Can Family Planning control Population growth in Nepal ?
By: Nawaraj Subba, MPH, MA

Introduction
Determinants of Population growth
Possible measures

Introduction
Family Planning solely cannot control the population growth of a country because components such as mortality and migration which are also responsible for population growth. All three components i.e. mortality, fertility and migration should be addressed to control the population growth in Nepal. It is also true that without controlling fertility population control is almost impossible. Though Family Planning is not enough to address the population problem; it is capable to control the natural growth of a population. Family planning is one of the best measures to control population. It has got multidimensional impact such as health of mother, child and family, good education for the children, check the deforestation etc.

As we see the phenomenon of population growth, we have a formula to understand the overall phenomena.

P^t = P^o + (B-D) + (I-E). Where P^t and P^o refer to sizes of population at the beginning and end of a time period, and B, D, I and E to the number of births, deaths, immigration and emigration respectively in the period concern.

According to the above formulae, population growth depends upon: -

Cultural Factor.
Early Marriage. There is strong hold of religious belief and traditional practices in a society. Early marriage of a girl child is one of its examples. Parents are keen to marry their girl child since due to either religious belief or it is considered more difficult to find husband as the girls get older or both.

Early Pregnancy. In Nepal 44% of 14-19 years of age group is having pregnancy. It is due to our tradition that groom's as well as bride's parents expect a child from a new bribe as soon as possible. Since immature reproductive system physically, mentally of a girl lead undermine health of both mother and baby.

Feeling about girl child is born for another house.

Traditional status of women determines so many aspects of a women's control of her own reproductive behavior including involvement in decision making of their own marriage, physical movements both inside and outside the home and control over property. Restriction on movement often prevents women from continuing education beyond primary school. It is found that early marriage is particularly high in areas where female literacy is low and women are restricted in their movements. In Srilanka and Indian State of Tamilnadu and Kerala where women work outside the house and women marry later. In regions where women's movement is restricted they are considered a burden so they marry earlier.

Educational Factor.
Education is an important variable affecting demographic behavior concerning marriage, fertility, mortality and migration. In a number of research studies; a clear-cut negative relationship has been established between educational level of women and their family. We have observed that educated women want fewer children and are better to care for their children. Educated girls and mother are the key to success in Family planning. Nepali culture is found as gender biased typed of culture, which favours male. So, special approaches are often needed to eradicate the special barrier that prevent girls from enrolling in school, completing school and achieving in school. There is also UN report (1987) has also highlighted that in fact education leads to improvements in social status for women and families.

A study uncover that unschooled mother's contributed 49% of total childcare time, compared with 62% among schooled women (Joshi 1994). It is also found that lack of education acts as a constraints on rational and secular living and influence of religious dogmas persists.

High Infant Mortality Rate.
Since IMR in national average is now 79/1000 which was 107/1000 before a decade. But there is still disparity of the distribution of the figure within the different part of the country. According to the census (1991) there is great variation of the distribution between rural and urban areas. Some of the study has discovered that there is still IMR above than 100/1000 in rural areas and less than 30/1000 in urban areas of Nepal. Because of this kind of high infant mortality rate there is still high fertility which is leading population growth in the country.

Family Planning.
Nepal has already spent more than 400 million US dollar in foreign aids as grants or loans for population activities since 1968 but success story of family planning is bleak up to now. Contraceptive prevalence rate, which is now 31%, TFR, is decreasing year by year that is 4.3 nowadays. But population growth rate is not noted accordingly. It does not mean that Family Planning does not has any role for decreasing population growth. Population growth will be controlled with the means of Family Planning as well as other contributing factors. We cannot imagine population control measures without Family Planning.

2. Mortality. It leads population indirectly by influencing fertility. It has created a culture as the value of number of children in the family and society. Accessibility of health services is important determinants for utilizing health services that makes difference in infant and maternal mortality. Consequently it affects fertility.

3. Migration.
Though migration does not fall under biological factor; is greatly influenced by social, cultural, economic and political variables. Migration has got such potentiality that can substantially change the existing population figure of a country within very short period of time.

Topographically, population distribution can be divided into 1. Mountain 2. Hill. and 3. Terai regions extending from east to west. Since Terai belt extending east to west of Nepal that is open bordered to India and having the tendency of continuously growing its population size since last four decades. It is because of control of malaria, fertile land, transportation as well as open border to India. According to the report of CBS-1991 Population density in Mountain, Hill and Terai was 27.85, 137.25 and 250.62 per sq. Km. respectively. Meanwhile, 7.8%, 45.5%, and 46.7% of total population were found in the mountain, Hill and Terai regions respectively.

Immigrants from India.
Many people in terai feel that migration of population to terai from hills to terai as well as across the border bought changes not only in its population size but also bought changes in the social make-up of population as well as socio-economic and environmental conditions in the terai. By marriage Indian girls are coming in terai and Terain girls are going to India. But the percentage of Indian girls coming in Terai is higher. According to the study done by Lall (1999) about 60% Indian girls are coming by marriage and 40% Terain girls are going to India.

      Source: Field survey V.K.Lal,1999.

Refugee from Tibet.
Since 60s following the Cultural Revolution in China, Tibetan refugees started to move towards India and other countries mostly through the way of Nepal. It is noted that some portion of those refugees has been absorbing in Nepal by marriage, relatives as well as taking citizenship.

Refugee from Bhutan.
More than 100,000 refugees are being settled in the eastern part of Terai districts Jhapa and Morang since 90s. It is also been noted that few percent of these refugees are being absorbed in Nepal through relatives, kinship or marriage as well as by taking citizenship.

B. Possible measures for population control.
Having analyzing the role of family planning and determinants of population; it is easy to explore the multidimensional measures to address the problem of population growth in Nepal. These potential measures are described as follows:

1. Formulation of appropriate population policy and its proper implementation.
Population policy is a guideline that throws light on the way of achieving our goal. Without policy the strategy and programs settings are impossible. Therefore, the consultative Group of Experts on population policy set up by the population commission of United Nations and social Council has included in population policy as measures and programs should be designed to contribute the achievement of economic, social, demographic, political and collective goals through affecting critical demographic variables, namely, the size and growth of population, its geographic distribution as well as its demographic characteristics. So the population policy of Nepal should incorporate those measures that are likely to affect critical demographic variables.

There are four types of population policies.

1. Reducing population with providing infrastructure by government.
2. Population growth reduced voluntarily entirely through education.
3. Policies to reduce birth rate and have a small family after two children to have sterilization.
4. Instituting package for incentives and disincentives.

A.A.Bhende and T. Kanitkar have described following population policies; which are named as:

Government of Nepal has adopted two-child policy but people are taking it relatively; as consequences of Family Planning are being experiencing rather slowly as expected. There are so many factors responsible for this outcome. Accessibility and continuity of FP services and contraceptives as well as IEC intervention focussing generally should be diverted into specific and purposive targeting each and every community and groups of people in the country. Now Nepal needs a comprehensive population policy that must incorporate all potentials to address the population problem in a holistic approach.

Strategy : In order to make FP message effective target group and audience should be identified and prioritized according to their own Reproductive Health and Family Planning (RH/FP) needs. They are as follows: (a)Influential Groups (b) Women (c) Men (d) Newly married young couples (e) Spacers (f) LimitersCCORDING TO THE fAMILY hEALTH sURVRY (g) Adolescents (h) Service Providers (i) Community based Health workers: Trained Traditional Birth Attendants, Female Community Health Volunteers, Community Workers, Mother's Group, and Faith Healers. They are the core-group living at the grass-root level. They are in contact with the grass root people and having potential of behavior change of the people.

3. Liberalizing the Abortion law.
The existing law contains rigid provisions against induced abortion. The intent of the law in effect seems to be to equate abortion with infanticide or other kind of murder or homicide. The laws fail to recognize any mitigating or exceptional circumstances. Laws prohibit medical practitioner from recommending abortion even in situation where the pregnant woman's life is at risk. Though induced abortion is not a method of FP but high maternal mortality rate of multigravida and their behavior cannot be ignored at all. Studies have suggested that at least a fourth of all maternal deaths could be prevented if women said they want no more children were able to avoid further pregnancies. By satisfying unmet needs for family planning maternal death could be reduced by 17% in Africa, 33% in Latin America and 35% in Asia. So simply helping women to realize their childbearing desires would prevent a substantial proportion of maternal deaths as well.

4. Improving the poor status of women in a family. Empowerment can be achieved by: -
1. Girls child Education.2. End of discrimination between boy and girl child. 3. Involvement of women in decision-making process regarding reproductive health and family planning. 4.End of early marriage. 5. Educating about late pregnancy, spacing and family planning. 5. Discourage unnecessary restriction of movement of women. 6. Women's domestic works considered as chores should be regarded as significant contribution that raise morale high.

Now Nepal is experiencing the declining death rate and virtually unchanged birth rate have resulted almost constant population growth. Since Nepal is already over-populated so it must be remembered and emphasized that the future course of population growth of Nepal is dependent on the reproductive behavior of its population. In 1981 the average number of children desired was 4. In 1991, ten years later couples wanted only 3.2 children. This change is associated with an increase in contraceptive use. The CPR has risen from 7.6 in 1981 to 24% in 1991 so the demand of FP services have been steadily rising. Therefore, population policy and FP strategy should be focussed on - 1. Late marriage (after 20 years) 2. Birth Spacing. 3. Informed Choice. 4. Fulfillment of unmet needs. 5. Addressing Limiters/Spacers. 6. Counseling.

5.Health Education intervention about population growth: -Through IEC
I. Mass media. II. Group media. III. Individual method.

Since IEC could be a useful method to remove cultural barrier and stigma could bring change in the population growth gradually.

6.Regulation of open border. An open border is one of the factors for contributing the movement of people. Most of the Terai people think that open border policy should be continue because it is beneficial for terai people and fulfill many daily needs. Social relations, cultural also compel that the border should be open between two countries. From security point of view there is some problem arising due to open border and there is deficit in government revenue also. Therefore they feel that open border should be regulated rather than closed so that it becomes beneficial for terai people economically and for business and industry as well.

7. Regulation of Migration. Emigration and immigration are not beneficial for economic development and national integration of Nepal. Therefore we have needed a long term prospective, a mechanism to regulate and discourage such movements should be developed at the national level. Some of the immediate actions that the government can start to reduce migration are: -

1.Initiate the commercial activities viable to local resources. 2.Motivate the local population for development of one's own locality. 3. Vocational and skills development programs should be launched. 4. Effective and Systemic urbanization policy and programs are needed immediately. However, first of all there should be assessment of needs of population, potential natural and human resources and markets before launching such programs.

8. Successful Diplomatic Affairs. By and large, in the context of Bhutanese refugee issue HMG/Nepal seems unsuceed in diplomatic affairs. It is a crucial area for population problem as well as socio-cultural and political concern.

9.Citizenship amendment bill -2057. A controversial citizenship amendment bill-2057 has been passed from parliament and now attracting the attention of Supreme Court. Many worries are being raised, since it is likely to be misused. They supposed that this act would make easier to get citizenship for Non-Nepali citizen.

10. Regulation of Voter-list. There are many story coming during every election that voters from across the border are coming and casting their votes. No parties are hesitating to get voters even from outside. They deserve the potential of making legislation in parliament of the country. Almost all parties are silent and closing their eyes at this issue. There are so many people across the border of both side are having dual citizenship of Nepal and India.

11. The role of WHO in health, population and development in Nepal. The challenge to WHO and Nepal is to stimulate a redefinition of priorities for national and international resources allocation, especially in the context of health, population and development of the country.

Conclusion: Population itself is a complex. It has got multidimensional forms. It ranges from individual to national level and up to global level. Family Planning solely is not capable to control the overall population growth in Nepal. However, we cannot ignore the role of Family Planning. Because it address the fertility of the population. Population growth resulting from migration and mortality require appropriate and effective measures such as regulation of migration and open border, proper citizenship distribution, Safe-motherhood, RH/FP program etc. Therefore, population control should be considered as state and global concern. This endeavor requires multidimensional approaches addressing Fertility, Mortality, and Migration. Moreover, it should come up with a leadership, having political commitment and proper implementation, determination at all levels.

References:
1.Bhattarai, K.D., 2000, Notes on Population and Fertility.
2. Bhende, A.A., & Kanitkar, T., 1999, Principles of Population Studies, Himalayan Publishing House,India.
3. C.B.S., 1998, Statistical Pocket Book, HMG NPC Central Bureau of Statistics, Kathmandu Nepal. 
4. K.C., B.K., 2000, Journal of Population & Development (editor), Vol.7, Central Department ofPopulation Studies, TU, Kathmandu Nepal.
5. Lal, V. K., 2000, Issues of Internal &International Migration in Terai region of Nepal, The EconomicJournal of Nepal, Vol.23, No.1, Nepal.
6.Thapa, Shyam, 1996, Infant Mortality & its correlates & determinants in Nepal; A district levelAnalysis, Journal of the Nepal Medical Association, Vol.34, No.118, 119, NMA, Kathmandu Nepal.
7. WHO, 1994, Health, Population and Development, Executive Summery.
8.Gorkhapatra, World Population day-2057. Gorkhapatra Sansthan Kathmandu Nepal.

                                     ©2002. Nawaraj Subba, MPH.     Feedback:     [email protected]