
35 - 39
40 - 44
45 - 49
1998 - 2000
Table 2.3 shows that the estimate of TFR for Nepal was more or less constant till mid eighties and thereafter it started to decline. The level of TFR till mid eighties was around 6.3. A substantial reduction in fertility can be seen during the period 1999 to 2004 when a decline of one child was observed. The
Nepal Demographic and Health Survey 2006 provided an estimate of TFR for
Nepal to be 3.1. Although a detailed analysis of causes of decline in fertility has not been done, possible causes for this decline after mid-eighties could be include a) increased use of family planning methods b) increased age at marriage c) improved level of education d) increased urbanization and e) spousal separation due to conflict and employment etc.
Figure 2. 1 :Age Specific Fertility Rates Nepal, 1998-2000 and 2003-2005
The two ASFR lines clearly indicate that there has been a decrease in the age specific fertility in all the age groups in Nepal during the last five-years.
Nepal Population Report 2011 - 21
22 - Nepal Population Report 2011
Replacement Level of fertility is the average number of children sufficient to replace their parents. The replacement level of fertility is measured by GRR (Gross
Reproductive Rate) and NRR (net Reproductive Rate).If the NRR=1, then we called it as the replacement level of fertility. Actually it is the level of fertility at which women in the same cohort have exactly enough daughters on average to replace themselves in the population.
Population momentum refers to the tendency of the population to continue to grow after replacement level of fertility has been achieved. A population that has achieved replacement of below replacement level of fertility may still continue to grow for some decades because past high fertility leads to a high concentration of people in the youngest ages. Total births continue to exceed the total deaths as these youth becomes parents. Eventually, however, this large group becomes elderly then deaths increase to equal or out number of births. Thus it may take two or three generations before each new birth is upset by a death in the population.
Hill
Terai
Development Region
Eastern
Central
Western
Midwestern
Far Western
Educational Status
None
Primary
Secondary
SLC and above
Total
4.5
4.6
4.0
4.1
3.0
3.1
5.6
5.7
5.4
5.3
4.6
5.0
4.1
4.6
4.7
5.5
5.2
3.8
4.3
3.5
4.7
4.7
3.1
3.0
3.1
3.5
3.5
5.4
5.6
5.5
6.6
6.2
4.9
5.4
5.3
6.4
6.0
4.7
4.7
4.6
5.6
5.6
5.1
3.8
2.5*
4.6
4.8
3.2
2.3
2.1
4.1
3.9
2.8
2.3
1.8
3.1
5.8
5.3
3.7*
5.7
5.6
4.5
3.7
2.6
5.4
5.1
4.0
3.3
2.6
4.9
* includes secondary or higher level of Education
2.2 Fertility Differentials
Source : MOH, 1997,2002.2006
The change in fertility in fertility level by some specific phenomenon or characteristics is called fertility differential. During the early phase of fertility transition, the differentials in fertility emerge and large differentials can be observed for some key socio-economic variables. Table 2.4 provides fertility differentials by place of residence, ecological region, development region and education. In Table 2.4, mean number of children ever-born (CEB) by women aged 40-49 have also been displayed. Mean number of children ever-born for women 40-49(or 45-49) can be regarded as a cohort measure of TFR. It should be noted that some women may have given births to their children quite early, thus, they might misreport live births, which might have resulted in death soon after birth. Following differentials in TFR can be clearly seen, when one looks at the NDHS 2006 data on TFR:
Comparison of TFR differentials for the period 1994-1996 and 1998-2000 and
2003-2005 suggest that the differentials by socio-economic variables have increased substantially over the years. This is an indication of declining fertility trend in Nepal as well as faster decline in fertility for the advantaged group of population as indicated by lower fertility for educated women as well as women living in urban areas.
1. The TFR in the Terai region is similar to that observed in the Hill region while the TFR in the mountain region is around one child higher. 2. By development regions the TFR in the central region is the lowest
(3.0) and the highest TFR is observed for the mid western region and
Far western region (3.5).
3. Women with SLC and above have a TFR of 1.8, which is less than half of the rate for women with no education.
4. Similarly, urban women have lower fertility (on an average by two births) than their rural counterparts.
Table 2. 4 : Level of TFR and Mean Children Ever Born [Mean CEB] 40-49) by
Background Characteristics Nepal, 1994-1996 and 1998-2000
Background Variables
Region of Residence
Urban
Rural
Ecological Region
Mountain
19941996
TFR
19982000
20032005
Mean CEB 40-49
1994- 1998- 20031996
2000
2005
2.9
4.8
2.1
4.4
2.1
3.3
4.6
5.8
4.5
5.5
3.7
5.1
5.6
4.8
4.1
6.2
6.1
5.4
Nepal Population Report 2011 - 23
Table 2.4 also provides the mean number of children born to women aged 4049. Similar differentials in the mean number of children born to women aged
40-49 can also be seen. However, the differentials are smaller and increase in the differentials over the last five years is also smaller.
Moreover, it should be noted that the mean number of children ever born to these women (40-49) is considerably higher than the TFR discussed earlier.
Recall once again that the TFR is a synthetic cohort measure based on period data, while the mean number of children ever-born to women (40-49) is a cohort measure. TFR is based on the recent data on ASFRs, while the mean number of children ever-born to women is based on the ASFRs prevalent during the last 25-30 years. As the fertility was higher in earlier period, it is natural that the cohort TFR measure is also higher.
2.3 Proximate Determinants of Fertility
Earlier we discussed fertility and its differentials. The differentials in fertility were demonstrated for different demographic and socio-economic variables.
In fact, socio-economic variables do not have a direct causal link with fertility, however, their effect is mediated through behavioral factors as well as biological factors. These are the factors which Davis and Blake (1956) called intermediate variables (also known as proximate determinants of fertility)
Davis and Blake in their classical articles described the mechanism through which different biological as well as behavioral factors had effects on fertility.
Bongaarts (1978,1982) attempting to model the intermediate variable frame24 - Nepal Population Report 2011
work of Davis and Blake identified only four factors out of several factors identified by them as the major determinants of fertility in a population. His regression model showed that nearly 96 percent of variation in fertility in a population was explained by the following four factors
a)
b)
c)
d)
Proportion of females married
Post-partum infecundity due to lactation amenorrhea
Contraceptive prevalence rate and
Prevalence of induced abortion.
In the following section we will mainly deal with these four proximate determinants and their role in reducing fertility in Nepal.
2.4 Nuptiality
In societies, where child bearing takes place mostly within marriage, timing of marriage marks the beginning of women’s exposure to child bearing. In other words, age at marriage in most of the societies, begins a woman's exposure to the risk of child bearing. Age at marriage is a major determinant of the duration and tempo of fertility in a population. Consequently, age at marriage and proportion of women never married are important proximate determinants of fertility (Bongaarts and Potter, 1983).
Nupiality refers to Marriage, separation, divorce, widowhood and remarriage in Demography. Their importance arises partly from their relationship with the age at which sexual relation begins and end and partly with the formation and dissolution of families and households.
The Nepalese society is characterized by early and nearly universal marriage.
Marriage usually takes place early and by the age of 30 almost every woman is already married. In populations, where use of contraception is low, early marriage leads to longer exposure to child bearing. Therefore, early and universal marriage practice in Nepal results in long-term social and economic consequences including higher fertility.
Table 2. 5 : Percentage of Women Never Married by Age, Nepal, 1961-2006
Age group
15-19
20-24
25-29
30-35
35-39
40-44
45-49
1961
25.7
5.3
1.9
1.0
0.8
0.7
0.6
1971
39.3
7.9
2.6
1.4
1.1
0.9
0.8
1981
49.2
13.1
5.4
3.1
2.6
2.5
2.9
1991
52.7
12.8
3.7
1.9
1.3
1.1
0.9
2001
66.1
21.0
5.6
2.6
1.8
1.5
1.2
2006
67.7
17.9
4.4
1.6
1.4
1.3
1.2
1961-91 data are from censuses and 2001 are based on NDHS2001.
Source: CBS 1995, 2002; MOH 2002 and 2006
2.4.1 Widow/Widower
In Nepal, as discussed earlier, almost all of the childbearing takes place within marriage. Therefore proportion of population widower or widow will also have an effect on fertility. Data on widowhood for both men and women have been presented in Table 2.6. Table 2.6 indicates that from 1961 to 1991 the number of both widow and widower have gone down significantly. This indicates that mortality for adult population has declined over the years. For example, among men, in 1961 percentage of widower was 4.8, which decreased to 3.0 by 1991. Among women in 1961, percentage widowed was
14.3, which decreased to 7.2 by 1991. Nepal Family Health Survey 1996 provided estimate of widowhood as 2.7 per cent, for women 15 years and older. The census of 2001 indicated that of the total male population 10 years or older only 1.3 percent are widowers while this figure is 3.7 for women aged
10 years or older. This sharp decline in proportion of widow and widower is due to fall of mortality among adult population. Proportionately more women are widowed compared to males for all age categories. This could be partly explained by a) age difference between males and females at the time of marriage; as husbands are older it is more likely that proportionately more women become widows b) a substantial proportion of males remarry when they are widowers, while very few women remarry when they are widowed and c) during reproductive years female mortality could also be higher, as depicted by a high maternal mortality.
Table 2. 6 : Percentage of widow/widower, 10 years and above, Nepal, 1961 - 2001
Sex
1961
Male
Female
1971
Census Years
1981
1991
2001
4.8
14.3
3.7
10.1
2.4
5.5
3.0
7.2
1.3
3.7
Source : CBS 1995, 2002.
Divorce and separation between husbands and wives are another important variable, which affects fertility. Although the proportion of men and women divorced or separated is increasing over time, this figure is still too low to have any significant effect on fertility.
2.4.2 Age at First Marriage
In Nepal, with parental consent, legal minimum age at marriage for both girl and boy has been set at 18 years. If the boys and girls want to marry on their own then the minimum legal age at marriage for both girls and boys is 20 years. In many ethnic groups, this was hardly followed in the beginning and the mean age at marriage was quite low then. In some societies, girls are still married at younger ages indicating that the above mentioned legal provision is yet to be practiced to a full extent.
As discussed earlier, the increase in the proportion of men and women remaining single for different age group indicates that the mean age at marriage for men and women is increasing over the years.
Nepal Population Report 2011 - 25
26 - Nepal Population Report 2011
The trend of age at marriage since 1961 is provided in Table 2.7. It should be noted that the age at marriage provided below is calculated from the census data and is based on persons remaining single for different age categories.
These means are thus called singulate mean age at marriage.
2.5 Effect of Changes in Marital Status on Fertility:
The above discussions have shown that the singulate mean age at marriage is increasing (15 in 1961 to 20 years in 1991) and the proportion of widowed is decreasing (14.3percent in 1961 to 7.2percent 1991).
Table 2. 7 : Singulate Mean Age at marriage by sex, Nepal 1961-2001
Sex
Male
Female
Difference of age at marriage between male and female
Age at the marriage
1961
1971
1981
19.5
20.8
20.7
15.4
16.8
17.2
+4.1
+4
+3.5
1991
21.4
18.1
+3.3
2001
22.9
19.5
+3.4
Source : CBS 1995, 2003
Singulate Mean Age at Marriage
Table 2.7 indicates that the age at marriage for both the males and the females has been increasing gradually over the years. The 1991-2001 decade has shown a remarkable change in the Singulate mean age at marriage.
Perhaps, this increase is due to increasing urbanization and education
(including literacy) among men and women. Although data have not been presented here, the NDHS, 2001 has shown that education and urban residence are the key variables associated with higher ages at marriage among Nepalese men and women.
25
20
15
10
5
0
Male
Female
1961 1971 1981 1991 2001
Year
Figure 2. 2:Singulate Mean age at Marriage Men
Nepal Population Report 2011 - 27
The increase in age at marriage has a negative impact on fertility for two basic reasons. First women who marry later have a shorter reproductive life span and second the factors that affect the age at marriage also affects the desired family size norms thereby reducing fertility. For example, if a woman marries later because she is studying then her fertility will also be lower as her desired family size is smaller.
On the other hand, as most all of the births take place within marriage, decrease in the proportion widowed in the reproductive ages will increase the number of women at risk of child bearing. It is of interest to know the balancing effect of these two opposite forces operating on fertility. From the analysis of 1961 and 1991 census figures, it is observed that fertility was lower by 8.1 percent because of increased age at marriage, while it increased by about 2.2 percent due to declining widowed (CBS, 1995). In other words, the effect of increasing the age at marriage on fertility is much higher than the fertility increasing effect of lowering widowhood in Nepal.
2.6 Family Planning
Nepal’s Family planning programme started with the organization of Family
Planning Association of Nepal in 1959. In fact, Nepal was one of the first countries of South Asia, where information about family planning was available through a non-governmental programme. Since 1968 Government of Nepal has been actively involved in providing family planning services with the establishment of Nepal Family Planning and Maternal Child Health (NFP and MCH Project) project. Initially family planning programme was integrated with maternal child health services. Since the nineties, as all the health services were brought together, family planning has become an integral part of the country's health services.
Currently, besides the governmental programmes, different NGOs and INGOs are also providing family planning services as well as information education and communication services related to the family planning. Some of these institutions are a) Nepal Family Planning Association b) Care Nepal c) Plan international d) Nepal Red Cross society e) ADRA and f) Mary Stoves etc.
The National Health Policy (1991) related to the National Reproductive Health and Family Planning (RH/FP) Programme aims at increasing the coverage of the family planning services to the village level through health facilities and activities, such as a) hospitals, b) primary health care (PHC) centres, C) Health posts (HP), d) Sub health posts (SHP), e) PHC outreach clinics and f) mobile voluntary surgical contraception (VSC) camps. This health policy also attempts to sustain adequate quality of family planning services through adequately trained manpower as well as supplies.
28 - Nepal Population Report 2011
At the same time, the health policy also aims at mobilizing NGOs, social marketing organizations, and private practitioners to complement and supplement the efforts of the government. The governmental family planning programmes have trained and fielded community-level volunteers (TBAs,
FCHVs) for the promotion of condom distribution and the re-supply of oral pills.
Intensified IEC activities are also being carried out utilizing different media to increase awareness on RH/FP in the community. Moreover, through active involvement of FCHVs and Mothers’ Groups, it is expected that a high level of awareness will be reached in the community levels.
In Nepal family planning services are provided using a cafeteria approach; which means that different methods of contraception are made available to most of the health institutions and a client is to choose the method that suits his or her objectives. It is expected that this approach will not only increase the prevalence of contraceptive use but also reduce the fertility. This approach is also based on client’s right and option.
There has been a five-fold increase in the percentage of currently married women, who have heard about modern methods of contraception in the last
25 years (from 21 percent in 1976 to nearly 100 percent in 2006). This high level of knowledge is a result of the successful dissemination of family planning messages through the mass media as well as interpersonal communication established through mother groups, FCHVs and TBAs
2.6.4 Demand for Contraception
Unmet need for family planning has been defined as the proportion of women who want no more children or want children only after two years but are not using any form of contraception. On the other hand, current users of family planning methods are categorized as having a met need for family planning.
The total demand for family planning is defined as the sum of these two components. The Fertility, Family Planning and Health Survey of 1991, Nepal
Family Health Survey of 1996 and NDHS2001 provide data on met and unmet need of contraception. These data have been summarized in Table 2.8.
2.6.1 Objectives of Family Planning Programme in Nepal
Following are the major objectives of the family planning programme in Nepal.
•
•
•
•
Space and/or limit their children,
Prevent unwanted pregnancies,
Adolescent Reproductive Health and
Manage infertility
2.6.2 Targets
Nepal’s Family Planning programmes have the target of reducing the TFR from
4.1 per women in 2001 to 3.6 per women by the end of the Tenth Plan (2007) and to 2.1 in 2017. If we refer to the fertility chapter we can say that fertility th targets for the 9 plan have already been met as indicated by the NDHS, 2001.
In order to meet the fertility targets mentioned earlier, the contraceptive prevalence rate (CPR) has been envisaged to increase to 37 percent of currently married women of reproductive age (MWRA). As we will observe later in this chapter, this target has also been already met as indicated by the NDHS,
2001. The long-term target is to increase the CPR to 65percent by 2017.
Below we discuss the summary of findings in family planning obtained from the NDHS2001 survey.
From the Table it is clear that the total demand for family planning has been increasing over the years. In 1991 it was 51 percent, which increased to 67 percent in 2001. In a like-wise manner, there has been a nearly 72 percent increase in CPR during these 10 years. Because of the increase in CPR over the years the proportion of unmet need has decreased during the period 1996 and 2001. However, it is still around 28 percent indicating that the family planning programmes should target these groups to make their family planning demand met. If the programmes were successful in fulfilling the demand for family planning then the CPR would increase to 67 percent. In fact, the family planning programmes should have a two-pronged strategy in this area. One is to work towards fulfilling the unmet demand of contraception and the other is to increase the demand for family planning by decreasing the family size norm through intensive IEC activities.
Table 2. 8 : Demand for contraceptives among currently married women aged 15-49, Nepal, 1991-2001.
Years
1991
1996
2001
2006
Unmet need for contraception 27.7
31.4
27.8
24.6
percent currently using contraception(met need)
22.8
28.5
39.3
48.0
Total demand for contraception 50.5
59.9
67.1
72.6
2.6.3 Knowledge of Contraception
Source : MOH,1993,1997,2002,2007
In Nepal, the year 1976 marks the beginning of the first national level family planning and fertility survey. Since then a survey is being carried out at five year intervals. The first survey was the Nepal Fertility Survey, which was conducted in 1976 and the latest survey was conducted in 2006 which is known as Nepal Demographic Health Survey (NDHS 2006).
Out of the total demand, the demand for spacing is estimated to be 14.1 percent (4.8 percent use family planning to space, plus 9.4 have unmet need for spacing).
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30 - Nepal Population Report 2011
2.6.5 Current Use of Contraception
The current use of contraception or Contraceptive Prevalence Rate (CPR) is expressed as the percent of currently married women who report using a method at the time of the interview. The level of modern contraceptive use in
Nepal has increased gradually in the last two decades. This trend has been shown in Table 2.9 and Figure 2.3. The current use of contraceptives has gone up from 3 percent in 1976 to 48 percent in 2006. Of this 48 percent sterilization accounts for 24 percentage points and the users of temporary methods of contraception account for about 24 percentage points. Among methods, female sterilization has become most popular with nearly 18 percentage points, whereas male sterilization has not gained similar popularity. Table 2. 9 : Current use of Contraception among non-pregnant women (percent)
Nepal 1976 - 2006
Method
Any modern method Female sterilization Male sterilization Pill
InjecTables
Condom
Norplant
IUD
1976
NFS
2.9
1981
NCPS
1986
NFFS
1991
NFFS
1996
NFHS
2006
NDHS
28.8
2001
NDHS
38.9
7.6
15.1
24.1
0.1
2.6
6.8
12.1
13.3
16.5
18.0
1.9
3.2
6.2
7.5
6.0
7.0
6.3
0.5
0.0
0.3
0.1
1.2
0.1
0.4
0.1
0.9
0.5
0.6
0.1
1.1
2.3
0.6
0.3
0.2
1.5
5.0
2.1
0.5
0.3
1.8
9.3
3.2
0.7
0.4
3.5
10.1
4.8
0.8
0.7
44.2
NFS-Nepal Fertility Survey; NCPS-Nepal Contraceptive Prevalence Survey; NFFS Nepal Fertility and Family Planning Survey, NFHS - Nepal Family Health Survey, NDHS
Nepal Demographic Health Survey.
Source :MOH 2002a, 2006
Among the temporary methods of contraception, Depo-Provera accounts for
9 percentage points indicating that it is the most popular temporary methods of contraception. Although, one expects a larger proportion of CPR to come from temporary methods, it is still lower than the permanent methods.
However, surveys have indicated the increasing trend in the use of temporary methods of contraception in Nepal. This is an indication that more and more women are using contraception to space rather than limit births
Figure 2. 3: Contraceptive Prevalence Rate Nepal, 1976-2006
Although the uses of family planning methods have been increasing over the years, CPR in Nepal is still low. Serious efforts need to be carried out to increase the demand for the family planning services and to fulfill the unmet need for the family planning services. If family planning programs are to make a bigger dent on fertility then the IEC programmes should bring down the family size norms.
2.7 Breastfeeding
Breastfeeding is another important proximate determinants of fertility.
Although breastfeeding in Nepal is almost universal and prolonged, most women are not aware of its contraceptive effect. Breastfeeding increases the length of post-partum amenorrhea, thereby providing protection against pregnancy for some time after the birth of the child. Nepal Demographic
Health Survey 2001 indicated that breast-feeding is nearly universal and about 98 percent women breastfed their children after birth, indicating that this proportion has been more or less constant over the years. Differentials in breast-feeding indicate that younger, urban, and educated (literate) women are less likely to breast feed their children than their counterparts. Median duration of breastfeeding in Nepal has been observed to be 33 months in
Nepal.
The fertility reducing effect of breastfeeding arises from its role in lengthening the period of postpartum amenorrhea and consequently in extending the birth interval (in the absence of use of contraception). Studies have shown that the average length of inter-birth interval in Nepal is more than 30 months and there is a direct positive correlation between duration of breastfeeding and birth interval (UNFPA, 1989).
2.8 Abortion
Abortion is one of the ways to limit fertility. Practice of abortion is as old as the society itself. Although, access to induced abortion is restricted by law and prohibited by religion and customs in Nepal, its practice can not be denied.
Nepal Population Report 2011 - 31
32 - Nepal Population Report 2011
Many studies have found that abortion is widely practiced in Nepal. However, due to the fear of legal punishment, majority of women seek abortion clandestinely and most often they consult unskilled or unqualified health persons for abortion. This in most cases results in complications resulting in the deaths of mothers or hospitalization.
Recently, (in March 2002), the parliament has passed a bill legalizing abortion. The bill is to be noted. It is legal to have an abortion under the following three conditions provided the fact that conditions (a) and (b) are met
a) the health worker performing abortion is a skilled professional with license from Government of Nepal and b) if the woman, who is pregnant, consents to have an abortion.
•
If the fetus is less than 12 weeks old
•
If the pregnancy is the result of incest or rape and the pregnancy is less than 18 weeks
•
If the pregnancy results in health hazard of the mother or the unborn child or the pregnancy results in deformed/disabled child.
Chapter 3
Mortality
3.1 Mortality
Like fertility mortality is also one of the factors, which affect the structure, size and growth of a population. Mortality rates are based on death statistics, which usually come from vital registration data. Vital registration system normally follows the definition of death put forward by UN and WHO, which define death as “the permanent disappearance of all evidence of life at any time after a live birth has taken place”. Here one should note that birth refers to a live birth.
Mortality refers to deaths that occur within a population. While we all eventually die, the probability of dying within a given period is linked to many factors, such as age, sex, race, occupation, and social class. The incidence of death can reveal much about a population's standard of living and health care.
Death is the permanent disappearance of all evidences of life at any time after live births has taken place. A death can occur only after a live birth has occurred. The definition of a death can be understood, therefore only in relation to the definition of live birth.
In Nepal, earlier decline of mortality and later decline in fertility have resulted in relatively high rate of natural growth of population. The mortality decline is relatively faster due to increased access and improved health services. There has been secular decline in mortality during the recent past, but the decline in fertility is slower than the mortality. Consequently Nepal’s population is increasing fast.
Like fertility, there are different indices for the description of trend and level of mortality. Here we discuss some of these indicators. These are:
a) Crude Death Rate
b) Infant Mortality Rate
c) Child and Under 5 Mortality Rate
d) Maternal Mortality Ratio and
e) Life Expectancy
The main source of death data is the hospital death records and vital registration system. As vital registration system is still not efficient, there is a serious under registration of vital events. Consequently, the mortality indicators discussed below are either based on sTable or quasi-sTable population analysis or data based on survey, where both the direct and indirect measures of estimation are employed.
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34 - Nepal Population Report 2011
3.1.1 Crude Death Rate (CDR)
Crude Death Rate (CDR) is defined as the ratio of annual number of deaths to the person years of exposure to death during that period multiplied by a constant (usually 1000). It should be noted that for simplicity and ease of approximation, person-years of exposure is usually approximated by mid-year population. Like crude birth rate this is usually widely understood and is very frequently used summary measure of mortality. However, like CBR, CDR is also heavily affected by age and other compositional structure of the population. For example, it should be noted that age specific death rate at age 15-19 is very low compared to age specific death rate at 0-4 or 60-64 years of age. Therefore, combining all the deaths into one group and calculating the rate for all the population combined, ignores the age composition of the population. In two populations even if, the age specific death rates are exactly the same, if age-sex structure is different then they will have different crude death rates (CDR).
Different estimates of CDR for Nepal available since 1954 are provided in
Table 3.1. Because most of these estimates are based on sTable population techniques, these estimates do not present a very consistent trend.
Moreover, this could be also due to the use of different data that come either from censuses or surveys. It should be borne in mind that both of these sources of data suffer from inherent errors.
The Table indicates that CDR was a little over 35 in 1950s, which decreased to less than 20 in 1970s, and further to 9.6 in 2001. Despite fluctuations in the estimate of CDR, it can easily be concluded from the Table that mortality in
Nepal has been declining over the years.
Another thing that emerges from the Table is that these estimates consistently indicate higher mortality for females than males. Nepal is one of the few countries in the world where female mortality is higher than male mortality.
There is no reliable information on Age Specific Death Rates (ASDR) in
Nepal, which could provide mortality information for different age groups. The lack of reliable estimates of adult mortality by age has led us to use CDR.
Table 3. 1;Crude Death Rate, Nepal, 1954 - 2006
Source
Estimate d duration
1. Vaidhyanathan & Gaige, 1973
2. CBS, 1977
3. Guvaju, 1975
4. CBS, 1977
5. CBS, Demographic Sample Survey,1976
6. CBS, Demographic Sample Survey,1977
7. CBS, Demographic Sample Survey,1978
1954
1953-61
1961
1961-71
1974-75
1976
1977-78
Crude death rate
Total
36.7
27.0
22.0
21.4
19.5
22.2
17.1
Male
28.0
21.3
18.6
21.5
17.9
Female
24.8
22.6
20.4
22.8
16.2
Nepal Population Report 2011 - 35
8. CBS, 1977 (Census data)
9. New Era, 1986
10. CBS, Demographic Sample Survey, 1986
11. CBS Census
12. CBS
13. MOPE*
14 MOHP
15 CBS
1971-81
1984
1985-86
1991
1996
2001*
2006
2008
13.5
10.9
16.1
13.3
11.6
9.62
9.0
8.3
12.2
10.8
12.9
-
14.9
11.0
13.6
-
Source : CBS, 1995; CBS, 1998; MOPE, 1998
* Projected Mortality
3.1.2 Infant Mortality Rate (IMR)
The IMR is the number of deaths under one year of age per 1000 live births during a year. Although it is called a rate, in fact, it is the probability of dying before the first birthday. Several factors affect the IMR of a country:
a)
Nutrition of mothers and children
b)
Birth intervals
c)
Parity
d)
Age of mother at child’s birth
e)
Mother’s education and economic status
f)
Basic health services including:
i.
Immunization
ii.
ARI
iii.
Diarrhea
iv.
Safe motherhood program
v.
Environment etc;
In other words, IMR usually declines with a certain level of socio-economic development as reflected by the above mentioned factors. Therefore IMR has been commonly considered as an indicator to assess socio-economic development and general health condition of a society. However the adult mortality is relatively lower even in developing countries and a smaller proportion of population is in the older group, a substantial number of deaths occur during the first five years of life. In developing countries where health system is not fully developed, infant death is a substantial part of under five deaths. Therefore, reduction in IMR is a fundamental strategy to achieve a significant reduction in the overall mortality. Moreover, the interdependent relationship between fertility and infant mortality suggests that a reduction in infant mortality will trigger a subsequent decline in fertility. It has also been found that a lower IMR motivates couples to produce fewer number of children. 36 - Nepal Population Report 2011
Table 3. 2: Infant Mortality Rate, Nepal, 1954 – 2006
Source
1. Vaidhyanathan & Gaige, 1973
2. Guvaju, 1974
3. CBS, 1974
4. Nepal Fertility Survey, 1976
5. CBS, 1985
6. New Era, 1986
7. Fertility and Family Planning Survey,1986
8. Fertility and Family Planning Survey, 1991
9. Census, 1991
10. Nepal Family Health Survey,1996
11. Nepal Demographic Health Survey,2001
12. Nepal Demographic Health Survey, 2006
Reference
Period
1954
1961-71
1971
1976
1978
1981
1983-84
1989
1991
1993-96
2001
2006
Infant mortality rate
Total
172
152
144
117
108
102
97
79
64
48
Male
260
200
147
136
117
94
79.2*
60*
Female
250
186
142
111
98
101
75.2*
61*
Source : CBS, 1995; MOH 1997, 2002a.
* IMR estimates are based on births 10 year prior to the survey
Table 3.2 provides estimates of infant mortality based on different sources. It should be noted that since 1991 all the estimates of infant mortality are based on direct estimates of the rates except for the census estimate for 1991, which used indirect techniques of estimation. Since the 1991 survey it has been argued that the quality of pregnancy history data has improved and there is a little omission of births and deaths especially during the recent past. As the effect of these omissions on the calculation of demographic rates is minimal, direct method of IMR estimation has been used since then.
Table 3.2 indicates that a high IMR of around 250 per thousand live births prevailed in the country during the fifties. In the sixties it was decreased to around 150 to 200 per thousand live births. Since the mid seventies, decline in
IMR is secular and during 2001-2005 it has reached 51 per 1000 live births.
This also indicates that IMR for female babies are slightly lower than that for male babies.
Infant mortality is affected by various socio-economic and demographic factors. These factors are of particular interest, since these provide clues for the identification of priority groups in policy formulation and program implementation. Differentials in IMR have been presented in Table 3.3.
Before the data in Table 3.3 is discussed, it should be noted that the estimate of IMR from NFHS 1996 and NDHS 2006 presented in Table 3.2 were based on births that occurred during the preceding three to five years. The estimate of infant mortality differentials presented in Table 3.3 is based on births that occurred during the preceding 10-year period. Both of these surveys indicate that mother's education, place of residence; birth interval and age of mother have great influence on IMR. IMR for those babies whose mothers age is less
Nepal Population Report 2011 - 37
than 20 years and are born in the birth interval of less than two years, are much higher than those babies whose mother’s are aged 20+ and are born after a birth interval longer than two years. In general the differentials observed during the 1996 survey seem to have decreased in the 2001 and
2006 surveys. This indicates that decrease in IMR is somewhat faster in groups where IMR used to be higher.
Table 3. 3: Infant Mortality Rates by socio-economic & demographic characteristics, Nepal, 1996-2001
(for ten year period preceding the survey)
Characteristics
NFHS 1996
NDHS 2001
NDHS 2006
Residence
Urban
Rural
Ecological Region
Mountain
Hill
Terai
Development Region
Eastern
Central
Western
Mid-western
Far western
Education
No education
Primary
Secondary
SLC and above
Age of mother at birth**
< 20
20-29
30-39
40-49
Previous birth interval**
< 2 yrs
2-3 yrs
3
4+
Sex of Child**
Male
Female
61.1
95.3
50.1
79.3
37
64
136.5
87.4
90.9
112
66.2
80.8
99
47
65
79.4
86.3
84.3
114.8
124.3
77.5
77.4
60.1
72.9
112.2
45
52
56
97
74
97.5
80
53.4
-
84.6
61
49.9
69
58
35
13
120.1
79.5
103.9
-
108.2
67.6
72.9
-
83
50
62
91
141.4
78.8
44.7
124.4
67.8*
45.2
38.9
96
57
38
28
101.9
83.7
79.2
75.2
60
61
*Refers to two year birth interval. Source : MOH, 1997, NDHS2001
**Refers the rates calculated for 10 year period preceeding the survey.
38 - Nepal Population Report 2011
3.1.3 Child and Under 5 Mortality
Before we present the data from the two recent surveys i.e. NDHS 2001 and
NDHS 2006, the definitions of these mortality indicators are in order. Child mortality rate is defined as the probability of dying between age one and five.
This assumes that the child has already survived to age one to begin with.
Under-five mortality rate is defined as follows. Of the 1000 children born today th how many will die before their 5 birthday?. In other words, it is probability of dying between birth and before their fifth birthday. It should be noted once again that the estimate of these indicators are based on the births that occurred during the last five years. Data on child and under five mortality obtained from NDHS 2006 has been summarized in Table 3.4.
Table 3. 4: Child and under 5 mortality rates for five year periods preceding the survey Nepal 2006
Years preceding the Survey
Child Mortality
0-4
5-9
10-14
Under 5 mortality
14
26
38
61
96
117
Source : NDHS 2006, MoHP
The Table indicates that the child mortality 0-4 years preceding the survey is
38 percent of what it was 10-14 years preceding the survey. In other words there has been a remarkable decline in child mortality during the last 15 years.
A very similar picture in decline in under five mortality can also be seen.
Table 3. 5: Child and under 5 Mortality Rates by socio-economic & demographic characteristics, Nepal,
(for ten years period preceding the survey)
Characteristics
NDHS 2001
Child
Under 5
Mortality
Mortality
NDHS 2006
Child
Under
5
Mortality
Mortality
Residence
Urban
Rural
Ecological Regions
Mountains
Hill
Terai
Development Regions
Eastern
Central
Western
Mid Western
Far western
Education
16.7
35.4
65.9
111.9
10
21
47
84
51.2
29.7
34.8
157.4
93.9
112.8
32
16
21
128
62
85
29.6
36.4
25.1
41.2
41.7
104.8
110.9
83.7
111.0
149.2
15
17
18
28
28
60
68
73
122
100
Nepal Population Report 2011 - 39
No education
39.5
Primary
13.4
Secondary
14.3
S.L.C.+
3.7
Age of the mother at birth of the child
2011
Nepal Population Report 2011
Published by:
Government of Nepal
Minstry of Health and Population
Population Division
Ramshahpath, Kathmandu, Nepal
Tel No.: 01- 4262987
600 pcs
Website: www.mohp.gov.np/population
Government of Nepal
Ministry of Health and Population
Population Division
Ramshahpath, Kathmandu, Nepal
Nepal Population Report 2011 - 1
Printed by:
Saugat Printing Press
Anamnagar, Kathmandu.
Phone: 4233474
2 - Nepal Population Report 2011
Preface
Acronyms
This report is an analytic version of the demographic situation, structures; trends related with socio-economic and cultural aspects and are prepared on the information based on population census 2001 and other related surveys, reports, plan/policies and estimations of population and reproductive health.
On behalf of the Ministry of Health and Population, I would like to thank
Centre for Social Sciences Studies (COSSS) for undertaking the status review task and preparing this report. Likewise, I would like to thank all those individuals and organizations who extended their support and provided us relevant information. I would also like to thank my colleagues of Population
Division.
I hope this report will be of great value to researchers, policy makers, students, teachers, various institutions and the public at large.
Padam Raj Bhatta
Chief
Population Division
Nepal Population Report 2011 - 3
ARI
ASDR
AIDS
ASFR
BCC
CDPS/TU
-
CBOs
CBS
CDR
CMR
CPR
CTEVT
DOHS
FPAN
GDP
GOs
HIV
ICPD
IDU
IMR
IEC
INGO
IDU
LLPM
MMR
MoHP
NDHS
NFFS
NFHS
NGO
NHEICC
-
NPC
POA
PPP
PRSP
PHC
RH
STD
TBA
TFR
The high rate of population growth in Nepal has affected both social and economic aspect of Nepalese people in general. Excessive population growth has caused increased pressure on limited resources available in the country.
This Nepal Population Report presents a status review of the population and its dimensions in Nepal. The report also includes the population policies and programmes that are implemented by different government and other agencies in Nepal.
-
Acute Respiratory Tract Infection
Age Specific Death Rate
Acquired Immune Deficiency Syndrome
Age Specific Fertility Rate
Behavioral Change Communication
Central Department for Population Studies, Tribhuvan
University
Community Based Organizations
Central Bureau of Statistics
Crude Death Rate
Child Mortality Rate
Contraceptive Prevalence Rate
Council for Technical Educational and Vocational Training
Department of Health Services
Family Planning Association of Nepal
Gross Domestic Product
Government Organization
Human Immune Deficiency Virus
International Conference on Population and Development
Injecting Drug User
Infant Mortality Rate
Information, Education and Communication
International Non Governmental Organization
Injecting Drug Users
Local Level Population Management
Maternal Mortality Ratio
Ministry of Health and Population
Nepal Demographic and Health Survey
Nepal Fertility and Family Planning Survey
Nepal Fertility, Family Planning and Health Status Survey
Non Governmental Organization
National Health Education, Information and Communication
Centre
National Planning commission
Programme of Action
Population Perspective Plan
Poverty Reduction Strategies Paper
Primary Health Centre
Reproductive Health
Sexually Transmitted Diseases
Traditional Births Attendant
Total Fertility Rate
4 - Nepal Population Report 2011
Table of Contents
Chapter 1
Demographic Situation
1
Chapter 2
Fertility and its Proximate Determinants
19
Chapter 3
Mortality
34
Chapter 4
Migration
43
Chapter 5
Urbanization
49
Chapter 6
Education, Language, Religion and Ethnicity
54
Chapter 7
National Health Policies and Programs
62
Chapter 8
Women Empowerment
86
Chapter 9
Ageing
91
Chapter 10
Economically Active Population
102
Chapter 11
Sources of Demographic Data
109
Chapter 12
Population Policies and Programmes
115
Chapter 13
International Conferences
132
Chapter 14
Millennium Development Goals
138
Chapter 15
Poverty in Nepal
143
Chapter 16
Population Projections for Nepal 2001 – 2021
154
Chapter 17
Social Exclusion, Population and Conflict
160
Nepal Population Report 2011 - 5
6 - Nepal Population Report 2011
Chapter 1
Demographic Situation
These population growth figures for the world as a whole suggest that the rate of growth of population was quite low during earlier years when fertility and mortality were quite high. The growth rate slowly started to increase as mortality started to decline.
1.1 What is Population?
Years to Add Each Billion to
World Population
The word “Population” usually denotes all the inhabitants of a specified geographical area at a given time. This is concerned with its size, its structure and characteristics, its distribution and the changes taking places due to the interaction of fertility, mortality and migration.
The study of human population can be encompassed into two types of demography: formal demography and Population studies. Donald Bogue, in his book entitled
“Principles of Demography” defines “demography as the statistical and mathematical study of the size, composition and spatial distribution of human population, and of changes over time in these aspects through the operation of the five processes of fertility, mortality, marriage, migration and social mobility. Although it maintains a continuous description and comparative analysis of trends, in each of these process and their net result, its long run goal is to develop a body of theory to explain the events that it charts and compares(1969).However, population studies is concerned with population compositions and changes from substantive viewpoints anchored in another discipline. By definition, population studies are interdisciplinary, bordering between formal demography and a substantive discipline that is often, but not necessarily, a social science.
1.2 Population Situation of the world and SAARC region
It is important to study the history of world’s population growth rate to find out how the growth of population varies in different parts of the world. The world's population was estimated at about 300 million in the year A.D. 1, which increased to about 500-800 million by 1750 A.D. The average annual growth rate of population during the period 1 A.D. to 1750 A.D was around 0.56 per
1000 per year, while the growth rate for the period 1750 to 1800 was th estimated around 4.4 per 1000 per year. In the beginning of the 19 century world population was estimated to be around one billion. By 1850 the population has already increased by 300 million i.e. world population in 1850 was estimated to be 1.3 billion. By 1920 the population reached 2 billion, which was estimated to be 3 billion by 1960 (Coale 1974). The next billion in world’s population was added by 1975. World reached a population of 5 billion in 1987. It was estimated that the population of the world reached six billion in October 12, 1999.
Table 1. 1: World Population (in Millions)
Year
Population
1750
791
1800
978
1850
1262
1900
1650
1950
2521
1999
5978
Source : PRB datasheet 2010.
Nepal Population Report 2011 - 1
First
(1800)
All of Human History
Second
130 years (1930)
Third
30 years (1960)
Fourth
14 years (1974)
Fifth
13 years (1987)
Sixth
12 years (1999)
Seventh
12 years (2011)
Eighth
13 years (2024)
Sources: UN Population Division and Population Reference Bureau.
© 2010 Population Reference Bureau. All rights reserved. www.prb.org
Figure 1. 1:Years to Add Each Billion to World Population
At some point around 1800, after untold millennia of human history, global population reached its first billion. The world’s population now grows by 1 billion about every 12 years. The 20th century began with 1.6 billion and, at the end of that century; those two numbers had simply reversed to 6.1 billion.
If birth rates continue to decline in developing countries, the increase to 8 billion could take slightly longer (PRB 2010). It is estimated that world population has reached 7 billion in 2011.
Table 1. 2: Selected Demographic Indicators of World,2010
Indicators
Midyear Population
(million) 2010
Rate of Natural
Increase
Projected Population
(million) 2025
Projected Population
(millions) 2050
Crude Birth Rate
Crude Death Rate
2050 Population as a multiple of 2010
Urban Population
(percent)
Infant Mortality Rate
World
Less
Developed
Regions
5656
Least
Developed
Asia
Nepal
6892
More
Developed
Regions
1237
857
4157
28
1.2
0.2
1.4
2.3
1.2
1.9
8108
1290
6819
1172
4845
35.7
9485
1326
8159
1710
5424
46.1
20
8
1.4
11
10
1.1
22
8
1.4
35
12
2
19
7
1.3
28
8
1.6
50
75
44
27
43
17
46
6
50
81
41
48
2 - Nepal Population Report 2011
Life
Expectancy
at birth Male
Female
Total
Total Fertility Rate
Population under Age
15 Years (%)
Population Aged 65 years above (%)
Contraceptive
Prevalence Rate
Any method
Modern Method
Population with
HIV/AIDS among the population aged 1559 years (%)
Male
Female
67
74
66
55
69
64
71
69
2.5
27
81
77
1.7
17
68
67
2.7
30
57
56
4.5
41
74
72
2.2
26
65
64
3
37
8
16
6
3
7
4
USA
Indonesia
Brazil
Pakistan
Bangladesh
Nigeria
Russia
Japan
310
235
193
185
164
158
142
127
USA
Pakistan
Nigeria
Indonesia
Bangladesh
Brazil
Ethiopia
Congo, Dem. Rep.
423
335
326
309
222
215
174
166
Source : PRB datasheet 2010
62
55
71
60
60
54
29
23
66
60
48
44
0.8
0.7
0.9
1.9
0.3
0.7
0.9
0.3
1.1
2.7
0.2
0.3
Population Density
(per sq. miles)
51
23
68
41
130
191
GNP Per capita (2008 in US$)
Mobile Phone
Subscribers per 100
Inhabitants
10030
32370
5150
1240
6000
1120
60
109
49
21
49
15
Table 1. 4: Selected Demographic Indicators of the SAARC regions, ,2010I
Source : PRB datasheet 2010.
By 1950, nearly one third of the world's population lived in the developed countries, but this proportion is declining over the years as the growth rate of population in less developed countries are substantially higher than that in developed one. The average growth rate of the world population has been estimated at 1.2 percent per annum. In the less developed regions this rate is around 1.5 percent while it is much lower in more developed regions. It has been projected that the world’s population will reach 9.5 billion by 2050.
Some demographic indicators of the world have been presented in Table 1.2
Table 1.3 shows the most populous ten countries in the world in the year
2010 and projected for 2050. India will be most populous country in 2050. In
2050, three countries from SAARC will reached at most ten populous countries. Table 1. 3: Ten most populous countries in the world
Country
China
India
The following Table shows the comparative demographic situation in the
SAARC region. India is the most populous country followed by Pakistan. Total fertility rate is highest in Afghanistan and other demographic indicators also show the worse situation in the country.
2010
Population (million) Country
1338
India
1189
China
2050
Population (million)
1748
1437
Nepal Population Report 2011 - 3
Indicators
Mid year
Population
(million) 2010
Projected
Population
(million) 2025
Crude Birth
Rate
Crude Death
Rate
Urban
Population
(percent)
Infant Mortality
Rate
Life
Male
Expect Female ancy at Total birth Total Fertility
Rate
Population under
Age 15 Years (%)
Contraceptive
Prevalence Rate
Any method
Modern Method
Srilanka India Pakistan Afgha nistan 20.7 1188.8 184.8
29.1
23.2
1444.5 246.3
Bhutan
0.7
Bangl Maldiv adesh es
164.4
0.3
Ne pal 28
39.4
0.9
195
0.4
35.
7
19
19
30
39
25
39
22
28
7
6
7
18
8
18
3
8
15
29
35
22
32
25
35
17
15
53
64
155
40
45
12
48
72
76
74
63
65
64
66
67
66
44
44
44
67
68
68
65
67
66
72
74
73
64
65
64
2.4
2.6
4.
5.7
3.1
2.4
2.5
3.0
26
32
38
44
31
32
30
37
68
53
56
49
30
22
19
16
31
31
56
48
35
27
48
44
Source : PRB datasheet 2010
4 - Nepal Population Report 2011
Population Clock, 2010
Table 1.5 describes the current population change with the form of population clock. Implicit in the classical demographic transition theory is the concept of modernization and development, which brings about changes in mortality and fertility. Initially decline in mortality takes place and fertility decline is the response to this decline in mortality. Timing of fertility response depends on the levels of development and modernization in the countries concerned.
Table 1. 5: Population Clock 2010
WORL D
6,892,319,000
Population
Births per
Year
Day
Minute
More Developed
Countries
1,236,646,000
Less Developed
Countries
5,655,673,000
140,184,169
384,066
267
14,215,211
38,946
27
125,968,959
345,120
240
56,907,606
155,911
108
12,125,055
33,219
23
44,782,552
122,692
85
83,276,563
228,155
158
2,090,156
5,726
4
81,186,407
222,429
154
6,383,531
17,489
12
80,133
220
0.2
6,303,398
17,270
12
Deaths per
Year
Day
Minute
Natural increase (birthsdeaths) per
Year
Day
Minute
Infant deaths per
Year
Day
Minute
However, this explanation of fertility and mortality decline was challenged by new information obtained from the European Fertility Project, which found no evidences of association between socio-economic development and demographic change (Knodel and van de Walle (1979). Caldwell provided further critique to demographic transition theory by stressing the importance of western values regarding nuclear families. In another words, western values were more important than the level of development (Caldwell1976).
Caldwell’s argument has also been challenged by different studies, which have cited the presence of nuclear families before the demographic transition
(Smith 1982). In a similar manner, although there has been a remarkable decline in fertility in Taiwan, extended family system is still in place thereby indicating that nuclear family (westernization) is not the prerequisite for fertility decline (Sun et. al.1978).
Stage 1
Stage 2
Stage 4
Birth rate
Natural
increase
1.3 Demographic Transition
Demographic transition is a description of the observed long-term trends in fertility and mortality and a model, which attempts to explain them. Demeny
(1972) has summarized it very succinctly “In traditional societies both the fertility and mortality are high and in modern society both the fertility and mortality is low. In between, there is a demographic transition”.
Death rate
First proponents of demographic transition theory were Thompson (1929),
Davis (1945) and Notestein (1945). Three basic elements of the transition can be obtained from their writings;
a) It describes the changes that have taken place in fertility and mortality over time.
b) It attempts to construct theoretical causal models to explain the changes that have taken place.
c)
Stage 3
Prediction for the changes, which might occur especially in the developing countries in the light of the experience of the developed countries. Nepal Population Report 2011 - 5
Time
Figure 1. 2: Demographic Transition Model
Although there is still some controversy over the demographic transition theory, it is still an important theory commonly discussed to explain the demographic changes, which are taking place around the world. Basically it can be described in four stages (Fig 1.2). The first stage of demographic change is the time when both the fertility and mortality fluctuate and are quite high. This is the period when the natural growth rate of population is quite low.
6 - Nepal Population Report 2011
The second stage of transition is when the mortality starts to decline while fertility remains more or less constant. This is the period when the growth rate starts to increase and reaches the maximum just before the decline in fertility starts to take place. At the third stage, fertility also starts to decline as a response to declining mortality. Finally the fourth stage is when fertility and mortality are quite close and fertility is close to replacement and fluctuates according to different environmental conditions.
As we will see later, mortality in Nepal started to decline since the late fifties and the pace of mortality decline has become faster since the 1990s. If one looks at the fertility transition in Nepal one would find that fertility started to decline much later and at much slower speed than mortality. For example, fertility in Nepal was more or less constant till early eighties and started to decline thereafter. Thus it can be argued that Nepal is in the third phase of demographic transition where both the fertility and mortality are declining.
1.4 Size and Growth Rate of Population of Nepal.
Geographically Nepal is situated between China and India. These two neighbours are the most populous countries in the world with both having more than one billion people. Nepal’s population of 28 million (projected for
2010) is very small compared to its neighbours. Although the size of the
Nepalese population compared to its neighbours is quite small, its high rate of population growth has been a matter of great concern for the country.
Census operation started in Nepal since 1911. Initial censuses till 1952 were more or less head count based on household level information. The first census of Nepal (1911) yielded a population size of 5.6 million. Since then, census count has been conducted more or less at ten-year intervals. In the census of 1952/54, technical assistance in conducting the census was obtained from United Nations and in fact this census can be regarded as the first scientific census ever conducted in Nepal. Because of different reasons, this census was carried out at two points in time. For example, eastern part of the country was enumerated in 1952, while the western half was enumerated in 1954. Because the enumeration was carried out in two points in time, the
1961 census is generally accepted as the first scientific census in terms of international standard and comparisons.
According to the latest census of 2001, Nepal’s population was 23,151,423 as of June 2001. The average annual growth rate of population during the last decade i.e. 1991-2001 was 2.25 percent (CBS 2002). The census also revealed that the sex ratio i.e. males per 100 females was 99.8. In other words 49.95 percent of the total population was male, while the females comprised 50.05 percent of the population. The total population obtained in different censuses of Nepal, corresponding growth rates and times to double the population have been presented in Table 1.6. It should be noted that during the 2001 census, some of the districts could not be fully covered because of security reasons. Based on household level form and estimation
Nepal Population Report 2011 - 7
total population of Nepal were 23,151,423. Individual information (form-2) was filled in for only 22,736,934 individuals. Thus detailed data are available only for this number of persons.
Table 1. 6: Population size, growth rate and doubling time, Nepal,1911 – 2001
Census
year
1911
1920
1930
1941
1952-54
1961
1971
1981
1991
2001
Total
Population
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
Population
Change
- 64,961
41,214
7,51,075
19,72,976
11,56,371
21,42,987
34,66,856
34,68,258
46,60,326
Annual Growth Rate
(Exponential)
-0.13
-0.07
1.16
2.27
1.64
2.05
2.62
2.08
2.25
Doubling
Time
60
31
42
34
26
33
31
Source; CBS 2002
Fluctuations in the annual growth rate of population mostly relate to the quality of data obtained in the census notably the coverage and undercount and possibly over-count in different censuses. The Table shows that the rate of population growth in Nepal is still quite high (2.25percent). This high rate of growth of population has affected almost every aspect of life, both social as well as economic. It has caused increased pressure on limited land resource as more and more marginal land is being cultivated. The population growth has also led to shortages of food at places. Because of the need to farm marginal land for food production, forests are being depleted, which have resulted in frequent landslides, floods as well as soil erosion. High rate of population growth also warrants increased spending on the social services such as education, health, drinking water and other basic needs. It has increasingly been difficult to meet the growing demands of people for these services. 1.5 Population Distribution
1.5.1 Spatial Distribution
Nepal has three distinct ecological regions. These are mountains, which are defined as area that lies between the altitude of 4877 and 8848 meters comprise 35 percent of land area, while hills are defined as area that lies between the altitude from 610 to 4876 meters and comprises 42 percent of land area. Altogether these regions comprise about 77 percent of the total area and have about 52 percent of the total population in 2001. The Terai region lies below the elevation of 610 meters. It comprises of 23 percent of the total land area and contains nearly 48 percent of the population. The data in Table 1.7 also clearly show that the proportion of population living in Terai
8 - Nepal Population Report 2011
is increasing, while the proportion of people living in the hill and mountain is declining over the years. This disproportionate distribution of population among ecological regions of Nepal is most probably due to many reasons.
Some of these reasons could be
a)
b)
c)
d)
e)
f)
Unequal distribution of resources
Availability of productive land in Terai,
Difficult topography of Hill and Mountain
Disparity in socio-economic development and
The lack of basic facilities and infrastructure in these regions.
Lack of access to information.
Table 1. 8: Population Growth Rate by Ecological Region, Nepal, 1961/71 –
1991/2001
Geographic region Inter-census period
Average Annual Growth Rate
1971/81
1981/91
1.35
1.02
1.65
1.61
4.11
2.75
2.66
2.08
1961/71
Mountain
Hill
Terai
Total
1.85
2.39
2.05
1991/01
1.57
1.97
2.62
2.25
Source: CBS, 1995 CBS 2002.
Table 1. 7: Population Distribution by Ecological Zones Nepal .1952/54 - 2001.
Census yrs.
1952/54
Mountain
-
Hill
-
1961
-
-
1971
1138610
(9.9)
1302896
(8.7)
1443130
(7.8)
1687859
(7.3)
6071407
(52.5)
7163115
(45.5)
8419889
(45.5)
10251111
(44.3)
1981
1991
2001
Mountain & Hill
5349988
(64.8)
5991297
(63.6)
7210017
(62.4)
8466011
(56.4)
9863019
(53.3)
11938970
(51.6)
Terai
2906637
(35.2)
3421699
(36.4)
4345966
(37.6)
6556828
(43.6)
8628078
(46.7)
11212453
(48.4)
Total
8256625
9412996
11555983
15022839
18491097
23151423
1.6 Population Distribution by Development Region
If one looks at the Nepal’s population by development regions, one would find that the highest proportion of population is in the Central Development Region and Far-Western Development Region has the lowest proportion of population. During 1981-91, the population growth rate has gone down in all the development regions as compared to previous decades. The decrease in growth rate was highest in the Eastern Development Region. It should be noted that this deceleration in population growth could also be the result of the undercounting and over-counting of population in different censuses concerned. Table 1. 9: Population Distribution and Growth by Development Regions Nepal,
1981 – 2001
Note: The figures in Parenthesis indicate percentages.
Source: CBS 1995, 2002
Development
Region
These factors have led to increased migration to the Terai area from hills and mountains and at the same time flow of immigrants from the bordering country have played crucial role in the increased population living in the Terai region.
Eastern
1.5.2 Population growth rate by ecological region
Central
The rate of increase of population is higher in the Terai compared to the hills and mountains. During the decade of 1971-81, population in the Terai has increased by 4.1 per cent. However, the population growth rate has gone down during 1981-91, in all the three geographical regions. During the period
1991-2001 rate of population growth has increased in the hills and mountains but has slightly decreased in the Terai. Still the growth rate of population in the Terai is much higher than that of the hills or mountains.
Western
Mid-West
Far-West
Total
Distribution of Population(%)
1981
1991
2001
3708923
(24.49)
4909357
(32.68)
3128859
(20.83)
1955611
(13.02)
1320089
(8.78)
15022839
(100)
4446749
(24.05)
6183955
(33.44)
3770678
(20.39)
2410414
(13.04)
1679301
(9.08)
18491097
(100)
Source : CBS 2002, 2003
Nepal Population Report 2011 - 9
10 - Nepal Population Report 2011
Average Annual Growth Rate (%)
1971-81 1981-91
19912001
5344476
2.86
1.83
1.84
(23.09)
8031629
2.42
2.33
2.61
(34.09)
4571013
2.49
1.88
1.92
(19.74)
3012975
2.77
2.11
2.26
(13.01)
2191330
3.25
2.44
2.26
(9.47)
23151423
2.66
2.08
2.25
(100)
Eastern development region had a growth rate of 2.86 per cent per year in
1971-81 decade, which decreased 1.83 percent in 1981-91 decade. However, the growth rate of Central Development Region came down merely to 2.33 percent from 2.42 percent per year. During the decade 1991 to 2001 highest growth rate was recorded for Far-Western Development Region
(2.66percent), while the second highest rate of growth was recorded for
Central Development Region (2.61percent).
1.7 Growth rate and distribution of population by districts
The distribution and the growth rate of population by districts over the census years are presented in Table 1.6. Kathmandu district has the largest population as indicated by the different censuses of Nepal. The census of
2001 showed a population of 1081845 in the Kathmandu district. The smallest population was recorded in the Manang district. The census of 2001 showed that the population in the Manang district was 9587. The Table 1.10 also provides area of the districts as well as population density per square kilometer. Kathmandu district has the highest density with 2739 persons per square kilometer. The lowest population density was observed for the Dolpa district with 3.7 persons per square kilometer.
120780
153746
178356
479743
534692
344594
129781
92454
129414
192689
88245
137640
212571
159805
379055
375358
432569
361054
398766
183705
161445
134698
202056
282806
688109
843220
625633
166479
113111
159203
203018
107686
156702
231385
287689
570282
572399
671364
553481
635701
279821
212408
1241
1703
1606
1855
1257
891
679
3480
1507
3312
1074
1591
2063
1363
1188
1180
1002
1259
2491
1546
162.8
166.1
428.5
454.6
497.7
186.8
166.6
45.7
134.7
32.5
145.9
145.4
139.5
418.4
481.8
569.0
552.4
504.9
112.3
137.4
Average
Annual
Growth
Rate19912001
120053
175206
229214
593737
674823
463481
146386
102870
141903
198784
97200
139457
215965
221256
465668
460746
543672
440146
492798
223900
188064
Population
Density
per sq km
2001
Taplejung
Panchthar
Ilam
Jhapa
Morang
Sunsari
Dhankuta
Terhathum
Sankhuwasabha
Bhojpur
Solukhumbu
Okhaldhunga
Khotang
Udayapur
Saptari
Siraha
Dhanusha
Mahottari
Sarlahi
Sindhuli
Ramechhap
1991
District
1981
Population
Area in sq. Kms.
Table 1. 10: Distribution and the Growth Rate of Population by Districts, Nepal 1981-2001
1.43
2.10
1.48
2.23
3.00
1.29
0.95
1.15
0.21
1.02
1.17
0.69
2.63
2.03
2.17
2.11
2.29
2.55
2.23
1.22
Nepal Population Report 2011 - 11
Dolakha
Sindhupalchok
Kavrepalanchowk
Lalitpur
Bhaktapur
Kathmandu
Nuwakot
Rasuwa
Dhading
Makawanpur
Rautahat
Bara
Parsa
Chitawan
Gorkha
Lamjung
Tanahun
Syangja
Kaski
Manang
Mustang
Myagdi
Parwat
Baglung
Gulmi
Palpa
Nawalparasi
Rupandehi
Kapilvastu
Arghakhanchi
Pyuthan
Rolpa
Rukum
Salyan
Dang
Banke
Bardiya
Surkhet
Dailekh
Jajarkot
Dolpa
Jumla
Kalikot
Mugu
Humla
148510
234919
307150
199688
144420
426281
210549
30241
236647
243411
332526
318957
284338
259571
231294
152720
223438
271824
221272
7021
12930
96904
128400
215228
238113
214442
308828
379096
270045
157304
157669
168166
132432
160734
266393
197152
198544
167111
165612
99312
22043
68797
79736
35287
28721
173236
261025
324329
257086
172952
675341
245260
36744
278068
314599
414005
415718
372524
354488
252524
153697
268073
293526
292945
5363
14292
100552
143547
232486
266331
236313
436217
522150
371778
180884
175469
179621
153554
181785
354413
285604
290313
225768
187400
113958
25013
75964
88805
36364
34383
12 - Nepal Population Report 2011
204229
305857
385672
337785
225461
1081845
288478
44731
338658
392604
545132
559135
497219
472048
288134
177149
315237
317320
380527
9587
14981
114447
157826
268937
296654
268558
562870
708419
481976
208391
212484
210004
188438
213500
462380
385840
382649
288527
225201
134868
29545
89427
105580
43937
40595
2191
2542
1396
385
119
395
1121
1544
1926
2426
1126
1190
1353
2218
3610
1692
1546
1164
2017
2246
3573
2297
494
1784
1149
1373
2163
1360
1738
1193
1309
1879
2877
1462
2955
2337
2025
2451
1502
2230
7889
2531
1741
3535
5655
93.2
120.3
273.6
877.4
1894.6
2738.8
257.3
29.0
175.8
161.8
484.1
469.9
367.5
212.8
79.8
104.7
203.9
272.6
188.7
4.3
4.2
49.8
319.5
150.7
258.2
195.6
260.2
520.9
277.3
174.7
162.3
111.8
65.5
146.0
156.5
165.1
189.0
117.7
149.9
60.5
3.7
35.3
60.6
12.4
7.2
1.65
1.59
1.73
2.73
2.65
4.71
1.62
1.97
1.97
2.22
2.75
2.96
2.89
2.86
1.32
1.42
1.62
0.78
2.62
5.81
0.47
1.29
0.95
1.46
1.08
1.28
2.55
3.05
2.60
1.42
1.91
1.56
1.92
1.61
2.66
3.01
2.76
2.45
1.84
1.68
1.67
1.63
1.73
1.89
1.91
Bajura
81801
92010 108781
2188
49.7
Bajhang
124010 139092 167026
3422
48.8
Achham
185962 198188 231285
1680
137.7
Doti
153135 167168 207066
2025
102.3
Kailali
257905 417891 616697
3235
190.6
Kanchanpur
168971 257906 377899
1610
234.7
Dadeldhura
86853 104647 126162
1538
82.0
Baitadi
179136 200716 234418
1519
154.3
Darchula
90218 101683 121996
2322
52.5
Note: These are adjusted figures and take into account the boundary changes districts. 1.67
1.83
1.54
2.14
3.89
3.82
1.87
1.55
1.82 of the
Source: CBS 1995, CBS 2002.
1.8 Population Density
Ecologically, Nepal is divided into 3 regions; mountain, hill and Terai. As these three regions differ from each other in climate and topography, population distribution is also different in these regions. Data obtained from different censuses indicate that population density has increased in all three regions over the years, with Terai witnessing a much higher density than Mountains and Hills.
Table 1. 11: Population density (person per sq. km.) by ecological zones & development regions, Nepal, 1981-2001.
Zones/Regions
Mountain
Eastern Central Western Mid Western Far Western Total
6277
5819
21351
7932
51817
1981
32.41
65.82
3.43
11.35
36.42
25.14
1991
34.40
75.03
3.37
12.20
41.95
27.85
2001
Hill
Area sq.km. 10438
38.47
88.39
4.22
14.48
50.15
6762
116.94 178.60 117.41
76.03
89.37
116.76
1991
132.95 226.98 132.15
88.95
99.18
The sex ratio at birth is around 105 male births for every 100 female births and existing higher risk of death among females than males in the country, low sex ratio can only be explained by the possibility of a large volume of temporary male emigration.
152.87 300.10 152.47
107.44
118.15
167.11
7317
4845
34024
Table 1.12 shows that females have slightly outnumbered males, mainly because adult males used to go abroad in search of livelihood.
Table 1. 12: Sex Ratio by Ecological Regions, Nepal,1952/54 – 2001
Sex Ratio
Ecological Regions
1952/54
1961
1971
94.26
102.14
97.05
100.79
98.02
106.39
101.37
1981
1991
2001
98.43
95.34
103.85
99.47
98.39
95.84
103.77
99.80
137.25
2001
Area sq.km. 7269
9328
5260
1981
290.70 255.97 182.11
91.67
88.23
192.71
1991
365.72 325.18 252.87
127.14
139.62
253.58
2001
Total
The sex composition of a population is indicated by sex ratio. It is calculated as a ratio of total number of males to that of females multiplied by 100. Thus it shows the number of males per 100 females. In normal populations sex ratio of 103-105 is obtained at birth. This indicates that for every 100 female babies born nearly 105 male babies are born. As the age increases i.e. by the age of five, the sex ratio is considered to be more or less equal as infant and child mortality is higher for male babies. As the age increases, sex ratio gets in favor of females as mortality for males are higher than females.
61345
Area sq.km. 10749 11805 18319
1981
Terai
1.9 Sex Ratio
32.57
13710
Table 1.11 presents population density for Nepal by ecological and development regions. In 1981 population density for Nepal was 102 persons per square kilometer, which is increased to 157 in a period of 20 years. In
1981 only 193 persons per square kilometer resided in Terai region, which increased to 330 in 2001. Mountain region had 25 persons per square kilometer in 1981, which increased to only 33 after 20 years in 2001. In the
Hill region it reached 167 from 117 in the same 20 year period. Among development regions, the lowest population density is observed for MidWestern Development Region (71), while it is the highest in the Central
Development Region (293) in 2001.
453.93 421.75 333.32
168.22
205.28
42378
19539
147181
67.56
102.01
95.95
100.10
96.80
104.71
102.14
108.33
105.02
329.59
Area sq.km. 28456 27410 29398
Mountain
Hills
Terai
Nepal
1981
130.32 179.10 106.43
46.14
1991
156.25 225.61 128.26
56.87
85.95
125.63
2001
187.82 293.02 155.49
71.10
112.15
157.30
Source: CBS 2002.
Nepal Population Report 2011 - 13
Source : CBS, 1995,2002.
However, in the censuses of 1971 and 1981 more males were counted than females. The censuses of 1991 and 2001 yielded more females than males and as a consequence overall sex ratio was less than 100. This sharp decline in sex ratio during 1981-1991 periods is unexplained, because there is no authentic evidence to explain such changes in the sex ratio. Only exodus of male population for work outside the country, can be speculated, again a large
14 - Nepal Population Report 2011
exodus could be hardly possible. Table 1.13 shows sex ratio of population by ecological and development regions from 1981 to 2001.
Table 1. 13: Sex ratio of population by ecological & development regions, Nepal,
1981-2001.
Development Regions
Ecological
Zones
Year
Mountain
1981
102
107
108
107
102
105
1991
96
100
109
103
94
98
2001
97
99
116
103
96
98
Hill
Eastern
Central Western Mid Western Far-western
Total
101
106
100
100
92
102
97
102
88
96
92
95
2001
Terai
1981
1991
97
103
87
97
94
96
108
107
109
107
116
108
103
106
103
102
101
104
2001
Nepal
1981
1991
102
107
102
101
103
Table 1. 14: Percentage Distribution of Population by Five-year age groups,
Nepal, 1981-2001
Age
Groups
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65+
Male
15.5
14.5
11.9
9.0
8.3
7.4
6.1
6.0
4.9
4.3
3.8
2.4
2.5
3.4
1981
Female
15.3
14.6
10.8
8.6
9.5
8.1
6.9
5.9
5.1
3.9
3.4
2.2
2.4
3.1
Male
14.9
15.5
13.1
9.5
7.9
7.0
6.0
5.6
4.5
4.1
3.3
2.7
2.3
3.6
1991
Female
14.4
14.8
12.1
9.9
9.3
7.8
6.5
5.5
4.7
3.9
3.1
2.3
2.3
3.4
Male
12.29
14.38
13.50
10.44
8.33
7.23
6.39
5.73
4.75
4.13
3.46
2.80
2.31
4.26
2001
Female
11.95
13.87
12.73
10.57
9.40
7.95
6.71
5.79
4.82
3.99
3.28
2.49
2.27
4.16
Total
12.12
14.12
13.11
10.51
8.87
7.59
6.55
5.76
4.79
4.06
3.37
2.65
2.29
4.20
104
1981
105
107
103
103
105
1991
100
104
93
99
96
105
99
2001
100
105
93
99
98
100
1.10 Age Structure
Whether a population is young or old, or getting older or younger depends on the proportion of people at different age groups. In general, a population with more than 35 percent under age 15 is considered young and population with more than 10 percent aged 65 and above is considered old. Age structure is affected by the fertility, mortality and migration. However, under normal situation, the affect of mortality and migration is smaller and proportion of population at each age group is mainly affected by fertility. Distribution of population by five year age group is shown for males and females based on census data in Table 1.14.
Source : CBS, 1995,2002.
The present age structure suggests that a large share of resources have to be spent on basic facilities such as education, nutrition and health of young people just to maintain a status quo. It also suggests that because of young nature of Nepalese population, population momentum for Nepal is still very high, indicating that Nepal’s population will continue to grow for quite some time even if the fertility were to reach replacement level today.
From the Table it can be seen that percentage of 5-9 age group population is highest in the census periods except 1981. Under normal situation age group
0-4 should have the largest population. Usually children under 5 year of age are undercounted especially children under one years of age therefore age group 5-9 shows the largest population in different censuses of Nepal. After the age group 5-9, the proportion decreases with age, following more or less the expected pattern. The age structure of the population in the census year
2001 is shown in the figure 1.3.
The Table 1.14 shows that the population of Nepal is composed primarily of young people and since 1960s it has remained young. More than 39 percent of its present population is under 15 years of age. Similarly, more than half of the population is in the age group 15-59. This age structure indicates approximately one person is in the working ages (15-59 years) for every person less than 15 years old and aged 60 years or more. This age structure of Nepalese population is mainly due to high fertility and declining mortality in all ages, particularly in younger ages.
Nepal Population Report 2011 - 15
16 - Nepal Population Report 2011
If one were to look for the proportionate share of population in these groups, one would find that adolescents in Nepal cover 23.62 percent of the total population i.e. nearly a quarter of the population. It should be noted that for a period of nearly three decades this group of the population will be in the reproductive age and will be bearing children. If we were to look at the proportion of population in the youth category we would find that 19.38 percent i.e. nearly a fifth of the total population is in this group. It should be noted that this group is already in the reproductive age group and already contributing to population growth. If we are to control the rate of population growth through addressing fertility then these groups need to be targeted for the population related programmes. In general, young people (10-24 years) constitute of almost 33 % of the total population of Nepal.
75+
70-74
65-69
60-64
55-59
50-54
Male
Female
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
1.12 Distribution of Women aged 15-49, by five year age groups.
5-9
16
14
12
10
8
6
4
2
0
0
2
4
6
8
10
12
14
16
0-4
Percent
2001
Figure 1. 3: Population Pyramid of Nepal, 2001
Source: CBS, 2002
1.11 Adolescents and Youth
Adolescence is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological (i.e. pubertal), social, and psychological changes, though the biological or physiological ones are the easiest to measure objectively.
Historically, puberty has been heavily associated with teenagers and the onset of adolescent development. Adolescence is the second decade of life and it is a period of rapid development, major physical change take place and differences between boys and girls are emphasized. Adolescents are often thought of as a healthy group. Nevertheless, many of them do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either prevenTable or treaTable. In addition, many serious diseases in adulthood have their roots in adolescence. For example, tobacco use, sexually transmitted infections including HIV, lack of nutrition and exercise habits, lead to illness or premature death later in life (WHO).
As discussed earlier, the rate of population growth is highly affected by fertility. If there are more women in the reproductive age group then a larger number of births will take place given a fixed fertility rate. As the age group of women increases, the proportion of women in each group decreases.
However, in the 1981 census the number of women in the age group 20-24 was greater than the number of women in the age group 15-19. This could be due to age misreporting in the censuses of Nepal.
Among women, about 49 percent are in the reproductive age. In a likewise manner, of the total population about 24.6 percent of the population is in the reproductive age. In Nepal, female marriage takes place early and almost every woman marries. Thus higher proportion of married women coupled with higher fertility levels contributes to high rate of population growth.
The proportion of women in the reproductive age group has increased slightly over the last 10 years. This could be mainly due to declining fertility whereby the proportion of younger population less than 10 year of age has declined.
For example, among males it was 30.4 percent in 1991, which decreased to
26.7 by the year 2001. Corresponding figures for females are 29.2 percent and 25.8 percent respectively.
Youth is the time where a person's life is in between childhood and adulthood.
The majority (almost 85%) of the world’s youth live in developing countries, with approximately 60 percent in Asia alone. A remaining 23 percent live in the developing regions of Africa, and Latin America and the Caribbean. By
2025, the number of youth living in developing countries will grow to 89.5%.
Therefore, it is necessary to take youth issues into considerations in the development agenda and policies of each country.
Nepal Population Report 2011 - 17
18 - Nepal Population Report 2011
Chapter 2
Fertility and its Proximate Determinants
2.1 Fertility
The major three demographic processes that determine the structure, distribution and growth of any population are: fertility, mortality and migration.
Among these factors, fertility is one of the main factors in determining the age structure of a population. As Compared to other demographic processes, the study of fertility is more complex because it is affected by host of factors including biological as well as other behavioral.
Fertility refers to the number of live births per women in the population. It represents the actual performance and should not be confused with the ability of capacity to reproduce, which is termed as fecundity. The inability of reproduce is called sterility.
Only a section of the population namely women in the reproductive age group (1549) which is biologically identified as between menarche and menopause.
population and other available demographic parameters for the estimation of fertility and mortality indicators. Once the survey data are available, direct method of fertility estimates are commonly used. Demographic surveys carried out before 1991 have indicated some problems of data quality, especially omission and displacement of vital events. Because of this till 1986 different censuses and surveys provided fertility estimates based on indirect method [i.e. sTable population estimates or different versions of P/F ratio methods. P/F ratio may be defined as the ratio of present vs. past (cumulative fertility). Table 2.1 provides estimates of CBR over time for Nepal. It indicates that
CBR in Nepal was high till the mid eighties. After the mid-eighties, CBR has been gradually declining.
The Nepal Demographic and Health Survey, 2006 has indicated that the CBR is around 28 per thousand in Nepal. Although, this means a decrease of 4 points during the last 5 years, this CBR is still considered to be quite high.
Table 2. 1 :Crude Birth Rate by various sources, Nepal, 1952/54 - 2005
Sources
The demographic literature offers many measures of fertility. There are broadly two ways of approaching the study of fertility: period and cohort. Period analysis looks at fertility cross-sectional that is at births occurring in a specific period of time, normally one year. Cohort Analysis on the other hand looks over time, at their reproductive history. In spite of the general theoretical preference for cohort measures, the literature suggests that period influences tend to be more powerful than cohort influences in explaining fertility behavior.
Demographers have developed different measures of fertility for its analysis.
In this report, we will mainly focus on four indicators namely Crude Birth Rate
(CBR), Age Specific Fertility Rate (ASFR), Children Ever Born (CEB) and
Total Fertility Rate (TFR).
2.1.1 Crude Birth Rate
The Crude Birth Rate is defined as the number of live births per thousand persons in a given area for a particular year. Although, simple to calculate and easy to understand, it is a crude measure, because it uses persons from all age groups and both the sexes involve in the denominator. Age/sex structure of the population has an important bearing on the Crude Birth Rate, it is ignored altogether. For example, even if two countries have the same agespecific fertility rates, their crude birth rates may be substantially different if their age/sex compositions are different. Despite being a crude measure, it is one of the most commonly used summary measures for level and trend analysis of fertility.
Fertility measures including CBR are calculated either through indirect methods or through direct methods. In the absence of vital registration and survey data, indirect method of fertility estimation is usually used. These methods are based on sTable population, which utilizes the age-structure of
Nepal Population Report 2011 - 19
United Nations, ESCAP
Vaidhyanathan and Gaige
Krotki and Thakur
CBS(Census data)
Nepal Fertility Survey, MOH
CBS(Census data)
Nepal FP/MCH Project, MOH
CBS Demographic Sample Survey
CBS(Census data)
Nepal Family Health Survey, 1996
Nepal Demographic Health Survey, 2001
Nepal Demographic Health Survey, 2006
Years
1952-54
1954
1961
1971
1976
1981
1981
1986
1991
1994-96
1998-2000
2003-2005
Crude birth rates
(per 1000 population)
45.0
48.7
47.0
42.0
45.5
44.0
42.9
40.7
41.6
37.0
33.5
28
Source : CBS 1995, MOH, 1997,2002a and 2006
2.1.2 Age Specific Fertility Rates (ASFRs)
Age Specific Fertility Rates (ASFRs) are defined as the ratio of children born to a specific age group of women to the number of women in the risk of bearing children. These are more refined a measure of fertility as the age/sex structure of a population is taken into account.
Thus, international comparisons of ASFRs can easily be made while CBR described earlier should not be compared internationally unless standardized for the age/sex structure of the population. For the calculation of ASFRs, usually a five-year age groups are considered.
There is an inverted U-shaped relationship between fertility and the age of women. In other words, during early part of reproductive life fertility is low. It
20 - Nepal Population Report 2011
increases to a maximum value during the twenties and then declines women get older. Table 2.2 presents ASFRs for Nepalese women aged 15 to 49 from
1971 to 2003-2005.
The age pattern of fertility indicates that Nepalese women have the highest fertility in the early part of childbearing period. For example, in 2003-2005, of the one thousand women in the age range 20-24, 234 women give births in a given year while the corresponding figure for women in the age range 35-39 is only 48. If the age specific fertility rates for the period 1998-2000 and 20032005 are compared, we find that fertility has declined for all the ages during the last five-year period.
Table 2. 2 : Age Specific Fertility Rates, Nepal, 1971-2000
Age
group
1971
1976
15-19
0.074
0.145
20-24
0.267
0.290
25-29
0.310
30-34
0.261
35-39
1981
198486*
198991*
1994-
0.066
0.099
0.101
0.127
0.110
0.098
0.230
0.261
0.263
0.266
0.248
0.234
0.295
0.266
0.230
0.230
0.229
0.205
0.144
0.269
0.245
0.200
0.169
0.160
0.136
0.084
0.196
0.169
0.206
0.114
0.117
0.094
0.081
0.048
40-44
0.109
0.075
0.142
0.068
0.055
0.037
0.034
0.016
45-49
0.043
0.023
0.099
0.049
0.026
0.015
0.007
0.002
96*
19982000*
20032005
*ASFRs are based on births that occurred three years prior to the survey
Source : CBS 1995; MOH 1997; MOH 2002.
The figure 2.1 presented below provides the comparison of ASFR for the period 1998-2000 and 2003-2005.
2.1.3 Total Fertility Rate (TFR)
Another measure commonly used to describe the level of fertility is Total
Fertility Rate (TFR). Verbally TFR is defined as the number of children of a woman would bear during her childbearing period under prevailing age specific fertility rates (i.e. ASFRs). The TFR is calculated as the sum of
ASFRs. As we have used ASFR for 5 year age groups, the sum of ASFRs need to be multiplied by 5 to obtain the TFR. Although, defined as a cohort measure, in fact, it is a synthetic cohort measure based on period data. It is the most commonly used summary measure of fertility as it is free from age distribution of a population. This measure is also widely understood and used by policy makers and planners. Table 2.3 provides the different estimates of
TFR from 1971 to 2005.
Table 2. 3 : Total Fertility Rate Nepal, 1971-2000
Data Source
CBS Census, 1971
Nepal Fertility Survey 1976, MOH
Nepal Contraceptive Prevalence Survey 1981,
MOH
Nepal Fertility and Family Planning Survey
1986, MOH
Nepal Fertility Family Planning and Health
Survey 1991, MOH
Nepal Family Health Survey 1996, MOH
Nepal Demographic and Health Survey 2001,
MOH
Nepal Demographic and Health Survey, 2006
Year
1971
1975-1976
1980-1981
Total Fertility Rate
6.3
6.33
6.27
1984-86
5.1
1989-91
4.8
1993-95
1998-2000
4.6
4.1
2003-2005
3.1
*These rates are based on births occurring 3 years preceding the survey and are direct estimates. Source : CBS 1995; MOH 1997; MOH 2002a, MOHP, 2006.
0.3
0.2
0.1
0
15 - 19
20 - 24
25 - 29
30 - 34
Age
2003 - 2005
35 - 39
40 - 44
45 - 49
1998 - 2000
Table 2.3 shows that the estimate of TFR for Nepal was more or less constant till mid eighties and thereafter it started to decline. The level of TFR till mid eighties was around 6.3. A substantial reduction in fertility can be seen during the period 1999 to 2004 when a decline of one child was observed. The
Nepal Demographic and Health Survey 2006 provided an estimate of TFR for
Nepal to be 3.1. Although a detailed analysis of causes of decline in fertility has not been done, possible causes for this decline after mid-eighties could be include a) increased use of family planning methods b) increased age at marriage c) improved level of education d) increased urbanization and e) spousal separation due to conflict and employment etc.
Figure 2. 1 :Age Specific Fertility Rates Nepal, 1998-2000 and 2003-2005
The two ASFR lines clearly indicate that there has been a decrease in the age specific fertility in all the age groups in Nepal during the last five-years.
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22 - Nepal Population Report 2011
Replacement Level of fertility is the average number of children sufficient to replace their parents. The replacement level of fertility is measured by GRR (Gross
Reproductive Rate) and NRR (net Reproductive Rate).If the NRR=1, then we called it as the replacement level of fertility. Actually it is the level of fertility at which women in the same cohort have exactly enough daughters on average to replace themselves in the population.
Population momentum refers to the tendency of the population to continue to grow after replacement level of fertility has been achieved. A population that has achieved replacement of below replacement level of fertility may still continue to grow for some decades because past high fertility leads to a high concentration of people in the youngest ages. Total births continue to exceed the total deaths as these youth becomes parents. Eventually, however, this large group becomes elderly then deaths increase to equal or out number of births. Thus it may take two or three generations before each new birth is upset by a death in the population.
Hill
Terai
Development Region
Eastern
Central
Western
Midwestern
Far Western
Educational Status
None
Primary
Secondary
SLC and above
Total
4.5
4.6
4.0
4.1
3.0
3.1
5.6
5.7
5.4
5.3
4.6
5.0
4.1
4.6
4.7
5.5
5.2
3.8
4.3
3.5
4.7
4.7
3.1
3.0
3.1
3.5
3.5
5.4
5.6
5.5
6.6
6.2
4.9
5.4
5.3
6.4
6.0
4.7
4.7
4.6
5.6
5.6
5.1
3.8
2.5*
4.6
4.8
3.2
2.3
2.1
4.1
3.9
2.8
2.3
1.8
3.1
5.8
5.3
3.7*
5.7
5.6
4.5
3.7
2.6
5.4
5.1
4.0
3.3
2.6
4.9
* includes secondary or higher level of Education
2.2 Fertility Differentials
Source : MOH, 1997,2002.2006
The change in fertility in fertility level by some specific phenomenon or characteristics is called fertility differential. During the early phase of fertility transition, the differentials in fertility emerge and large differentials can be observed for some key socio-economic variables. Table 2.4 provides fertility differentials by place of residence, ecological region, development region and education. In Table 2.4, mean number of children ever-born (CEB) by women aged 40-49 have also been displayed. Mean number of children ever-born for women 40-49(or 45-49) can be regarded as a cohort measure of TFR. It should be noted that some women may have given births to their children quite early, thus, they might misreport live births, which might have resulted in death soon after birth. Following differentials in TFR can be clearly seen, when one looks at the NDHS 2006 data on TFR:
Comparison of TFR differentials for the period 1994-1996 and 1998-2000 and
2003-2005 suggest that the differentials by socio-economic variables have increased substantially over the years. This is an indication of declining fertility trend in Nepal as well as faster decline in fertility for the advantaged group of population as indicated by lower fertility for educated women as well as women living in urban areas.
1. The TFR in the Terai region is similar to that observed in the Hill region while the TFR in the mountain region is around one child higher. 2. By development regions the TFR in the central region is the lowest
(3.0) and the highest TFR is observed for the mid western region and
Far western region (3.5).
3. Women with SLC and above have a TFR of 1.8, which is less than half of the rate for women with no education.
4. Similarly, urban women have lower fertility (on an average by two births) than their rural counterparts.
Table 2. 4 : Level of TFR and Mean Children Ever Born [Mean CEB] 40-49) by
Background Characteristics Nepal, 1994-1996 and 1998-2000
Background Variables
Region of Residence
Urban
Rural
Ecological Region
Mountain
19941996
TFR
19982000
20032005
Mean CEB 40-49
1994- 1998- 20031996
2000
2005
2.9
4.8
2.1
4.4
2.1
3.3
4.6
5.8
4.5
5.5
3.7
5.1
5.6
4.8
4.1
6.2
6.1
5.4
Nepal Population Report 2011 - 23
Table 2.4 also provides the mean number of children born to women aged 4049. Similar differentials in the mean number of children born to women aged
40-49 can also be seen. However, the differentials are smaller and increase in the differentials over the last five years is also smaller.
Moreover, it should be noted that the mean number of children ever born to these women (40-49) is considerably higher than the TFR discussed earlier.
Recall once again that the TFR is a synthetic cohort measure based on period data, while the mean number of children ever-born to women (40-49) is a cohort measure. TFR is based on the recent data on ASFRs, while the mean number of children ever-born to women is based on the ASFRs prevalent during the last 25-30 years. As the fertility was higher in earlier period, it is natural that the cohort TFR measure is also higher.
2.3 Proximate Determinants of Fertility
Earlier we discussed fertility and its differentials. The differentials in fertility were demonstrated for different demographic and socio-economic variables.
In fact, socio-economic variables do not have a direct causal link with fertility, however, their effect is mediated through behavioral factors as well as biological factors. These are the factors which Davis and Blake (1956) called intermediate variables (also known as proximate determinants of fertility)
Davis and Blake in their classical articles described the mechanism through which different biological as well as behavioral factors had effects on fertility.
Bongaarts (1978,1982) attempting to model the intermediate variable frame24 - Nepal Population Report 2011
work of Davis and Blake identified only four factors out of several factors identified by them as the major determinants of fertility in a population. His regression model showed that nearly 96 percent of variation in fertility in a population was explained by the following four factors
a)
b)
c)
d)
Proportion of females married
Post-partum infecundity due to lactation amenorrhea
Contraceptive prevalence rate and
Prevalence of induced abortion.
In the following section we will mainly deal with these four proximate determinants and their role in reducing fertility in Nepal.
2.4 Nuptiality
In societies, where child bearing takes place mostly within marriage, timing of marriage marks the beginning of women’s exposure to child bearing. In other words, age at marriage in most of the societies, begins a woman's exposure to the risk of child bearing. Age at marriage is a major determinant of the duration and tempo of fertility in a population. Consequently, age at marriage and proportion of women never married are important proximate determinants of fertility (Bongaarts and Potter, 1983).
Nupiality refers to Marriage, separation, divorce, widowhood and remarriage in Demography. Their importance arises partly from their relationship with the age at which sexual relation begins and end and partly with the formation and dissolution of families and households.
The Nepalese society is characterized by early and nearly universal marriage.
Marriage usually takes place early and by the age of 30 almost every woman is already married. In populations, where use of contraception is low, early marriage leads to longer exposure to child bearing. Therefore, early and universal marriage practice in Nepal results in long-term social and economic consequences including higher fertility.
Table 2. 5 : Percentage of Women Never Married by Age, Nepal, 1961-2006
Age group
15-19
20-24
25-29
30-35
35-39
40-44
45-49
1961
25.7
5.3
1.9
1.0
0.8
0.7
0.6
1971
39.3
7.9
2.6
1.4
1.1
0.9
0.8
1981
49.2
13.1
5.4
3.1
2.6
2.5
2.9
1991
52.7
12.8
3.7
1.9
1.3
1.1
0.9
2001
66.1
21.0
5.6
2.6
1.8
1.5
1.2
2006
67.7
17.9
4.4
1.6
1.4
1.3
1.2
1961-91 data are from censuses and 2001 are based on NDHS2001.
Source: CBS 1995, 2002; MOH 2002 and 2006
2.4.1 Widow/Widower
In Nepal, as discussed earlier, almost all of the childbearing takes place within marriage. Therefore proportion of population widower or widow will also have an effect on fertility. Data on widowhood for both men and women have been presented in Table 2.6. Table 2.6 indicates that from 1961 to 1991 the number of both widow and widower have gone down significantly. This indicates that mortality for adult population has declined over the years. For example, among men, in 1961 percentage of widower was 4.8, which decreased to 3.0 by 1991. Among women in 1961, percentage widowed was
14.3, which decreased to 7.2 by 1991. Nepal Family Health Survey 1996 provided estimate of widowhood as 2.7 per cent, for women 15 years and older. The census of 2001 indicated that of the total male population 10 years or older only 1.3 percent are widowers while this figure is 3.7 for women aged
10 years or older. This sharp decline in proportion of widow and widower is due to fall of mortality among adult population. Proportionately more women are widowed compared to males for all age categories. This could be partly explained by a) age difference between males and females at the time of marriage; as husbands are older it is more likely that proportionately more women become widows b) a substantial proportion of males remarry when they are widowers, while very few women remarry when they are widowed and c) during reproductive years female mortality could also be higher, as depicted by a high maternal mortality.
Table 2. 6 : Percentage of widow/widower, 10 years and above, Nepal, 1961 - 2001
Sex
1961
Male
Female
1971
Census Years
1981
1991
2001
4.8
14.3
3.7
10.1
2.4
5.5
3.0
7.2
1.3
3.7
Source : CBS 1995, 2002.
Divorce and separation between husbands and wives are another important variable, which affects fertility. Although the proportion of men and women divorced or separated is increasing over time, this figure is still too low to have any significant effect on fertility.
2.4.2 Age at First Marriage
In Nepal, with parental consent, legal minimum age at marriage for both girl and boy has been set at 18 years. If the boys and girls want to marry on their own then the minimum legal age at marriage for both girls and boys is 20 years. In many ethnic groups, this was hardly followed in the beginning and the mean age at marriage was quite low then. In some societies, girls are still married at younger ages indicating that the above mentioned legal provision is yet to be practiced to a full extent.
As discussed earlier, the increase in the proportion of men and women remaining single for different age group indicates that the mean age at marriage for men and women is increasing over the years.
Nepal Population Report 2011 - 25
26 - Nepal Population Report 2011
The trend of age at marriage since 1961 is provided in Table 2.7. It should be noted that the age at marriage provided below is calculated from the census data and is based on persons remaining single for different age categories.
These means are thus called singulate mean age at marriage.
2.5 Effect of Changes in Marital Status on Fertility:
The above discussions have shown that the singulate mean age at marriage is increasing (15 in 1961 to 20 years in 1991) and the proportion of widowed is decreasing (14.3percent in 1961 to 7.2percent 1991).
Table 2. 7 : Singulate Mean Age at marriage by sex, Nepal 1961-2001
Sex
Male
Female
Difference of age at marriage between male and female
Age at the marriage
1961
1971
1981
19.5
20.8
20.7
15.4
16.8
17.2
+4.1
+4
+3.5
1991
21.4
18.1
+3.3
2001
22.9
19.5
+3.4
Source : CBS 1995, 2003
Singulate Mean Age at Marriage
Table 2.7 indicates that the age at marriage for both the males and the females has been increasing gradually over the years. The 1991-2001 decade has shown a remarkable change in the Singulate mean age at marriage.
Perhaps, this increase is due to increasing urbanization and education
(including literacy) among men and women. Although data have not been presented here, the NDHS, 2001 has shown that education and urban residence are the key variables associated with higher ages at marriage among Nepalese men and women.
25
20
15
10
5
0
Male
Female
1961 1971 1981 1991 2001
Year
Figure 2. 2:Singulate Mean age at Marriage Men
Nepal Population Report 2011 - 27
The increase in age at marriage has a negative impact on fertility for two basic reasons. First women who marry later have a shorter reproductive life span and second the factors that affect the age at marriage also affects the desired family size norms thereby reducing fertility. For example, if a woman marries later because she is studying then her fertility will also be lower as her desired family size is smaller.
On the other hand, as most all of the births take place within marriage, decrease in the proportion widowed in the reproductive ages will increase the number of women at risk of child bearing. It is of interest to know the balancing effect of these two opposite forces operating on fertility. From the analysis of 1961 and 1991 census figures, it is observed that fertility was lower by 8.1 percent because of increased age at marriage, while it increased by about 2.2 percent due to declining widowed (CBS, 1995). In other words, the effect of increasing the age at marriage on fertility is much higher than the fertility increasing effect of lowering widowhood in Nepal.
2.6 Family Planning
Nepal’s Family planning programme started with the organization of Family
Planning Association of Nepal in 1959. In fact, Nepal was one of the first countries of South Asia, where information about family planning was available through a non-governmental programme. Since 1968 Government of Nepal has been actively involved in providing family planning services with the establishment of Nepal Family Planning and Maternal Child Health (NFP and MCH Project) project. Initially family planning programme was integrated with maternal child health services. Since the nineties, as all the health services were brought together, family planning has become an integral part of the country's health services.
Currently, besides the governmental programmes, different NGOs and INGOs are also providing family planning services as well as information education and communication services related to the family planning. Some of these institutions are a) Nepal Family Planning Association b) Care Nepal c) Plan international d) Nepal Red Cross society e) ADRA and f) Mary Stoves etc.
The National Health Policy (1991) related to the National Reproductive Health and Family Planning (RH/FP) Programme aims at increasing the coverage of the family planning services to the village level through health facilities and activities, such as a) hospitals, b) primary health care (PHC) centres, C) Health posts (HP), d) Sub health posts (SHP), e) PHC outreach clinics and f) mobile voluntary surgical contraception (VSC) camps. This health policy also attempts to sustain adequate quality of family planning services through adequately trained manpower as well as supplies.
28 - Nepal Population Report 2011
At the same time, the health policy also aims at mobilizing NGOs, social marketing organizations, and private practitioners to complement and supplement the efforts of the government. The governmental family planning programmes have trained and fielded community-level volunteers (TBAs,
FCHVs) for the promotion of condom distribution and the re-supply of oral pills.
Intensified IEC activities are also being carried out utilizing different media to increase awareness on RH/FP in the community. Moreover, through active involvement of FCHVs and Mothers’ Groups, it is expected that a high level of awareness will be reached in the community levels.
In Nepal family planning services are provided using a cafeteria approach; which means that different methods of contraception are made available to most of the health institutions and a client is to choose the method that suits his or her objectives. It is expected that this approach will not only increase the prevalence of contraceptive use but also reduce the fertility. This approach is also based on client’s right and option.
There has been a five-fold increase in the percentage of currently married women, who have heard about modern methods of contraception in the last
25 years (from 21 percent in 1976 to nearly 100 percent in 2006). This high level of knowledge is a result of the successful dissemination of family planning messages through the mass media as well as interpersonal communication established through mother groups, FCHVs and TBAs
2.6.4 Demand for Contraception
Unmet need for family planning has been defined as the proportion of women who want no more children or want children only after two years but are not using any form of contraception. On the other hand, current users of family planning methods are categorized as having a met need for family planning.
The total demand for family planning is defined as the sum of these two components. The Fertility, Family Planning and Health Survey of 1991, Nepal
Family Health Survey of 1996 and NDHS2001 provide data on met and unmet need of contraception. These data have been summarized in Table 2.8.
2.6.1 Objectives of Family Planning Programme in Nepal
Following are the major objectives of the family planning programme in Nepal.
•
•
•
•
Space and/or limit their children,
Prevent unwanted pregnancies,
Adolescent Reproductive Health and
Manage infertility
2.6.2 Targets
Nepal’s Family Planning programmes have the target of reducing the TFR from
4.1 per women in 2001 to 3.6 per women by the end of the Tenth Plan (2007) and to 2.1 in 2017. If we refer to the fertility chapter we can say that fertility th targets for the 9 plan have already been met as indicated by the NDHS, 2001.
In order to meet the fertility targets mentioned earlier, the contraceptive prevalence rate (CPR) has been envisaged to increase to 37 percent of currently married women of reproductive age (MWRA). As we will observe later in this chapter, this target has also been already met as indicated by the NDHS,
2001. The long-term target is to increase the CPR to 65percent by 2017.
Below we discuss the summary of findings in family planning obtained from the NDHS2001 survey.
From the Table it is clear that the total demand for family planning has been increasing over the years. In 1991 it was 51 percent, which increased to 67 percent in 2001. In a like-wise manner, there has been a nearly 72 percent increase in CPR during these 10 years. Because of the increase in CPR over the years the proportion of unmet need has decreased during the period 1996 and 2001. However, it is still around 28 percent indicating that the family planning programmes should target these groups to make their family planning demand met. If the programmes were successful in fulfilling the demand for family planning then the CPR would increase to 67 percent. In fact, the family planning programmes should have a two-pronged strategy in this area. One is to work towards fulfilling the unmet demand of contraception and the other is to increase the demand for family planning by decreasing the family size norm through intensive IEC activities.
Table 2. 8 : Demand for contraceptives among currently married women aged 15-49, Nepal, 1991-2001.
Years
1991
1996
2001
2006
Unmet need for contraception 27.7
31.4
27.8
24.6
percent currently using contraception(met need)
22.8
28.5
39.3
48.0
Total demand for contraception 50.5
59.9
67.1
72.6
2.6.3 Knowledge of Contraception
Source : MOH,1993,1997,2002,2007
In Nepal, the year 1976 marks the beginning of the first national level family planning and fertility survey. Since then a survey is being carried out at five year intervals. The first survey was the Nepal Fertility Survey, which was conducted in 1976 and the latest survey was conducted in 2006 which is known as Nepal Demographic Health Survey (NDHS 2006).
Out of the total demand, the demand for spacing is estimated to be 14.1 percent (4.8 percent use family planning to space, plus 9.4 have unmet need for spacing).
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30 - Nepal Population Report 2011
2.6.5 Current Use of Contraception
The current use of contraception or Contraceptive Prevalence Rate (CPR) is expressed as the percent of currently married women who report using a method at the time of the interview. The level of modern contraceptive use in
Nepal has increased gradually in the last two decades. This trend has been shown in Table 2.9 and Figure 2.3. The current use of contraceptives has gone up from 3 percent in 1976 to 48 percent in 2006. Of this 48 percent sterilization accounts for 24 percentage points and the users of temporary methods of contraception account for about 24 percentage points. Among methods, female sterilization has become most popular with nearly 18 percentage points, whereas male sterilization has not gained similar popularity. Table 2. 9 : Current use of Contraception among non-pregnant women (percent)
Nepal 1976 - 2006
Method
Any modern method Female sterilization Male sterilization Pill
InjecTables
Condom
Norplant
IUD
1976
NFS
2.9
1981
NCPS
1986
NFFS
1991
NFFS
1996
NFHS
2006
NDHS
28.8
2001
NDHS
38.9
7.6
15.1
24.1
0.1
2.6
6.8
12.1
13.3
16.5
18.0
1.9
3.2
6.2
7.5
6.0
7.0
6.3
0.5
0.0
0.3
0.1
1.2
0.1
0.4
0.1
0.9
0.5
0.6
0.1
1.1
2.3
0.6
0.3
0.2
1.5
5.0
2.1
0.5
0.3
1.8
9.3
3.2
0.7
0.4
3.5
10.1
4.8
0.8
0.7
44.2
NFS-Nepal Fertility Survey; NCPS-Nepal Contraceptive Prevalence Survey; NFFS Nepal Fertility and Family Planning Survey, NFHS - Nepal Family Health Survey, NDHS
Nepal Demographic Health Survey.
Source :MOH 2002a, 2006
Among the temporary methods of contraception, Depo-Provera accounts for
9 percentage points indicating that it is the most popular temporary methods of contraception. Although, one expects a larger proportion of CPR to come from temporary methods, it is still lower than the permanent methods.
However, surveys have indicated the increasing trend in the use of temporary methods of contraception in Nepal. This is an indication that more and more women are using contraception to space rather than limit births
Figure 2. 3: Contraceptive Prevalence Rate Nepal, 1976-2006
Although the uses of family planning methods have been increasing over the years, CPR in Nepal is still low. Serious efforts need to be carried out to increase the demand for the family planning services and to fulfill the unmet need for the family planning services. If family planning programs are to make a bigger dent on fertility then the IEC programmes should bring down the family size norms.
2.7 Breastfeeding
Breastfeeding is another important proximate determinants of fertility.
Although breastfeeding in Nepal is almost universal and prolonged, most women are not aware of its contraceptive effect. Breastfeeding increases the length of post-partum amenorrhea, thereby providing protection against pregnancy for some time after the birth of the child. Nepal Demographic
Health Survey 2001 indicated that breast-feeding is nearly universal and about 98 percent women breastfed their children after birth, indicating that this proportion has been more or less constant over the years. Differentials in breast-feeding indicate that younger, urban, and educated (literate) women are less likely to breast feed their children than their counterparts. Median duration of breastfeeding in Nepal has been observed to be 33 months in
Nepal.
The fertility reducing effect of breastfeeding arises from its role in lengthening the period of postpartum amenorrhea and consequently in extending the birth interval (in the absence of use of contraception). Studies have shown that the average length of inter-birth interval in Nepal is more than 30 months and there is a direct positive correlation between duration of breastfeeding and birth interval (UNFPA, 1989).
2.8 Abortion
Abortion is one of the ways to limit fertility. Practice of abortion is as old as the society itself. Although, access to induced abortion is restricted by law and prohibited by religion and customs in Nepal, its practice can not be denied.
Nepal Population Report 2011 - 31
32 - Nepal Population Report 2011
Many studies have found that abortion is widely practiced in Nepal. However, due to the fear of legal punishment, majority of women seek abortion clandestinely and most often they consult unskilled or unqualified health persons for abortion. This in most cases results in complications resulting in the deaths of mothers or hospitalization.
Recently, (in March 2002), the parliament has passed a bill legalizing abortion. The bill is to be noted. It is legal to have an abortion under the following three conditions provided the fact that conditions (a) and (b) are met
a) the health worker performing abortion is a skilled professional with license from Government of Nepal and b) if the woman, who is pregnant, consents to have an abortion.
•
If the fetus is less than 12 weeks old
•
If the pregnancy is the result of incest or rape and the pregnancy is less than 18 weeks
•
If the pregnancy results in health hazard of the mother or the unborn child or the pregnancy results in deformed/disabled child.
Chapter 3
Mortality
3.1 Mortality
Like fertility mortality is also one of the factors, which affect the structure, size and growth of a population. Mortality rates are based on death statistics, which usually come from vital registration data. Vital registration system normally follows the definition of death put forward by UN and WHO, which define death as “the permanent disappearance of all evidence of life at any time after a live birth has taken place”. Here one should note that birth refers to a live birth.
Mortality refers to deaths that occur within a population. While we all eventually die, the probability of dying within a given period is linked to many factors, such as age, sex, race, occupation, and social class. The incidence of death can reveal much about a population's standard of living and health care.
Death is the permanent disappearance of all evidences of life at any time after live births has taken place. A death can occur only after a live birth has occurred. The definition of a death can be understood, therefore only in relation to the definition of live birth.
In Nepal, earlier decline of mortality and later decline in fertility have resulted in relatively high rate of natural growth of population. The mortality decline is relatively faster due to increased access and improved health services. There has been secular decline in mortality during the recent past, but the decline in fertility is slower than the mortality. Consequently Nepal’s population is increasing fast.
Like fertility, there are different indices for the description of trend and level of mortality. Here we discuss some of these indicators. These are:
a) Crude Death Rate
b) Infant Mortality Rate
c) Child and Under 5 Mortality Rate
d) Maternal Mortality Ratio and
e) Life Expectancy
The main source of death data is the hospital death records and vital registration system. As vital registration system is still not efficient, there is a serious under registration of vital events. Consequently, the mortality indicators discussed below are either based on sTable or quasi-sTable population analysis or data based on survey, where both the direct and indirect measures of estimation are employed.
Nepal Population Report 2011 - 33
34 - Nepal Population Report 2011
3.1.1 Crude Death Rate (CDR)
Crude Death Rate (CDR) is defined as the ratio of annual number of deaths to the person years of exposure to death during that period multiplied by a constant (usually 1000). It should be noted that for simplicity and ease of approximation, person-years of exposure is usually approximated by mid-year population. Like crude birth rate this is usually widely understood and is very frequently used summary measure of mortality. However, like CBR, CDR is also heavily affected by age and other compositional structure of the population. For example, it should be noted that age specific death rate at age 15-19 is very low compared to age specific death rate at 0-4 or 60-64 years of age. Therefore, combining all the deaths into one group and calculating the rate for all the population combined, ignores the age composition of the population. In two populations even if, the age specific death rates are exactly the same, if age-sex structure is different then they will have different crude death rates (CDR).
Different estimates of CDR for Nepal available since 1954 are provided in
Table 3.1. Because most of these estimates are based on sTable population techniques, these estimates do not present a very consistent trend.
Moreover, this could be also due to the use of different data that come either from censuses or surveys. It should be borne in mind that both of these sources of data suffer from inherent errors.
The Table indicates that CDR was a little over 35 in 1950s, which decreased to less than 20 in 1970s, and further to 9.6 in 2001. Despite fluctuations in the estimate of CDR, it can easily be concluded from the Table that mortality in
Nepal has been declining over the years.
Another thing that emerges from the Table is that these estimates consistently indicate higher mortality for females than males. Nepal is one of the few countries in the world where female mortality is higher than male mortality.
There is no reliable information on Age Specific Death Rates (ASDR) in
Nepal, which could provide mortality information for different age groups. The lack of reliable estimates of adult mortality by age has led us to use CDR.
Table 3. 1;Crude Death Rate, Nepal, 1954 - 2006
Source
Estimate d duration
1. Vaidhyanathan & Gaige, 1973
2. CBS, 1977
3. Guvaju, 1975
4. CBS, 1977
5. CBS, Demographic Sample Survey,1976
6. CBS, Demographic Sample Survey,1977
7. CBS, Demographic Sample Survey,1978
1954
1953-61
1961
1961-71
1974-75
1976
1977-78
Crude death rate
Total
36.7
27.0
22.0
21.4
19.5
22.2
17.1
Male
28.0
21.3
18.6
21.5
17.9
Female
24.8
22.6
20.4
22.8
16.2
Nepal Population Report 2011 - 35
8. CBS, 1977 (Census data)
9. New Era, 1986
10. CBS, Demographic Sample Survey, 1986
11. CBS Census
12. CBS
13. MOPE*
14 MOHP
15 CBS
1971-81
1984
1985-86
1991
1996
2001*
2006
2008
13.5
10.9
16.1
13.3
11.6
9.62
9.0
8.3
12.2
10.8
12.9
-
14.9
11.0
13.6
-
Source : CBS, 1995; CBS, 1998; MOPE, 1998
* Projected Mortality
3.1.2 Infant Mortality Rate (IMR)
The IMR is the number of deaths under one year of age per 1000 live births during a year. Although it is called a rate, in fact, it is the probability of dying before the first birthday. Several factors affect the IMR of a country:
a)
Nutrition of mothers and children
b)
Birth intervals
c)
Parity
d)
Age of mother at child’s birth
e)
Mother’s education and economic status
f)
Basic health services including:
i.
Immunization
ii.
ARI
iii.
Diarrhea
iv.
Safe motherhood program
v.
Environment etc;
In other words, IMR usually declines with a certain level of socio-economic development as reflected by the above mentioned factors. Therefore IMR has been commonly considered as an indicator to assess socio-economic development and general health condition of a society. However the adult mortality is relatively lower even in developing countries and a smaller proportion of population is in the older group, a substantial number of deaths occur during the first five years of life. In developing countries where health system is not fully developed, infant death is a substantial part of under five deaths. Therefore, reduction in IMR is a fundamental strategy to achieve a significant reduction in the overall mortality. Moreover, the interdependent relationship between fertility and infant mortality suggests that a reduction in infant mortality will trigger a subsequent decline in fertility. It has also been found that a lower IMR motivates couples to produce fewer number of children. 36 - Nepal Population Report 2011
Table 3. 2: Infant Mortality Rate, Nepal, 1954 – 2006
Source
1. Vaidhyanathan & Gaige, 1973
2. Guvaju, 1974
3. CBS, 1974
4. Nepal Fertility Survey, 1976
5. CBS, 1985
6. New Era, 1986
7. Fertility and Family Planning Survey,1986
8. Fertility and Family Planning Survey, 1991
9. Census, 1991
10. Nepal Family Health Survey,1996
11. Nepal Demographic Health Survey,2001
12. Nepal Demographic Health Survey, 2006
Reference
Period
1954
1961-71
1971
1976
1978
1981
1983-84
1989
1991
1993-96
2001
2006
Infant mortality rate
Total
172
152
144
117
108
102
97
79
64
48
Male
260
200
147
136
117
94
79.2*
60*
Female
250
186
142
111
98
101
75.2*
61*
Source : CBS, 1995; MOH 1997, 2002a.
* IMR estimates are based on births 10 year prior to the survey
Table 3.2 provides estimates of infant mortality based on different sources. It should be noted that since 1991 all the estimates of infant mortality are based on direct estimates of the rates except for the census estimate for 1991, which used indirect techniques of estimation. Since the 1991 survey it has been argued that the quality of pregnancy history data has improved and there is a little omission of births and deaths especially during the recent past. As the effect of these omissions on the calculation of demographic rates is minimal, direct method of IMR estimation has been used since then.
Table 3.2 indicates that a high IMR of around 250 per thousand live births prevailed in the country during the fifties. In the sixties it was decreased to around 150 to 200 per thousand live births. Since the mid seventies, decline in
IMR is secular and during 2001-2005 it has reached 51 per 1000 live births.
This also indicates that IMR for female babies are slightly lower than that for male babies.
Infant mortality is affected by various socio-economic and demographic factors. These factors are of particular interest, since these provide clues for the identification of priority groups in policy formulation and program implementation. Differentials in IMR have been presented in Table 3.3.
Before the data in Table 3.3 is discussed, it should be noted that the estimate of IMR from NFHS 1996 and NDHS 2006 presented in Table 3.2 were based on births that occurred during the preceding three to five years. The estimate of infant mortality differentials presented in Table 3.3 is based on births that occurred during the preceding 10-year period. Both of these surveys indicate that mother's education, place of residence; birth interval and age of mother have great influence on IMR. IMR for those babies whose mothers age is less
Nepal Population Report 2011 - 37
than 20 years and are born in the birth interval of less than two years, are much higher than those babies whose mother’s are aged 20+ and are born after a birth interval longer than two years. In general the differentials observed during the 1996 survey seem to have decreased in the 2001 and
2006 surveys. This indicates that decrease in IMR is somewhat faster in groups where IMR used to be higher.
Table 3. 3: Infant Mortality Rates by socio-economic & demographic characteristics, Nepal, 1996-2001
(for ten year period preceding the survey)
Characteristics
NFHS 1996
NDHS 2001
NDHS 2006
Residence
Urban
Rural
Ecological Region
Mountain
Hill
Terai
Development Region
Eastern
Central
Western
Mid-western
Far western
Education
No education
Primary
Secondary
SLC and above
Age of mother at birth**
< 20
20-29
30-39
40-49
Previous birth interval**
< 2 yrs
2-3 yrs
3
4+
Sex of Child**
Male
Female
61.1
95.3
50.1
79.3
37
64
136.5
87.4
90.9
112
66.2
80.8
99
47
65
79.4
86.3
84.3
114.8
124.3
77.5
77.4
60.1
72.9
112.2
45
52
56
97
74
97.5
80
53.4
-
84.6
61
49.9
69
58
35
13
120.1
79.5
103.9
-
108.2
67.6
72.9
-
83
50
62
91
141.4
78.8
44.7
124.4
67.8*
45.2
38.9
96
57
38
28
101.9
83.7
79.2
75.2
60
61
*Refers to two year birth interval. Source : MOH, 1997, NDHS2001
**Refers the rates calculated for 10 year period preceeding the survey.
38 - Nepal Population Report 2011
3.1.3 Child and Under 5 Mortality
Before we present the data from the two recent surveys i.e. NDHS 2001 and
NDHS 2006, the definitions of these mortality indicators are in order. Child mortality rate is defined as the probability of dying between age one and five.
This assumes that the child has already survived to age one to begin with.
Under-five mortality rate is defined as follows. Of the 1000 children born today th how many will die before their 5 birthday?. In other words, it is probability of dying between birth and before their fifth birthday. It should be noted once again that the estimate of these indicators are based on the births that occurred during the last five years. Data on child and under five mortality obtained from NDHS 2006 has been summarized in Table 3.4.
Table 3. 4: Child and under 5 mortality rates for five year periods preceding the survey Nepal 2006
Years preceding the Survey
Child Mortality
0-4
5-9
10-14
Under 5 mortality
14
26
38
61
96
117
Source : NDHS 2006, MoHP
The Table indicates that the child mortality 0-4 years preceding the survey is
38 percent of what it was 10-14 years preceding the survey. In other words there has been a remarkable decline in child mortality during the last 15 years.
A very similar picture in decline in under five mortality can also be seen.
Table 3. 5: Child and under 5 Mortality Rates by socio-economic & demographic characteristics, Nepal,
(for ten years period preceding the survey)
Characteristics
NDHS 2001
Child
Under 5
Mortality
Mortality
NDHS 2006
Child
Under
5
Mortality
Mortality
Residence
Urban
Rural
Ecological Regions
Mountains
Hill
Terai
Development Regions
Eastern
Central
Western
Mid Western
Far western
Education
16.7
35.4
65.9
111.9
10
21
47
84
51.2
29.7
34.8
157.4
93.9
112.8
32
16
21
128
62
85
29.6
36.4
25.1
41.2
41.7
104.8
110.9
83.7
111.0
149.2
15
17
18
28
28
60
68
73
122
100
Nepal Population Report 2011 - 39
No education
39.5
Primary
13.4
Secondary
14.3
S.L.C.+
3.7
Age of the mother at birth of the child
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