Dealing with 40 Million Nepalis

There are no quick-fixes to Nepal's population problem. It is past time to begin a resolute, long-term programme of fertility control.

Even though Nepal has been attempting to regulate population growth over the past couple of decades, the results have been less than satisfactory. The country's population reached 19 million in 1990 from 5.6 million in 1911, 6.3 million in 1941 and 15 million in 1981. While it took 60 years for the population to double between 1911 and 1971, at the prevailing annual population growth rate of 2.6 per cent it will take only another 25 years for it to double again.

There are 50 new mouths to feed in Nepal every hour, 1200 every day and 450,000 every year. There will be 24 million Nepalis crowded into these hills and plains by the turn of the century. A majority of these will be of economically and socially dependent age of below 15 years and above 60 years.

These data indicate that the situation is critical. With Nepal's decreasing resource base, there is no way to sustain even a minimal quality of life if the population continues to expand at the present rate. This low quality of life is indicated by the fact that today per capita income is below U$170, life expectancy is below 54 years, 100 out of 1,000 infants die during the first year, and nine out of 1,000 mothers die during childbirth.

Population control can only be tackled on a long-term perspective, as opposed to short-sighted, ad-hoc programmes that has been the hallmark of the past in Nepal. The basis for a long-term population plan does exist in the National Population Strategy adopted in 1983. But the document will, like most other master plans, remain a dead letter unless there is strong commitment.

It is true that over the past 20 years, attitude towards population programmes in Nepal has changed from indifference to lip service to a grudging acceptance. But we have still not reached a stage where society is galvanised to tackle the problem. In Indonesia, there is understanding of and action on population issues from President Suharto down to the village headman. Only when similar involvement is apparent in Nepali society will we even begin to address the question of population seriously.

AGENDA

 It is now urgent to adopt and implement a comprehensive and multi-sectoral strategic plan with realistic population targets, a time-bound plan of action and clear-cut division of responsbility between government and non-government sectors.

Enough human, financial and technical resources must be provided to population programmes. At the same time, villagers themselves must be allowed to participate in formulating and implementing programmes that affect them. It is they, after all, who will either accept or reject the small-family norm.

Quality family planning services will have to be expanded through hospitals, health-posts and non-government outlets to cover the entire area of the country. Presently, only 15 per cent of couples of reproductive age use population control methods. Such use will have to rise above 50 per cent to make a dent in fertility and population growth. Wives will have to receive increased decision-making powers with regard to use of contraceptives, without interference from mothers-in-law or husbands. Many more men have to be convinced to use contraceptives.

Improved service quality and acceptability is important to bridge the gap between knowledge and practice of family planning. In the past, emphasis was placed on sterilisation and new contraceptive methods were introduced on an almost ad-hoc basis. There have been lapses in providing medical and consultative support to women who have tried the pill, IUDs or the Depo-provera injectible.

The push should now be on making a broad range of contraceptive choices available to couples so that they can select the best possible method depending on their health, age, location and other socio-cultural factors.

Counseling programmes arc vital but virtually non-existent. They have to be expanded in order to assist and reassure couples. Lack of counseling programmes and follow-up, in fact, constitutes a major handicap. Family planning drives must be attuned to specific rural milieu and they must respect the rural person's need for information. It is in large measure a failure of past efforts that a majority of couples remain ignorant about contraceptive choices. Large-scale misinformation about contraceptive-use and sterilisation continues to permeate society and rumours of the ill-effects circulate freely. Motivation and method-specific information clearly is the key for a large part of the population.

Successful family planning depends upon other developmental factors and therefore has to be integrated with programmes such as mother and child health services. After all, acceptance of family planning to a large extent depends upon the survival of the desired number of children. Beyond that, in a country where a majority of women are said to be "poor, powerless and pregnant", improving women's social and economic status is in itself a family planning exercise. Since population is a mutli-sectoral problem, population activities also need to be integrated with other developmental, educational and environmental programmes.

Because so many societal factors are involved, there are no quick fixes towards a successful population control programme. Also, the impact of a good programme is not immediately apparent. That is every reason to act on population issues now, before millions more become part of our census figures.

Som Pudasaini is Director-General of the Family Planning Association of Nepal.