“Maternal Health Situation Can’t Improve Without Cooperation From Male”
Dr. Ram Hari Aryal 
DR.RAM HARI ARYAL, Chief of Population Division of Ministry of Health, is a
well known population expert. He has worked as a secretary at the Population Committee of House of Representatives and in the National Planning Commission. Dr Aryal
has done his Ph. D from Australia National University. Dr. Aryal spoke to SPOTLIGHT on various issues on the eve of World Population Day. Excerpts:
As Nepal has been celebrating the World Population Day since last many years and it has been conductive various population control measures, what implications they have had in overall population growth?
Yes we have been celebrating the World Population Day since 1987. After the world's population reached 5 billion and most of them concentrated in developing countries, UN announced July 11 as the World Population Day with aim to generate awareness, and involve stakeholders in developing countries. Every year, we celebrate world population day with various slogans.
What is the special message of this year?
As population is a multiple and diversified issue, this year we are celebrating the population day with a slogan of Men as a Partner of Maternal Health. This is a fact that men have to play important role in the maternal health. At a time when men's involvement is very negligible in maternal health in countries like Nepal, any program encouraging male in maternal health will be significant. One cannot change maternal health situation without the participation and involvement of male.
What is the state of maternal mortality rate now?
According to recently published Demographic and Health Survey 2006 maternal
mortality has drastically declined to 281 per 10,000 births. It was 539 in 1996. As the maternal mortality rate has declined, there is also a need to involve more men in maternal health to sustain it. We will conduct various programs to involve men as well as families in the maternal health. Maternal mortality is not only a responsibility of women but family as a whole need to be a partner. In our country, number of female is little bit higher than male. In this context, there is a need for a balanced development. Just giving
reservation to women is not enough for their overall development but what is required is to empower and educate them.
What is the state of fertility?
Total fertility rate has dramatically declined from 4.6 births per women in 1996 to 3.1 births in 2006. This is a very good trend - as a drop of one and half births per women in the past ten years. The challenge now is how to maintain it. In the year 2001, the total fertility rate was 4.1 but the decline started from 2001. The fertility is still higher in rural areas with 3.3 births and 2.1 in urban areas. This is a very exemplary progress where a
child was reduced in the period of just five years.
How has it declined in such a manner?
It surprises many but there are so many factors which are contributing to its decline. First of all, the growing number of migration, second is separation of spouse and higher awareness level among the male as well as change in marriage pattern. We are now further analyzing the new trend. We want to know why it declined sharply.
What are the major challenges now?
Our challenges are now to maintain it. Along with taking the programs to rural areas, we need to involve all kinds of people in the process. Our experiences have already shown that this kind of progress cannot be sustained without active involvement of people in the grass-root level.
How do you involve grass root people?
In this process, we have already formulated population perspective plan which is in the process of implementation. The plan will involve all the stakeholders in population management program. After the implementation of Population Perspective Plan, our program will be rural oriented and focus will be given for the involvement of the people in grass root level. From inception to monitoring and evaluation, involvement and inclusion of concerned stakeholders at grass root level are necessary.
How do you see the composition of population?
As Nepal's population composition consists of overwhelming number of adolescents and youth, Nepal's population growth will be higher for another 20 to 30 years. Because of relatively high fertility rate in the past, a large proportion of Nepal's population is under the age of 15. According to survey, 41 percent is under 15 years old with 13 percent under age 5. Next 20 to 30 years is going to be a period of population momentum. Our indicator shows that we need to work vigorously to achieve our target in the population management. Of course, there is a major challenge but we need to use these challenges as opportunity.
Every one is talking about the need of involvement of rural population, what programs do you have to implement them?
How we can involve rural population in our program will determine future of Nepal's population growth as we know the fertility rate in hills is still high at 4.1 births per woman. If we are able to involve rural population, the present rate of 3.1 of fertility rate will not reverse back again. We have seen this kind of situation in Bangladesh where the fertility was declined drastically and stalled for 15-20 years. According to a theory, once
the fertility declines, it will not reverse back. It will further decline or remain stalled for years.
What is the way to sustain it?
If we are able to stall the present fertility rate this will be major achievement for us. It will further decline because of change in the family relationship. There have already been perceptible changes in traditional family relation pattern. The preference of son against daughter is gradually reducing. The trend of going overseas for education and work has also brought the change in family relations. That change will definitely bring change in fertility. Another positive side is that the use of contraceptive has also increased. Nearly one in two currently married women are using a method of contraception with 44 percent women using a modern method. According to survey, nearly all Nepalese women and men know of at least one method of contraception.
How do you see the situation of child health?
In maternal child health, we have made tremendous achievement and we are now in a position to meet Millennium Development Goals. Our immunization program is very successful and there is growing awareness among the population about the need to immunize the children. This also assures male and female that they don't need many children.
How do you give general health service?
Now our challenge is to provide quality service in rural areas. Because of increase in access to health, one can see change in health indicators. We need to sustain change and make it more sustainable.
What will be the implications of growing number of population?
If our population will continue to grow at the rate of 2.5 percent, Nepal's population will be doubled in next 30 years. We have not done any analysis on what the carrying capacity of Nepal is in terms of population. It is necessary to conduct research on how much population will be sustained in given availability of resources.
What is the carrying capacity of Nepal?
After completing the research, we can say how many people will be sustained by our natural resources. For example, the population of the valley is over 3 million and it has made the valley overcrowded. If we are unable to manage the population growth in the valley, it will create major problems for us. To reduce migration to the valley, we need to build infrastructures in other parts of Nepal also. We have to develop opportunities in different parts of Nepal to retain the local population. When we are talking about new
Nepal, we need to expand our opportunities outside the valley. If people get opportunity in other parts of the country, people will not come to valley.
How supportive is the present health system in maternal health?
Although our survey report shows that only a small number of women have access to health centers during the time of delivery, more and more health centers continue to expand in the rural parts of Nepal. Only handful of women gets anti-natal and post natal care. Even in such a situation, our maternal mortality rate has declined. If women have more access to health centers, the situation will be much different. We need to generate
awareness. The health awareness in rural areas has tremendously increased as people understand the need to go to health centers in case of problems. Thanks to increase in the access to health services, we have seen the present change in fertility, maternal mortality and infant mortality. We have health volunteers, health staffs and doctors in the rural areas. We have been launching various programs involving the community.
Why is men's role important?
We have not done the research on involvement of male partners in maternal issues but it is still low. Men have to take care of women during child bearing.
How do you see the rate of delivery at the health posts?
Delivery at health facilities need to increase. This will result in low casualty. Nepal still has high prevalence of early marriage and there is a social pressure of early child. If a woman gives birth in younger age, maternal mortality as well as child mortality is higher. We need to encourage people to have late marriage and there is a need to discourage early child.
