NEPAL POPULATION REPORT 2016 SUBMITED TO GOVEMENT OF NEPAL MINISTRY OF POPULATION & ENVIRONMENT SUBMITED BY POPULATION EDUCATION & HEALTH RESEARCH CENTER(P) Ltd. 1 Acronyms AHW : Auxiliary Health Worker AIDS : Acquired Immuno-deficiency Syndrome ANC : Antenatal Care ANM : Auxiliary Nurse Midwife ASRH : Adolescent Sexual and Reproductive Health BCC : Behavior Change Communication CBS : Central Bureaus of Statistics CEDPA : Central for Development and Population Activities CPR : Contraceptive Prevalence Rate DFID : Department for International Development FCHV : Female Community health Workers FP : Family Planning FPAN : Family Planning Association of Nepal GBV : Gender-based Violence GDP : Gross Domestic Products GFATM : Global Fund for AIDS, Tuberculosis and Malaria GoN : Government of Nepal GPI The Gender Parity Index HA : Health Assistant HDI : Human Development Index HDR : Human Development Report HIV : Human Immuno-deficiency Virus I/NGOs : International Non-governmental Organisation ICDP : The International Conference on Population and Development IEC : Information and Educatin Center ILO : International Labour Organization MCHWs : Maternal and Child Health Worker MCRW : Micro-Credit for Rural Women MDG : Millennium Development Goal 2 MMR : Maternal Mortality Ratio MOAC : Ministry of Agriculture and Co-operatives MOHP : Ministry of Health and Population MOPE : Ministry of Population and Environment MOYS : Ministry of Youth and Sports MSM : Men having Sex with Men MWCSW : Ministry of Women, Child and Social Welfare NAC : National AIDS Council NAYS ; Nepal Adolescents' and Youth Survey NCASC : National Centre for AIDS and STD Control ND : No Date NDHS : Nepal Demographic and Health Survey NFHP : Nepal Family Health Programme NGO : Non-Government Organization NHSP : Nepal Health Sector Programme NLSS : Nepal Living Standard Surveys NPC : National Planning Commission NTAG : National Technical Advisory Group NYP : National Youth Policy PAF : Poverty Alleviation Fund PHC : Primary Health Care Center P&D. Population and Development PPI : Population Poverty Index PPP : Population Perspective Plan PRSP : Tenth Five-Year Plan, Poverty Reduction Strategy Paper SBA : Skilled Birth Attendants SDC : Swiss Agency for Development and Co-operation SHP : Sub Health Post SLTHP : Second Long Term Health Plan TB : Tuberculosis TYIDP : Three Year Interim Development Plan 3 TFR : Total Fertility Rate UN : United Nations UNAIDS : United Nations Program on HIV/AIDS UNFPA : United Nations Population Fund VDC : Village Development Committee VERS : Vital Events Registration System WB : World Bank WHO : World Health Organization 4 Table of Contents S N Chapter 1 Demographic Situation 2 Fertility and Its Proximate Determinants 3 Mortality 4 Migration 5 Urbanization 6 Education , language, Religion and Caste /Ethnicity 7 Economically Active Population 8 Adolescents and Youth 9 Ageing 10 Poverty in Nepal 11 Women Empowerment 12 National Health Policies and program 13 Population, Environment & Disaster management 14 Population Policies and Programs 15 Sources of Demographic Data and Population Projection 16 International Conference on Population and Development 17 Population and Conflict 5 CHAPTER 1 Demographic Situation 1.1 Define Demography, Population and Population Economics: The word “Population” refers to the number of inhabitants living in defined areas at a particular time. Several aspects of population such as size, growth rate, composition, distribution pattern, density, mobility pattern are the common phenomenon that poses several opportunities and constraints to resources and infrastructure planning and development. Population is always dynamic due to birth, death, and migration .Out of these three processes, birth and deaths are associated with issues of public health but third aspect migration is associated with human geography. The study of human population can be encompassed into two types of demography: formal demography and Population studies and recently various researchers and scholars define demography and population by linking with traditional micro and micro economics. The brief definition has been presented below. “Demography is the statistical and mathematical study of the size, composition, and spatial distribution of human populations, and the effects of changes on the composition and growth of such populations and a change over times these aspects through the operation of the five processes of fertility, mortality, marriage, migration and social mobility". Donald Bogue (1969) Demography is the study of human population in relation to the changes brought about by the interplay of births, deaths and migration. Pressat 1985) Demography is the scientific study of human populations, primarily with respect to their size, their structure, and their development. United Nations, (1953) Population studies are 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. Demographic economics or population economics is the application of economic analysis to demography, the study of human population, including size, growth, density, distribution, and vital statistics. The field of population economics is fertility, mortality, morbidity, migration, gender issue, GDP, GNP, and so on. 6 Relationship between Population Economics and Other Economics Population Economics and Macro and Micro Economics The various researches show the relationship between population dynamics and public choice, and the impact of population on the distribution of income and wealth. Theory of micro and macro economics can be applied in applied population management. In micro-level it examine individual, household or family behavior, including household formation, marriage, divorce, fertility choices, education, labor supply, migration, health, risky behavior and aging. In macro-level investigations may address such issues as economic growth with exogenous or endogenous population evolution, population policy, savings and pensions, social security, housing, and health care. Moreover, economics always calculate National income for example, GDP , GNP and Per capita income based on the population of that country. Population and Development Economics This fear of population growth is not new. Thomas Robert Malthus and other classical economists worried that as the growing population made land increasingly scarce, rising food prices would eventually choke off further economic and population growth, leading to the “stationary state.” For classical economists, natural resource constraints, particularly of land, were at the heart of the problem. However, Ester Boserup and the late Julian Simon, argued forcefully that population growth has positive economic effects. Simon pointed out that another birth means another mind that can help think up ways of using resources more efficiently. More population could also stimulate investment demand, break down traditional barriers to the market economy, spur technological progress, and lead to harder work (the latter because the presence of more dependents in the household raises the marginal utility of income relative to leisure and leads to longer hours of work). They noted also that a larger population can more easily bear the costs of providing certain kinds of social infrastructure—transportation, communications, water supply, government, research—for which the need increases less than proportionately with population. Indeed, Simon argued that the ultimate resource was people, and that the world would be better off with more of them. By the 1980s, policymakers were confused. Was population growth good? Was it bad? Did it matter at all? A reassessment in the 1980s revealed a surprisingly high degree of agreement among economists that population growth matters less than had previously been thought, in part due to the flexibility of free, competitive markets. In market economies, when population growth makes resources more scarce, the prices of those resources rise. This leads consumers to reduce their use of these resources and to find substitutes. The higher prices of resources also give producers an incentive to find new supplies and to substitute cheaper resources as inputs. But, more important, technological progress often reduces prices of resources, even in the face of higher demand. Population and Health Economics: The concept of health economics has been developed by Petty,(1623-1687) attempt to quantify the value of human life by measuring and expressing of an individual’s value in terms of that persons’ contribution to national production. Similarly Vein Dine (1916) estimates the economics effects of malaria in India in terms of lost output resulting from mortality, disability, and debility. Much of it was termed medical economics, and included gathering financial and social information on health care utilization patterns, investigating the efficiency of hospitals, exploring the desirability of health insurance and looking as the business side of medical practice. Such information shows the causal link between population and health economics. 7 Population, Health and Environmental Economics: 1.2 The Global Population Situation: Historically, 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