Nepal is a land-locked country located at the foothills of the Himalayas. The country is bordered by India to the east, south, west, and China to the north. Nepal is rectangular in shape and stretched 147, 181 square kilometers in total. Nepal is divided into three distinct ecological regions: Mountainous region, Hilly region, and the Terai (or plains) region. Nepal recently emerged from a decade-long armed conflict (1996-2006). This conflict had an effect on both the population’s health and the health care system. This conflict aggravated the already poor health service provision of Nepal.
The average household size in Nepal is 4.2 members. More than 3 in 10 households (31%) are headed by women. Nearly one-third (34%) of the population is under age 15. Migration is quite common in Nepal—nearly half of households (47%) reported at least one person who migrated from the household in the past 10 years. One in three men migrated in the past year. Nearly 8 in 10 men migrated for work and two-thirds of women migrated due to marriage.
Source: extracted from Nepal Demographic & Health Survey (NDHS) 2016
Sexual and Reproductive Health
Key findings from the 2016 NDHS on the situation of SRHR in Nepal are as follows:
- The maternal mortality ratio is 239 for every 100,000 live births.
- Eighty-four percent of women who gave birth in the 5 years before the survey received antenatal care from a skilled provider.
- Sixty-nine percent of women had at least four antenatal care visits.
- Ninety-one percent of women took iron tablets or syrup and 69% took drugs for intestinal parasites during the pregnancy for their last birth in the 5 years before the survey.
- Eighty-nine percent of women were protected against neonatal tetanus.
- Fifty-eight percent of deliveries are conducted by skilled birth attendants.
- 57% of deliveries take place in a health facility.
- Only 57% of both mothers and newborns receive a postnatal care check within 2 days of delivery.
- Women in Nepal have an average of 2.3 children.
- Women in rural areas have an average of 2.9 children, compared to 2.0 children among women in urban areas.
- Women living in the poorest households have an average of 3.2 children, compared to 1.6 children among women living in the wealthiest households.
- Since 1996, fertility has decreased from 4.6 children per woman to the current level.
- More than half (53%) of married women age 15-49 use any method of family planning—43% use a modern method and 10% use a traditional method.
- Female sterilization is the most popular modern method (15%).
- 61% of married women do not want any more children.
- Only 15% of currently married women age 15-19 use a modern method of contraception.
- Twenty-four percent of married women of reproductive age have an unmet need for family planning; that is, they want to space or limit births but are not using contraception.
- According to the UN Abortion Policies and Reproductive Health around the World (2014), abortion is permitted on all grounds.
- Of total pregnancies, 9% of all pregnancies were induced abortions.
- Overall, two in five (41%) women age 15-49 were aware that abortion is legal in Nepal.
- 48% of women age 15-49 report knowing a place where a safe abortion can be obtained.
- Abortions account for a higher proportion of pregnancy outcomes among women age 35-49 (27%) and among fifth- or higher-order births (21%).
- 72% of women used medicines to terminate the pregnancy (medical abortion), followed by manual vacuum aspiration (17%) and dilation and evacuation/dilation and curettage (7%).
- A large majority of women who had an abortion in the 5 years preceding the survey went to a doctor, nurse, or auxiliary nurse midwife (71%) for their most recent abortion.
- Only half of women who had an abortion in the 5 years preceding the survey were given information on family planning methods during the post-abortion period.
- One in four women used a family planning method within 2 weeks of their abortion.
- More than 8 in 10 women reported at least one problem in accessing health care for themselves.
HIV & AIDS:
- Eighty-one percent of women and 98% of men have heard of AIDS.
- Comprehensive knowledge about HIV is not widespread among either women (20%) or men (28%).
- Forty-seven percent of women and 51% of men know that HIV can be transmitted during pregnancy, during delivery, and by breastfeeding.
- 44% of women and 36% of men know that the risk of mother-to-child transmission can be reduced by the mother taking special drugs.
- Forty percent of women and 33% of men expressed discriminatory attitudes towards people living with HIV.
- Thirty-four percent of women and 58% of men know where to get an HIV test.
- 10% of women and 20% of men have ever been tested and received the results.
Sexual and Reproductive Rights
Child Early & Forced Marriage (CEFM):
- 17% of adolescent women age 15-19 are already mothers or pregnant with their first child.
- Teenage pregnancy decreases with increased education; 33% of young women with no education have begun childbearing, compared to 7% young women with SLC and above education.
- Eleven percent of women begin sexual activity before age 15, while 51% have sex before age 18.
- One in five women give birth by age 18.
Violence Against Women (VAW):
- Twenty-two percent of women in Nepal age 15-49 have experienced physical violence since age 15, and 7% have ever experienced sexual violence.
- Six percent of women who have ever been pregnant have experienced violence during pregnancy.
- Twenty-six percent of ever-married women have ever experienced spousal physical, sexual, or emotional violence.
- The most common type of spousal violence is physical violence (23%).
- Sixty-six percent of women who have experienced any type of physical or sexual violence have not sought any help or talked with anyone about resisting or stopping the violence they experience.
- More than one fourth (29%) of women agree that wife beating is justified under specific circumstances.
- It is, however, interesting that fewer men (23%) agreed in the survey.
- The wife neglecting the children was reported as the most common circumstance justifying wife beating (24% of women, 19% of men).
- Attitudes justifying wife beating are most common among women with a primary education (33%) and those in the middle wealth quintile (34%).
- Use of female sterilization is highest (28%) among women who justify wife beating in all five circumstances and lowest (14%) among those who justify none of the circumstances.
- A positive correlation existed between women who do not justify wife beating in any circumstance and those who received antenatal care from a skilled provider and postnatal checkups in the first 2 days after birth.