Current Situation of Child Mortality and Under-Five Mortality Rates in Nepal

Key concepts

• Neonatal mortality rate (NMR): deaths of children under 28 days of age per 1,000 live births.
• Infant mortality rate (IMR): deaths of children under 1 year per 1,000 live births.
• Under-five mortality rate (U5MR): deaths of children under 5 years per 1,000 live births.
• Child mortality rate: deaths of children aged 1–4 years per 1,000 children of that age.

Current situation (based on NDHS and national/international estimates)

Nepal has made remarkable progress. The U5MR fell from about 162 per 1,000 live births in 1990 to about 33 in 2022 — a decline of nearly 80 per cent — and Nepal has already met MDG 4 (reduce U5MR by two-thirds). The current SDG target is to bring U5MR down to 25 or below per 1,000 live births by 2030, so Nepal is close but not yet there. The NMR has stagnated at around 21, and neonatal deaths now form about two-thirds of all under-five deaths, making them the hardest part of the problem.

Differentials (who is most at risk)

• Rural vs urban: U5MR is higher in rural areas (about 37) than urban (about 27).
• Province: highest in Karnali and Sudurpashchim, lowest in Bagmati and Gandaki.
• Wealth: children in the poorest quintile have roughly twice the U5MR of the richest quintile.
• Mother's education: U5MR falls sharply as mothers' schooling rises.
• Ethnicity: relatively higher among Dalit and some Janajati groups.

Major causes

• Neonatal: prematurity, birth asphyxia, sepsis, low birth weight, hypothermia.
• Post-neonatal: pneumonia, diarrhoea, malnutrition, measles, and lack of immunisation.

Reasons for the improvement

• Expansion of FCHVs and community-based newborn care.
• Immunisation programme (over 90 per cent coverage), vitamin A and deworming campaigns.
• Safe motherhood programme, skilled birth attendance, and free delivery care.
• CB-IMNCI, ORS/zinc, and nutrition programmes (MSNP).
• Better female education, water and sanitation, and health-seeking behaviour.

Remaining challenges

• High and stagnant neonatal mortality; poor quality of care at birth.
• Geographical remoteness and difficult terrain in hill and mountain districts.
• Inequity by wealth, caste and province; poverty and food insecurity.
• Shortage of skilled health workers and weak referral services.
• Teenage pregnancy and low birth spacing.

Conclusion

Nepal's child survival indicators have improved greatly and the country is close to the SDG target for U5MR. However, further gains depend mainly on reducing neonatal deaths and closing the equity gap between rich and poor, urban and rural, and across provinces. Strengthening quality newborn care, skilled birth attendance and nutrition is therefore the priority.

Age and Sex Composition of Emigrants in Nepal

Meaning: Emigration means the departure of Nepali citizens from Nepal to live and work abroad, mainly for employment. The age and sex composition of these emigrants is highly selective and has important social and economic effects on Nepal.

Age Composition

1. Concentration in the working age group: The vast majority of emigrants fall in the 15–44 year age group, with the heaviest concentration in 20–35 years. This is the most productive and physically active segment of the population.

2. Predominance of young adults: Most migrants leave immediately after completing school or shortly after marriage, when the need for income and the capacity for hard manual labour are greatest.

3. Very few children and elderly: Children below 15 and persons above 50 form a very small share of emigrants. Foreign employers prefer young, healthy workers, and older persons find it difficult to get visas and jobs.

4. Result — "age-selective" migration: Because the young and middle-aged leave, the population left behind in Nepal becomes relatively older and more dependent. This raises the dependency ratio and reduces the size of the active labour force within the country.

Sex Composition

1. Heavy male dominance: Emigration from Nepal is male-dominated. Roughly 90 per cent or more of labour migrants going through official channels are men. Destination countries in the Gulf (Qatar, Saudi Arabia, UAE, Kuwait) and Malaysia demand mainly male workers for construction, factories, security and driving.

2. Rising but limited female migration: Female emigration has been increasing in recent years, but it remains much smaller than male migration. Women migrate mostly for domestic work, care-giving and nursing, and several destinations have age restrictions (for example, a minimum age of 24–30 years for women going to some Gulf countries).

3. Causes of male dominance: Social norms that restrict women's mobility, household responsibilities, childcare, safety concerns and legal restrictions in destination countries all keep female migration low.

4. Result — "feminization of agriculture" and left-behind women: When men emigrate, women remain behind to manage farms, households and children. This increases women's workload and responsibility but gives them some new economic roles. It also creates a large number of female-headed households.

Overall Effects

• The emigrant stream is young, adult and predominantly male.
• Remittances sent by these young men support the national economy, but the loss of young talent causes brain drain and labour shortage at home.
• The imbalance in sex composition leaves many young women without marriage partners in some areas and increases the burden on the elderly.

Conclusion: The age and sex composition of emigrants in Nepal is highly selective — young adult males dominate, while children, the elderly and women are under-represented. This selectivity shapes Nepal's dependency ratio, labour market and family structure.

Age at Marriage by Ecological Zones

Nepal is divided into three ecological zones — Mountain (Himal), Hill, and Terai — and the age at marriage differs noticeably among them due to differences in geography, economy, education, and social customs.

1. Mountain Zone: The age at marriage is generally highest in the mountain region. Harsh climate, difficult terrain, limited agricultural land, and seasonal migration for trade and labour make early marriage less practical. Girls often remain in school longer, and economic hardship delays marriage. However, in some remote Himalayan communities, traditional practices still encourage relatively early marriage.

Brahmin–Chhetri families in the mountains usually marry later than Dalit and some Janajati groups. Overall, the singulate mean age at marriage in the mountain zone is higher than in the Hill and Terai zones.

2. Hill Zone: The Hill zone shows a moderate age at marriage, falling between the mountain and Terai zones. Urban centres such as Kathmandu, Pokhara, and other district headquarters record later marriage because of higher education and employment opportunities. In rural hills, however, early marriage is still common among some ethnic communities, and practices like child marriage persist in pockets of poverty and low literacy.

3. Terai Zone: The age at marriage is generally lowest in the Terai. Factors responsible include:

• Cultural and religious traditions — early marriage is socially approved in many communities.
• Dowry system — families try to marry daughters early to reduce dowry burden.
• Poverty and low literacy, especially among Madhesi, Dalit, and some Muslim communities.
• Fear of social stigma attached to unmarried girls beyond a certain age.
• Lack of awareness about the legal minimum age (20 years for both sexes).

Conclusion: In general, the age at marriage increases from the Terai to the Hill and then to the Mountain zone. Ecological zone alone does not determine marriage age; it interacts with education, ethnicity, religion, and economic status. Government efforts through the National Strategy on Ending Child Marriage (2016) aim to raise the age at marriage across all zones.

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Age at Marriage by Rural–Urban Areas

The age at marriage in Nepal shows a clear rural–urban difference, mainly because of variations in education, employment, awareness, and social attitudes.

1. Urban Areas:

• The age at marriage is comparatively higher in urban areas.
• Higher levels of education, especially among girls, delay marriage.
• Greater employment opportunities and career aspirations encourage late marriage.
• Urban people are more aware of the legal minimum age of marriage (20 years).
• Mass media, women's empowerment, and modern lifestyles promote later marriage.
• In cities like Kathmandu, Pokhara, and Lalitpur, the average age at marriage is significantly above the national average.

2. Rural Areas:

• The age at marriage is comparatively lower in rural areas.
• Low literacy and limited educational facilities lead to early marriage.
• Poverty and the dowry system push families to marry daughters early.
• Strong influence of traditional customs, religious beliefs, and social pressure.
• Lack of awareness about legal provisions and health consequences.
• Girls are often seen as an economic burden, so parents arrange their marriage at an early age.
• Child marriage is more prevalent in rural Terai and remote hill villages.

3. Comparison:

Conclusion: Urban areas record a higher age at marriage than rural areas. The main reasons are education, employment, awareness, and weaker traditional pressure in cities. To reduce early marriage in rural areas, the government should expand education, create employment, and enforce the legal minimum age strictly.

Population size and growth trends of Nepal

Nepal's population has been counted by census since 1911, with modern, scientific censuses held every ten years from 1952/54. The population rose from about 8.26 million in 1952/54 to 29.16 million in 2021, more than three times as large.

Growth trends

1. Slow growth before 1950: Between 1911 and 1941 the population hardly grew (about 5.6 million to 6.3 million) because of high birth and death rates, epidemics, and poor health services.
2. Rapid growth from 1950s to 1981: After the 1950s, malaria control, better health care, and falling death rates while birth rates stayed high raised the growth rate from 1.6% to a peak of 2.6% in 1971-81. The settlement of the Terai after malaria eradication also contributed.
3. Fluctuation 1981-2001: The rate fell to 2.1% in 1981-91 and rose slightly to 2.2% in 1991-2001, as the population remained large and young.
4. Sharp decline 2001-2021: The growth rate fell to 1.4% in 2001-11 and to about 0.9% in 2011-21. Main causes are lower fertility due to family planning, female education, later marriage, urbanisation, and large-scale foreign labour migration.

Other features: population density rose from about 56 persons per sq. km in 1952/54 to about 198 in 2021. The Terai holds the largest share of the population, then the Hills, while the Mountain region has the smallest share.

Conclusion: Nepal's population has grown steadily in size but the growth rate has been falling since 2001 and is now below 1%, showing the country is moving through the demographic transition.

Discuss the level and trends of urbanization in Nepal

1. Concept of urbanization

Urbanization is the process by which an increasing share of a country's population comes to live in towns and cities, accompanied by a shift of economic activity from agriculture to industry and services. In Nepal, "urban" is officially defined in terms of population size, density and non-agricultural occupation, and the number of such designated settlements has changed repeatedly through the census years.

2. Level of urbanization in Nepal

Nepal remains one of the least urbanized countries in South Asia, though its urban share has risen steadily.

The 2021 census recorded roughly 27 per cent of the population as urban, a sharp jump from 17 per cent in 2011. This jump is explained less by natural growth or migration than by the federal restructuring of 2017, when many erstwhile villages were declared municipalities. Hence the "level" of urbanization in Nepal is modest in real economic terms but has risen rapidly in administrative terms.

3. Trends in urbanization

(a) Accelerating but uneven growth. The urban population has grown at roughly 3–5 per cent per year, far above the national population growth rate of about 1.3 per cent. Growth is concentrated in the Kathmandu Valley, Pokhara, Biratnagar, Birgunj, Butwal–Bhairahawa and the Terai corridor.

(b) Primacy of Kathmandu. Kathmandu Metropolitan City alone holds a large share of the national urban population, showing a primate-city pattern. The Valley attracts migrants for education, employment, health care and security.

(c) Regional imbalance. The Hill and Mountain regions have few and small towns; the Terai and the Valley dominate. The Karnali and Sudurpaschim provinces have very low urban shares.

(d) Migration-driven growth. Internal migration from hills to Terai and from rural areas to towns, plus remittance-financed house construction, drives urban expansion. Absentee population and foreign migration also distort urban figures.

(e) Unplanned and haphazard expansion. Urban growth has outpaced infrastructure: squatter settlements, encroachment of farmland, traffic congestion, air and water pollution, inadequate drinking water, drainage and solid waste management in Kathmandu Valley.

(f) Emerging counter-trend. After 2011 there is some evidence of return migration from the Valley to secondary towns and even to rural areas, partly due to the high cost of living and the COVID-19 experience.

4. Conclusion

Nepal's urbanization level is still low but its trend is rapid, administratively inflated and spatially unbalanced. Balanced regional planning, planned land use, investment in secondary towns and basic urban services are needed so that urbanization becomes a driver of development rather than a source of congestion.

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Analyze the recent trends of age-sex participation in economic activities in Nepal

1. Meaning

Economic participation is measured by the labour force participation rate (LFPR) — the percentage of the population aged 15 years and above that is either working or actively seeking work. Age-sex participation refers to how this rate differs by age group and by sex. In Nepal, the main sources are the Nepal Labour Force Survey (NLFS) and the census.

2. Age-wise trends

(a) Low participation of children. Child labour has declined over time because of compulsory basic education, awareness and legal prohibition. Participation below age 15 is now small.

(b) Rising participation in the young-adult group (15–29). This group has the highest LFPR. However, a large part of it is engaged in foreign employment; many youths migrate to Gulf countries and Malaysia. Among those who stay, underemployment and informal work are common.

(c) Peak participation in the prime age group (30–49). LFPR is highest here for both sexes, as this is the main earning period of life.

(d) Declining participation after 50. Participation falls with age because of retirement, illness and the absence of a universal pension. In rural areas, however, many elderly people continue subsistence farming.

(e) Feminization of agriculture among the aged. Because young men migrate, older women increasingly carry on farm work.

3. Sex-wise trends

(a) Persistent gender gap. Male LFPR is much higher than female LFPR. In recent surveys male participation is around 70–75 per cent while female participation is around 50–55 per cent, though the gap has narrowed slightly over time.

(b) Concentration of women in informal and unpaid work. Most economically active women work in agriculture as unpaid family labour or in the informal sector; their work is often not counted as "employment".

(c) Low female participation in non-agricultural wage work. Women are underrepresented in industry, construction, transport and public administration. Their share in formal salaried jobs is small.

(d) Marriage and household burden. Early marriage, child care and household responsibilities reduce women's participation in the prime age group, producing an M-shaped pattern in some surveys.

(e) Migration effect. Male out-migration has pushed more women into farm management and small enterprises, a slow "feminization" of the workforce, but mostly in low-productivity work.

4. Other notable features

• A very large share of workers is in the informal sector, with no social security.
• Unemployment is higher among educated youth and urban women.
• Remittances reduce the pressure to work, lowering measured participation for some households.
• The dependency ratio is affected as the working-age population migrates abroad.

5. Conclusion

Recent trends show a gradual rise in overall participation, a shift from agriculture to services and foreign employment, a declining role of child labour, and a still wide gender gap with women concentrated in informal, unpaid and low-productivity work. Skill development, childcare support, safe migration and formalization of work are needed to make participation productive and equitable.