“If Nepal Is To Benefit From Demographic Bonus, Utilize The Window Of Opportunity”
-Junko Sazaki
JUNKO SAZAKI is the United Nations Population Fund (UNFPA) country Representative to Nepal. She has been working in Nepal for more than three years and is very knowledgeable on demographic development and other population issues in the country. She spoke with KESHAB POUDEL on various issues related with population. Excerpts:
How do you see the over all population trend in Nepal? What is the present state of population growth?
We are encouraged by overall population trend in Nepal. After years of efforts from UNFPA and other donors, Nepal’s demographic transition is evident in every aspect. Although population growth is still high (2.25% per annum), mostly contributed by natural growth and in-built momentum resulting from age-sex-composition of Nepal’s population, we are encouraged to see other signs of demographic transition. Fertility and mortality has declined considerably over the years. The recently concluded Nepal Demographic Health Survey shows improvement in almost every aspect: Infant and child mortality has declined further from 64.6 in 2001 to 48 in 2006. Early indication is that maternal mortality has also come down. Life expectancy has cross 60 years for both sexes. The use of contraceptives has gone up to 44 percent and the total fertility rate has declined to 3.1 children per woman.
How will this demographic transition shape in coming years?
As Nepal moves forward in its demographic transition, we will see continued growth of adolescent and elderly population. Because of the development of transport and communication, both internal and international migration has increased further augmented by more than 10 years of civil unrest and insurgency. As a result, the speed of urbanization has increased so is the problem of internally displaced persons (IDPs). Adolescent and young, elderly, urbanization and IDPs are some emerging population issues in Nepal. These are issues which will be increasingly important for population and sustainable development in this country.
As it is reported that the fertility rate has declined drastically, how will it affect Nepal's long term population management?
We are very pleased to see continued decline in Nepalese women’s fertility. In 1971, Nepal’s total fertility rate was 6.1 children per woman; it came down to 5.6 in 1981, 4.6 in 1991 and 4.1 in 2001 and 3.1 in 2006. The decline is more pronounced in the five years between 2001 and 2006. Even though the decline is observed in every age group over the last 10 years, larger declines are seen in older age women. However, let me inform you that the decline has not been universally distributed across the development regions and ecological zones of Nepal. Total fertility rate in Nepal’s urban area is 2.1 compared to the 3.3 in rural areas, a difference of a child. Likewise, women in Nepal’s mountain region still bear 4.1 children in their life time compared with 3 and 3.3 children in the hills and terai respectively. Both Mid-western and Far-Western regions have higher fertility rate (3.5) than central (3.0) and eastern and western development region (3.1) respectively.
What effects will this disparity have?
I am highlighting these differentials to drive the point that fertility will further decline as we improve access to reproductive health services including family planning and other interventions such as education and rural infrastructures to those areas which are yet to benefit from these development interventions. Let us not say population management, let us say population and development, which is core to our mandate. There are two aspects of this demographic transition occurring elsewhere and in Nepal: one is to facilitate completion of this transition, the other one is to address the results/outcome of the transition. We must continue to build on our successes—continue to focus further on improving women and adolescent’s access to quality reproductive health information and services and, improving service delivery, improving utilization of services, making available human resources, specially, skilled birth attendants, providing choices of family planning services and improving the quality of care. All these efforts have to be sharpened further to ensure that Nepal achieves and completes demographic transition as quickly as possible.
What is your impression about fertility transition?
Let me enter into another element of the fertility transition: addressing the results of the transition. You will recall what I said in the beginning; new issues will emerge from transition: number of adolescents and youth will increase leading to a youthful working population. To benefit from this youthful population, policies and programs need to be formulated and implemented. Evidence all over the world has shown that investing in health and education and mainstreaming gender issues and empowering women go a long way to reap the benefits of one and only one window of opportunity popularly known as demographic bonus. UNFPA is working with national and international partners to see that Nepal increases its investment in these key sectors to reap the benefit of demographic transition. If that happens, not only Nepal’s issue of social exclusion will be addressed, the process will make Nepal a modern state as per the aspiration of Nepalese people.
As migration to urban areas continue to increase, does Nepal have capability to manage it? What will be the long run implication of population migration?
Over the years, lifetime migration has been increasing in the country and we expect this phenomenon to continue as Nepal integrates more to the global economy. When there are pockets of affluence and deprivation, it is but natural, people are attracted to areas of affluence. Uneven distribution of resources among geographic and social groups results in uneven development. Urbanization is critical for industrialization. No country has prospered without urbanization. Urbanization leads to industrialization and prosperity. Nepal is least developed, partially because it has low level of urbanization and industrialization. Urbanization and industrialization is synonymous. It is also a force of modernization. Urbanization makes it possible to deliver resources at a reasonable cost giving economy of scale.
The theme of this year’s Population Day was also urbanization and youth. Can you elaborate?
On 27 of June we launched the State of the World Population Report 2007. This year’s theme was on urbanization and urban youth. Urbanization is accelerated with inflow of people to areas with higher potentials for growth, where people can have education, health and employment opportunities. In Nepal, urbanization is rapid—urban growth is more than 5% compared to population growth of 2.25 percent. Conflict and internal disturbances has further increased the speed of out migration from rural to urban areas. Conflict and disasters both natural and man-made have also contributed to internally displaced people, and this number is likely to grow if root causes of conflict: deprivation and social exclusions are not addressed. Personally, I favor rapid urbanization as it has greater potential to solve poverty, deprivation and social exclusion because targeted programs can be implemented with minimal transition costs in urban area than serving a sparsely populated rural area.
What Nepal needs to do?
We need to strengthen the capacity of the government to provide services. Nepal’s development partners are working to strengthen capacity of central and local governance bodies to take the challenges of increased migration and urbanization, and I do not think, Nepal will lag behind to benefit from this growth potential. Improving governance, service delivery and decentralization will be important milestones in managing urbanization. However, if we fail to design and implement appropriate policies, we will have a chaotic situation: urban slums, congested cities, traffic jams, lack of basic infrastructures and facilities, environmental degradation and inhabitable landscape.
What is the age structure of population composition? What Nepal needs to do to manage large number of adolescent population?
Because of on-going demographic transition, age, sex composition of population continues to change and this will be more visible when the demographic transition further intensifies. Of the total population enumerated in 2001, around 39 percent is below 15 years of age, another 19.4 percent is between 15-24 years of age indicating youthfulness of the population composition. Population aged 15-60 years also known as working age group population is 54 percent. Elderly population aged 60 years and above is 6.5%. Population less than 15 years and above 60 years is regarded as dependent population. In Nepal, every 100 adult population (15-60 years) is supporting 85 children and elderly. However, as fertility declines further, and socio-economic interventions improves people’s living standards, many more people will survive to old age. As a result, elderly population will continue to increase. Whereas, deepening of fertility transition will reduce the share of less than 15 populations increasing the share of working age population. That’s when you will have “demographic bonus”—the dependent population will be less than the working age population. Therefore Nepal must design appropriate policies and programs to address these issues.
As youth population grows, what policies should the government introduce?
According to a projection carried out by Central Bureau of Statistics and Ministry of Health and Population (that time Ministry of Population and Environment), the population of youth ages 15–24 will grow from 4.6 million in 2001 to an estimated 6.5 million in 2021- an increase of 41 percent in just 20 years. However, if you look development polices and programs, you would not find much on adolescent and youths. This is even true of the MDGs, although MDGs is comprehensive, however, it has also failed to include adolescents/youths in its goals, as a result, the issues of adolescents are likely to be less attended.
How do you see Reproductive Health issues?
In Nepal, there has been almost neglect of reproductive health care needs of these people. However, this age group is very dynamic, transitory and formative. They need proper and youth friendly information, education and services so that they are well-informed and skilled to make right decision affecting their lives. Providing, youth-friendly information, education and services will be critical so that the youths behave in a responsible way. The reproductive health needs of Nepalese youth will remain a significant challenge in the future. Yet youth have received only limited attention from policymakers and are largely invisible in the MDGs.
After twelve years of conflict, Nepal has hopes for peace. How can UNFPA support those rural populations who did not get basic health services in the past?
To cater to the emerging reproductive and other heath care needs of people affected by conflict, we have been continuously reviewing our policies, strategies and programs so that we are effective to deliver services where it is needed most. During the 5th Country Program, we made a major departure to prioritize our support to the districts. In last two years, we have further intensified our support to the communities in the districts where we have been working. Under this framework, we are working with GON/NGOs and community groups to strengthen their management capacity and improve RH service delivery.
What are you targets?
Our target is to reach the un-reached, marginalized and disadvantaged communities who have been left out by development interventions. We would like to empower them to plan, implement, monitor and evaluate their own development programs. The second mode of delivery is through reproductive health mobile camps. As conflict ended and peace prevailed, we also worked with other UN counterparts and participated in Flash appeals for funds to provide mobile reproductive health clinics in mid-west and far west districts. Donors show that as a priority and we have received funds from European Commission, Directorate-General For Humanitarian Aid – ECHO and ECHO Japanese Government. We are expecting funds from the Embassy of Denmark to support these important initiatives. Our mobile clinics are filling important gaps of health services in general and reproductive health services in particular. They not only provide RH services, they also provide surgical treatment of U. prolapse, a hidden diseases affecting a large number of women of reproductive age in Nepal, which is less covered by government policies and programs.
How is UNFPA supporting Nepal to cope with overgrowing population?
Population is a cross-cutting issue. Our support comes under three different thematic areas: Reproductive health, Population and development strategies and Gender and advocacy. Decades of our support to the Government of Nepal has strengthened its capacity to formulate appropriate policies and programs in RH, population and development strategies and Gender issues. Reproductive health is now largely integrated in the framework of Primary health care and we have assisted Government to develop Reproductive Health strategy following the Program of Action of the International Conference on Population and Development (ICPD). Based on that, several protocols for different tiers of service providers are developed, implemented and followed. Our support to family planning services and reproductive health commodities is critical to ensure that couple who want to limit their family sizes have the choice of methods available in service delivery points. To reduce maternal mortality, we have been working with the technical backstopping of WHO to introduce Skilled Birth Attendant (SBA). To strengthen service delivery, we have been continually supporting training of service providers. Providing appropriate IEC/BCC messages for utilization of services has been one of the pillars of support. In the meanwhile, we have also been integrating and mainstreaming emerging issues such as Gender and GBV in RH policies and programs.
How you have been assisting the government?
We have assisted GON to prepare a Population Perspective Plan. The Plan is a reference document lying out polices and programs for integration of various sectors to integrate and mainstream population variables so that each sector contributes to improve the quality of life of Nepalese people. If its recommended polices and programs are followed properly, it will significantly contribute to achieve Millennium Development Goals. On gender, our support has been directed to formulate policies and programs for mainstreaming gender issues in Nepal’s development and advocate for women’s empowerment, equity and equality. Over the years, there has been a progressive change in reducing gender differentials and improving women’s status. Our focus is on educating girls. These interventions we believe will inform every individuals and couples of their reproductive health and rights. As educational status and reproductive health services are improved, people desire fewer children as is already evidenced by various surveys and recently NDHS. Enabling couples and individuals to enjoy their reproductive rights and educating girls in the long run will help to slower population growth. We are working with donors, NGOs, Civil Societies and GON to increase funding on health, education, and social sectors so that Nepal achieves its demographic transition as soon as possible.
Do you think Nepal can maintain MMR and CMR as envisaged by MDG?
Our efforts are directed to contribute to the achievement of these goals. Sooner the political transition is over, we hope the better for creating an enabling environment for achievement of internationals goals and targets including Nepal’ own development goals. Current assessment is that CMR is likely to be achieved but MMR is less likely if business continues as usual. If we are serious, even this can be achieved. From the results of the recently concluded NDHS, we have known that all health indicators including MMR and CMR have been improved significantly over the period. Although it is too early whether we have achieved that level of MMR to be sure under conflict condition is something we are looking forward to further investigation. However, to focus on further reducing the MMR, we have been working and advocating provision of SBAs and a consensus has already been reached to field them to service delivery points. As MMR is a result of combination of various factors, improvement of service delivery alone will not suffice, we also need to focus on empowering women through education and income generation, increasing men’s involvement in mother/child care and political will of leaders at all levels is also critically important. Sooner Nepal is able to do this; nearer we will be meeting the target.
