Nepal - Demographic and Health Survey - 2002

Publication date: 2002

2001 N epal 2001 D em ographic and H ealth Survey Nepal Demographic and Health Survey World Summit for Children Indicators, Nepal 2001 Childhood mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Family planning Antenatal care Delivery care Vitamin A supplements Night blindness Exclusive breastfeeding Continued breastfeeding Timely complementary feeding Vaccinations Diarrhea control Home management of diarrhea Acute respiratory infection Home management of illness HIV/AIDS Infant mortality rate (per 1,000 live births) Under-five mortality rate (per 1,000 live births) Percent stunted (children under 5 years) Percent wasted (children under 5 years) Percent underweight (children under 5 years) Percent of households within 15 minutes of safe water supply1 Percent of households with flush toilets, pit toilet/latrine Proportion of children reaching grade 52 Net primary-school attendance rate2 Proportion of children entering primary school2 Contraceptive prevalence rate (any method, currently married women) Percent of women who received antenatal care from a health professional3 Percent of births in the 5 years preceding the survey attended by a health professional Percent of children age 6-59 months who received a vitamin A dose in the 6 months preceding the survey Percent of women age 15-49 who received a vitamin A dose in the 2 months after delivery3 Percent of women age 15-49 who suffered from night blindness during pregnancy3,4 Percent of children under 4 months who are exclusively breastfed Percent of all children age 12-15 months still breastfeeding Percent of all children age 20-23 months still breastfeeding Percent of children age 6-9 months receiving breast milk and complementary foods Percent of children age 12-23 months with BCG vaccination Percent of children age 12-23 months with at least 3 DPT vaccinations Percent of children age 12-23 months with at least 3 polio vaccinations Percent of children age 12-23 months with measles vaccination Percent of children whose mother received at least 2 tetanus toxoid vaccinations during pregnancy3 Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the survey who received oral rehydration salts (ORS) Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the interview who took more fluids than usual and continued eating somewhat less, the same, or more food Percent of children age 0-59 months with acute respiratory infection (ARI) in the 2 weeks preceding the survey who were taken to a health provider Percent of children age 0-59 months with diarrhea, fever, and/or ARI who were taken to a health provider Percent of women age 15-49 who correctly state two ways of avoiding HIV infection5 Percent of women age 15-49 who believe that AIDS can be transmitted from mother to child 64.4 91.2 50.5 9.6 48.3 78.3 30.4 91.5 73.0 41.0 39.3 48.5 12.9 81.0 10.3 19.6 78.8 98.1 87.3 66.2 84.5 72.1 91.5 70.6 45.3 32.2 24.5 26.1 22.6 31.3 41.2 1Piped water or protected well water 2Based on de jure children 3For the last live birth in the five years preceding the survey 4Includes women who report night blindness and difficulty with vision during the day 5Having sex with only one partner who has no other partners and using a condom every time they have sex Nepal Demographic and Health Survey 2001 Family Health Division Department of Health Services Ministry of Health His Majesty’s Government Kathmandu, Nepal New ERA Kathmandu, Nepal ORC Macro Calverton, Maryland USA April 2002 Ministry of Health New ERA ORC Macro The 2001 Nepal Demographic and Health Survey (NDHS) was implemented by New ERA under the aegis of the Family Health Division, Department of Health Services, Ministry of Health. ORC Macro provided technical assistance through its MEASURE DHS+ program. The survey was funded by the U.S. Agency for International Development (USAID under the terms of Contract No. HRN-C-00-97-0019-00). The 2001 Nepal Demographic and Health Survey is part of the worldwide Demographic and Health Surveys (DHS) program. Additional information about the 2001 NDHS may be obtained from the Family Health Division, Department of Health Services, Ministry of Health, P.O. Box 820, Teku, Kathmandu, Nepal (telephone: 262155; fax: 262238) and New ERA, Rudramati Marg, Kalopul, P.O. Box 722, Kathmandu, Nepal (telephone: 413603 or 423176; fax: 419562; email: info@newera.wlink.np). Information about the MEASURE DHS+ project may be obtained from ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572- 0200; fax: 301-572-0999; email: reports@macroint.com; internet: www.measuredhs.com). Suggested citation: Ministry of Health [Nepal], New ERA, and ORC Macro. 2002. Nepal Demographic and Health Survey 2001. Calverton, Maryland, USA: Family Health Division, Ministry of Health; New ERA; and ORC Macro. Contents * iii CONTENTS Page Tables and Figures . vii Foreword. xiii Acknowledgments.xv 2001 NDHS Technical Advisory Committee . xvii Contributors to the Report . xix Summary of Findings. xxi Map of Nepal . xxviii CHAPTER 1 INTRODUCTION. 1 1.1 Geography and Economy.1 1.2 Population .2 1.3 Population and Reproductive Health Policies and Programs .3 1.4 Objectives and Organization of 2001 NDHS Survey .5 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS. 9 2.1 Age and Sex Composition of the Household Population.9 2.2 Household Composition.12 2.3 Education of Household Members.13 2.4 Housing Characteristics .19 CHAPTER 3 RESPONDENTS’ CHARACTERISTICS AND STATUS . 23 3.1 Background Characteristics of Respondents .23 3.2 Educational Attainment by Background Characteristics .25 3.3 Literacy .27 3.4 Exposure to Mass Media.30 3.5 Employment Status .33 3.6 Occupation .36 3.7 Type of Employment .39 3.8 Decision on Use of Earnings.41 3.9 Women’s Empowerment and Status.44 3.10 Smoking and Alcohol Consumption.53 iv * Contents Page CHAPTER 4 FERTILITY . 55 4.1 Current Fertility .55 4.2 Pregnancy Outcomes .59 4.3 Children Ever Born and Living.60 4.4 Birth Intervals .61 4.5 Age at First Birth .63 4.6 Adolescent Fertility.65 CHAPTER 5 FAMILY PLANNING . 67 5.1 Knowledge of Contraceptive Methods .67 5.2 Ever Use of Contraception.68 5.3 Current Use of Contraception .69 5.4 Current Use of Contraception by Background Characteristics.71 5.5 Trends in Current Use of Family Planning .74 5.6 Current Use of Contraception by Women’s Status.76 5.7 Number of Children at First Use of Contraception.78 5.8 Knowledge of Fertile Period.78 5.9 Sterilization .79 5.10 Condom Use.82 5.11 Men’s Attitudes toward Contraception.82 5.12 Source of Contraception .85 5.13 Time Taken to Reach Source of Contraception.87 5.14 Informed Choice .88 5.15 Future Use of Contraception.90 5.16 Reasons for Nonuse of Contraception .91 5.17 Preferred Method of Contraception for Future Use.92 5.18 Exposure to Family Planning Messages .93 5.19 Exposure to Specific Radio Shows on Family Planning .95 5.20 Contact of Nonusers with Family Planning Providers.97 5.21 Discussion of Family Planning Between Spouses .99 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY . 101 6.1 Current Marital Status.101 6.2 Polygyny .103 6.3 Age at First Marriage .105 6.4 Age at First Sexual Intercourse.105 6.5 Recent Sexual Activity .107 6.6 Postpartum Insusceptibility .110 6.7 Termination of Exposure to Pregnancy .113 Contents * v Page CHAPTER 7 FERTILITY PREFERENCES . 115 7.1 Desire for More Children.115 7.2 Desire to Limit Childbearing by Background Characteristics .117 7.3 Need for Family Planning Services .119 7.4 Ideal Family Size .121 7.5 Fertility Planning .123 CHAPTER 8 INFANT AND CHILD MORTALITY. 127 8.1 Data Quality .127 8.2 Levels and Trends in Infant and Child Mortality.128 8.3 Socioeconomic Differentials in Mortality .130 8.4 Demographic Differentials in Mortality .132 8.5 Women’s Status and Child Mortality .134 8.6 Perinatal Mortality .134 8.7 High-Risk Fertility Behavior .136 CHAPTER 9 MATERNAL AND CHILD HEALTH . 139 9.1 Antenatal Care .139 9.2 Delivery Care .147 9.3 Postnatal Care .153 9.4 Reproductive Health Care and Women’s Status.153 9.5 Vaccination of Children.155 9.6 Prevalence and Treatment of ARI and Fever.159 9.7 Diarrhea.161 9.8 Women’s Status and Use of Health Services.167 9.9 Women’s Perceptions of Problems in Accessing Health Care .168 9.10 Use of Smoking Tobacco .168 CHAPTER 10 INFANT FEEDING AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS . 171 10.1 Initiation of Breastfeeding .171 10.2 Breastfeeding Status by Age of the Child.173 10.3 Duration and Frequency of Breastfeeding .175 10.4 Types of Complementary Foods.177 10.5 Frequency of Food Supplementation .178 10.6 Micronutrient Intake .181 10.7 Nutritional Status of Children.185 10.8 Nutritional Status of Women .191 vi * Contents Page CHAPTER 11 KNOWLEDGE OF HIV/AIDS . 195 11.1 Knowledge of HIV/AIDS .196 11.2 Knowledge of HIV/AIDS Prevention.196 11.3 Knowledge of HIV/AIDS-Related Issues.200 11.4 Spousal Communication about HIV/AIDS.200 11.5 Sexual Behavior .203 11.6 Knowledge and Use of Condoms .203 REFERENCES . 209 APPENDIX A SAMPLE DESIGN. 211 APPENDIX B SAMPLING ERRORS. 221 APPENDIX C DATA QUALITY TABLES . 229 APPENDIX D SURVEY STAFF . 235 APPENDIX E QUESTIONNAIRES .239 Tables and Figures * vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators .3 Table 1.2 Results of the household and individual interviews .7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence .11 Table 2.2 Household composition .12 Table 2.3.1 Educational attainment of household population: male.14 Table 2.3.2 Educational attainment of household population: female.15 Table 2.4 School attendance ratios .17 Table 2.5 Grade repetition and dropout rates.18 Table 2.6 Housing characteristics .20 Table 2.7 Household durable goods.21 Figure 2.1 Distribution of de facto household population by single year of age and sex .10 Figure 2.2 Population pyramid, Nepal, 2001 .12 Figure 2.3 Age-specific school attendance rates .19 CHAPTER 3 RESPONDENTS’ CHARACTERISTICS AND STATUS Table 3.1 Background characteristics of respondents.24 Table 3.2.1 Educational attainment of women .25 Table 3.2.2 Educational attainment of men .26 Table 3.3.1 Literacy of women .28 Table 3.3.2 Literacy of men .29 Table 3.4.1 Exposure to mass media: women.31 Table 3.4.2 Exposure to mass media: men.32 Table 3.5.1 Employment status: women.34 Table 3.5.2 Employment status: men.35 Table 3.6.1 Occupation: women .37 Table 3.6.2 Occupation: men .38 Table 3.7.1 Type of employment: women .39 Table 3.7.2 Type of employment: men .40 Table 3.8 Decision on use of earnings .42 Table 3.9 Contribution of earnings to household expenditures .43 Table 3.10 Women’s control over earnings .44 Table 3.11 Women’s participation in decisionmaking .45 Table 3.12 Women’s participation in decisionmaking by background characteristics.46 Table 3.13.1 Women’s attitude toward wife beating .48 viii * Tables and Figures Page Table 3.13.2 Men’s attitude toward wife beating .49 Table 3.14.1 Women’s attitude toward refusing sex with husband .51 Table 3.14.2 Men’s attitude toward refusing sex with husband .52 Table 3.15 Smoking and alcohol consumption.54 Figure 3.1 Employment status of women age 15-49.36 Figure 3.2 Type of earnings of employed women age 15-49.40 Figure 3.3 Distribution of women by number of decisions in which they participate .47 CHAPTER 4 FERTILITY Table 4.1 Current fertility .56 Table 4.2 Fertility by background characteristics.57 Table 4.3 Trends in fertility .58 Table 4.4 Trends in age-specific fertility rates .59 Table 4.5 Pregnancy outcome.60 Table 4.6 Children ever born and living .61 Table 4.7 Birth intervals.62 Table 4.8 Age at first birth .63 Table 4.9 Median age at first birth.64 Table 4.10 Teenage pregnancy and motherhood .65 Figure 4.1 Trends in total fertility rate 1984-2001.58 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods.68 Table 5.2 Ever use of contraception.69 Table 5.3 Current use of contraception.70 Table 5.4.1 Current use of contraception by background characteristics: women .72 Table 5.4.2 Current use of contraception by background characteristics: men .73 Table 5.5 Trends in current use of modern contraceptive methods .75 Table 5.6 Current use of contraception by women’s status .77 Table 5.7 Number of children at first use of contraception .78 Table 5.8 Knowledge of fertile period .79 Table 5.9 Timing of female sterilization.80 Table 5.10 Sterilization regret.81 Table 5.11 Men’s attitudes toward contraception and gender roles .83 Table 5.12 Men’s attitudes toward injectables.84 Table 5.13 Men’s attitudes toward female sterilization.85 Table 5.14 Source of contraception .86 Table 5.15 Time taken to reach source of contraception .87 Table 5.16 Informed choice .89 Table 5.17 Future use of contraception.90 Table 5.18 Reason for not intending to use contraception.91 Tables and Figures * ix Page Table 5.19 Preferred method of contraception for future use .92 Table 5.20 Exposure to family planning messages.94 Table 5.21 Exposure to specific radio shows on family planning .96 Table 5.22 Contact of nonusers with family planning providers.98 Table 5.23 Discussion of family planning with spouse .99 Table 5.24 Decision on use of contraception.100 Table 5.25 Wife’s perception of husband’s attitude toward family planning.100 Figure 5.1 Trends in current use of modern contraceptive methods among currently married non-pregnant women age 15-49, Nepal, 1976-2001 .76 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status.102 Table 6.2 Trends in proportion never married .103 Table 6.3 Polygyny .104 Table 6.4 Median age at marriage and median age at first sexual intercourse .106 Table 6.5 Recent sexual activity: women .108 Table 6.6 Recent sexual activity: men .109 Table 6.7 Postpartum amenorrhea, abstinence and insusceptibility .111 Table 6.8 Median duration of postpartum insusceptibility by background characteristics .112 Table 6.9 Menopause .113 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children .116 Table 7.2 Desire for more children among monogamous couples .117 Table 7.3 Desire to limit childbearing .118 Table 7.4 Need for family planning.120 Table 7.5 Ideal number of children.122 Table 7.6 Mean ideal number of children by background characteristics .123 Table 7.7 Fertility planning status.124 Table 7.8 Wanted fertility rates.125 Table 7.9 Ideal number of children and unmet need for family planning by women’s status.126 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates.129 Table 8.2 Trends in infant mortality .129 Table 8.3 Early childhood mortality rates by socioeconomic characteristics.131 Table 8.4 Early childhood mortality rates by demographic characteristics .132 Table 8.5 Early childhood mortality rates by women’s status.134 Table 8.6 Perinatal mortality.136 Table 8.7 High-risk fertility behavior .137 x * Tables and Figures Page Figure 8.1 Trends in infant mortality, Nepal, 1969-2001 .130 Figure 8.2 Under-five mortality rates by place of residence.131 Figure 8.3 Under-five mortality by selected demographic characteristics.133 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care .140 Table 9.2 Number of antenatal care visits and timing of first visit.142 Table 9.3 Components of antenatal care.144 Table 9.4 Tetanus toxoid injections .146 Table 9.5 Place of delivery .148 Table 9.6 Assistance during delivery.150 Table 9.7 Use of clean home delivery kits.151 Table 9.8 Delivery characteristics.152 Table 9.9 Postnatal care by background characteristics .154 Table 9.10 Reproductive health care by women’s status.155 Table 9.11 Vaccinations by source of information .156 Table 9.12 Vaccinations by background characteristics .158 Table 9.13 Prevalence and treatment of symptoms of ARI and fever .160 Table 9.14 Disposal of child’s stools .162 Table 9.15 Prevalence of diarrhea.163 Table 9.16 Knowledge of ORS packets .164 Table 9.17 Diarrhea treatment .165 Table 9.18 Feeding practices during diarrhea.166 Table 9.19 Child health care by women’s status .167 Table 9.20 Problems in accessing health care.169 Table 9.21 Use of smoking tobacco.170 Figure 9.1 Antenatal care, tetanus toxoid (TT) vaccinations, place of delivery, and delivery assistance .141 Figure 9.2 Percentage of children age 12-23 months who received specific vaccinations by 12 months of age, 1996 and 2001 .157 CHAPTER 10 INFANT FEEDING AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS Table 10.1 Initial breastfeeding .172 Table 10.2 Breastfeeding status by age.174 Table 10.3 Median duration and frequency of breastfeeding .176 Table 10.4 Foods consumed by children in the day or night preceding the interview .177 Table 10.5 Frequency of foods consumed by children in the day or night preceding the interview.179 Table 10.6 Frequency of foods consumed by children in preceding seven days.180 Table 10.7 Vitamin A intake among children.182 Table 10.8 Vitamin A supplemnt.184 Tables and Figures * xi Page Table 10.9 Micronutrient intake among mothers.186 Table 10.10 Nutritional status of children .188 Table 10.11 Trends in nutritional status of children .191 Table 10.12 Nutritional status of women by background characteristics .192 Figure 10.1 Number of meals consumed per day by children under 36 months living with the mother .181 Figure 10.2 Nutritional status of children by age.190 CHAPTER 11 KNOWLEDGE OF HIV/AIDS Table 11.1 Knowledge of AIDS .197 Table 11.2 Knowledge of ways to avoid HIV/AIDS.198 Table 11.3 Knowledge of programmatically important ways to avoid HIV/AIDS.199 Table 11.4 Knowledge of HIV/AIDS-related issues .201 Table 11.5 Discussionof HIV/AIDS with spouse .202 Table 11.6 Number of sexual partners .204 Table 11.7 Knowledge of source of condoms, and access to condoms .205 Table 11.8 Use of condoms by type of partner .207 APPENDIX A SAMPLE DESIGN Table A.1 Sample allocation.213 Table A.2.1 Sample implementation: women.218 Table A.2.2 Sample implementation: men .219 APPENDIX B SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Nepal 2001 .224 Table B.2 Sampling errors - Total sample, Nepal 2001 .225 Table B.3 Sampling errors - Urban sample, Nepal 2001.226 Table B.4 Sampling errors - Rural sample, Nepal 2001.227 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution .229 Table C.2.1 Age distribution of eligible and interviewed women.230 Table C.2.2 Age distribution of eligible and interviewed men.230 Table C.3 Completeness of reporting .231 Table C.4 Births by calendar years.232 Table C.5 Reporting of age at death in days.233 Table C.6 Reporting of age at death in months .234 Foreword * xiii FOREWORD Periodic demographic and health surveys have supplemented and complemented censuses. The Nepal Fertility Survey 1976 (a part of the World Fertility Survey) was the first nationally repre- sentative demographic and health survey conducted in Nepal. Since then, the Department of Health, Ministry of Health, has conducted several similar surveys at intervals of five years. The 2001 Nepal Demographic and Health Survey (NDHS) is the sixth such survey and the second survey conducted as part of the worldwide Demographic and Health Surveys (DHS) program. These types of surveys will continue to be the main sources of demographic estimates until the registration of all vital events are reported correctly and in a timely fashion. The 2001 Nepal Demographic and Health Survey (NDHS) is the sixth in a series of demo- graphic surveys. The 2001 NDHS was conducted under the aegis of the Family Health Division and was implemented by New ERA. Technical support was provided by ORC Macro, and financial sup- port was provided by the United States Agency for International Development. The 2001 NDHS included important areas such as maternal and child health; perinatal, neona- tal, infant, and child mortality; knowledge of HIV/AIDS; family planning knowledge and use; fertil- ity; fertility preference; marriage; abortion; amenorrhea; and status of women. This information is important in understanding the issues related to population and health and is at the same time instru- mental to monitoring and evaluating population and health programs. The wealth of information ob- tained from the 2001 NDHS will also help in formulating short- and long-term plans. The govern- ment of Nepal is in the process of formulating the Tenth (five-year) Development Plan, and it should be of immense satisfaction to all that the information obtained form this survey is being used in the formulation of the plan. It is immensely satisfying to acknowledge that the 2001 NDHS has been successfully com- pleted on time despite the heightened security concerns when the survey was in the field. It is not only important to complete such surveys on time, but it is also important to ensure that the data is of good quality. It is assuring to note that every effort was made to obtain correct data and ensure its quality. I believe that the information obtained from this survey will help in the formulation of pro- grams for family planning, safe motherhood, HIV/AIDS, and child health and survival for the Tenth Development Plan. I deeply appreciate the United States Agency for International Development for providing the financial support for the 2001 NDHS and ORC Macro for providing valuable technical assistance. I express my gratitude to Dr. B. D. Chataut, my predecessor, for chairing the Technical Advisory Committee for the 2001 NDHS. I appreciate New ERA and its staff for supervising the fieldwork and data entry. My sincere thanks go to Mr. Ajit Pradhan, Senior Demographer and Member Secretary to the 2001 NDHS Technical Advisory Committee, and Mr. Bharat Ban, Executive Director, New ERA, for their dedication in the successful completion of the 2001 NDHS. Last but not least, I highly ap- preciate the technical input provided by the members of the 2001 NDHS Technical Advisory Com- mittee. Dr. Laxmi Raj Pathak Director General Department of Health Services Ministry of Health His Majesty's Government Teku, Kathmandu, Nepal Acknowledgments * xv ACKNOWLEDGMENTS This study is the outcome of the dedicated efforts of many institutions and individuals. The 2001 Nepal Demographic and Health Survey (NDHS) was conducted under the aegis of the Family Health Division, Department of Health Services, Ministry of Health of His Majesty’s Government of Nepal. The 2001 NDHS was funded by the United States Agency for International Development (USAID) through its mission in Nepal and was implemented by New ERA, a local research firm. ORC Macro provided technical support for the survey. We would like to thank Ms. Anjushree Pradhan, Deputy Project Director; Dr. Gokarna Regmi, Technical Advisor; Mr. Matrika Chapagain, Research Officer; Mr. Muneshor Shrestha and Mr. Pushpa Basnet, research assistants; Ms. Sarita Vaidya and Mr. Rajendra Lal Singh, data process- ing staff; Mr. Sanu Raja Shakya, word processing staff; and other field and data entry staff of New ERA who made significant contributions to the successful completion of this study. A number of persons from various institutions contributed to the preparation of this report. Their contribution is highly acknowledged. Our sincere gratitude goes to all the members of the Technical Advisory Committee for the 2001 NDHS, for their time, support, and valuable feedback. Our deep appreciation also goes to the USAID mission in Nepal. We would like to express our sincere gratitude to Ms. Rebecca Rohrer, Chief, Office of Health and Family Planning, and Mr. Terence Murphy, Reproductive Health Advisor, for their keen interest and active support throughout this survey. We also acknowledge the valuable inputs of Mr. Lyndon Brown, Technical Advisor for Child Health and Nutrition; Ms. Anne Peniston, Technical Advisor for Health and Fam- ily Planning; Ms. Cathy Thompson, Technical Advisor for HIV/AIDS; and Mrs. Pancha Kumari Manandhar, Family Planning Program Specialist. The technical support provided by ORC Macro is highly acknowledged. Our special thanks go to Dr. Pav Govindasamy, the country manager for Nepal, for her effort and contribution through- out the survey. We also wish to thank Ms. Anne Cross, regional coordinator; Dr. Alfredo Aliaga, sampling expert; Mr. Guillermo Rojas, data processing specialist; and Ms. Livia Montana, geo- graphic information specialist. We greatly appreciate the support from various institutions in implementing the survey. We would especially like to thank the support provided by officials of the District Health Offices, Dis- trict Administrative Offices, District Police Offices, Health Posts, Sub-health Posts, Village Devel- opment Committees, non-governmental organizations, and other individuals. The survey was conducted in an extremely difficult field environment and our gratitude goes to the supervisors, field editors, interviewers, and members of the quality control teams whose dedi- cated efforts made completing the survey possible. We would also like to thank all the respondents for their time and patience during the interview. We believe that this study has truly captured the facts related to the demographic and health situation in Nepal. We also hope that this information will help in improving the quality of life of the Nepalese people. Bharat Ban Ajit Pradhan Executive Director Senior Demographer New ERA Family Health Division 2001 NDHS Technical Advisory Committee * xvii 2001 NDHS TECHNICAL ADVISORY COMMITTEE Dr. Laxmi Raj Pathak, Director General, Department of Health Services, Ministry of Health Dr. B. D. Chataut, former Director General, Department of Health Services, Ministry of Health Mr. Ram Krishna Tiwari, Joint Secretary, National Planning Commission Secretariat Dr. Bimala Ojha, former Director, National Center for AIDS and STD Control Mr. Laxmi Raman Ban, former Director, National Health Education Information and Communication Center Dr. Ram Hari Aryal, Joint Secretary, Parliament Secretariat Mr. Badri Niroula, Deputy Director, Central Bureau of Statistics Representative, National Health Research Council Dr. Ram Sharan Pathak, Associate Professor, Central Department of Population Studies, Tribhuvan University Mr. Terence Murphy, Reproductive Health Advisor, USAID/Nepal Dr. Shyam Thapa, Senior Scientist, Family Health International Mr. Tek Bahadur Dangi, Senior Public Health Administrator, Management Division, Ministry of Health Mr. Munishwor Mool, Senior Public Health Administrator, Management Division, Ministry of Health Dr. Son Lal Thapa, CDD/ARI Chief, Child Health Division, Ministry of Health Mr. Upendra Adhikary, Under Secretary, Ministry of Population and Environment Mr. Ajit Pradhan, Senior Demographer, Family Health Division, Ministry of Health Mr. Bharat Ban, Executive Director, New ERA Dr. Pav Govindasamy, Country Manager, ORC Macro Contributors to the Report * xix CONTRIBUTORS TO THE REPORT The following persons contributed to the preparation of this report: Mr. Munishwor Mool, Management Division, Ministry of Health Mr. Ajit Pradhan, Family Health Division, Ministry of Health Dr. Ram Sharan Pathak, Central Department of Population Studies, Tribhuvan University Mr. Upendra Adhikary, Ministry of Population and Environment Mr. Bharat Ban, New ERA Dr. Gokarna Regmi, New ERA Ms. Anjushree Pradhan, New ERA Dr. Pav Govindasamy, ORC Macro Dr. Alfredo Aliaga, ORC Macro Summary of Findings * xxi SUMMARY OF FINDINGS The 2001 Nepal Demographic and Health Sur- vey (NDHS) is a nationally representative sur- vey of 8,726 women age 15-49 and 2,261 men age 15-59. This survey is the sixth in a series of national-level population and health surveys and the second comprehensive survey con- ducted as part of the global Demographic and Health Surveys (DHS) program, the first being the 1996 Nepal Family Health Survey (NFHS). The primary purpose of the NDHS is to gener- ate recent and reliable information on fertility, family planning, infant and child mortality, ma- ternal and child health, and nutrition. In addi- tion, the survey collected information on knowledge of HIV/AIDS. FERTILITY Comparison of data from the 2001 NDHS with earlier surveys conducted in Nepal indicates that fertility has declined steadily from 5.1 births per woman in 1984-1986 to 4.1 births per woman in 1998-2000. Further evidence of recent fertility decline is obtained from the pregnancy history information collected in the 2001 NDHS. There has been an 18 percent decline in fertility among women below age 30, from 3.6 births per woman during the period 15-19 years before the survey to 2.9 births per woman during the period 0-4 years before the survey, with the largest decline in fertility (14 percent) occurring between 5-9 and 0-4 years before the survey. Differences by place of residence are marked, with rural women having more than twice as many children (4.4) as urban women (2.1). Fertility is highest in the mountains (4.8 births per woman), with little dif- ference in fertility between the hills (4.0 births per woman) and the terai (4.1 births per woman). Education is strongly related to fertility, with un- educated women having more than twice as many children (4.8) as women with at least some secondary education (2.3). Data from the national censuses and the 2001 NDHS indicate that the proportion never married among women and men below age 25 has in- creased gradually over time. Only one in four women age 15-19 was not married in 1961, compared with three in five women in 2001. Similarly in 1961, 5 percent of women age 20-24 had never married, compared with more than three times as many in the same age group five decades later. A similar pattern of decline in nuptiality is observed among men as well, with a proportionately larger change again observed among the youngest age group. These trends result in a small but noticeable in- crease in age at marriage. The median age at marriage has risen slowly over the last two dec- ades, from 16.1 years for women age 45-49 to 16.8 years among women age 20-24. Data also show a small change in the median age at mar- riage among males, with men marrying about three years later than women. Overall, the median age at first sexual inter- course among Nepalese women in the reproduc- tive age group is nearly identical to their median age at first marriage, implying that women’s first sexual experience usually occurs within the con- text of marriage. However, there is little differ- ence in the median age at first sexual intercourse among women by age, implying that there has been little change in the median age at first sex- ual intercourse over the years. Women generally have their first sexual experience two years ear- lier than men. However, men tend to initiate sex about one year before marriage. The median age at first birth is about 20 years across all age cohorts, indicating virtually no change in the age at first birth over the last two decades. At least 70 percent of women in all age cohorts had their first birth by age 22, with the proportion of women having their first birth by age 22 declining with increasing age of the mother. About 90 percent of Nepalese women have their first birth by age 25. One in five ado- lescent women age 15-19 are already mothers or pregnant with their first child. The proportion of teenage women who have started childbearing increases from 2 percent among women age 15 to 41 percent among women age 19. xxii * Summary of Findings The interval between births is long in Nepal. Half of all births in Nepal occur within just under three years (32 months) of a previous birth. The median birth interval did not change over the last five years. The long period of breastfeeding in Nepal (32 months) and the corresponding rela- tively long period of postpartum amenorrhea (11 months) are factors contributing to the long birth interval. The mean ideal number of children among ever- married women declined only slightly from 2.9 in 1996 to 2.6 in 2001. Nevertheless, women in Nepal continue to revise downward the number of children they would like to have. Sixty-six percent of currently married women either want no more children or have been sterilized accord- ing to the 2001 NDHS, compared with 59 percent found in the 1996 NFHS. If all un- wanted births were prevented, the total fertility rate would fall to 2.5 births per woman. As in the 1996 NFHS, the 2001 NDHS gathered complete pregnancy histories from women and hence provides information on pregnancy out- comes. Eight percent of all pregnancies that oc- curred in the ten years preceding the survey did not end in a live birth, with pregnancy losses highest among women age 40-44 (13 percent) and slightly higher among urban women (9 percent) than among rural women (8 percent). FAMILY PLANNING Findings from the 2001 NDHS show that knowledge of family planning is nearly univer- sal among Nepalese women and men. Knowl- edge of modern methods is generally much higher than knowledge of traditional methods, with women and men being most familiar with female and male sterilization. The mass media are important sources of information on family planning. Three in five women and seven in ten men have heard or seen messages about family planning on the radio, on television, or in print media. The majority of couples approve of family planning. Discussion of family planning between spouses continues to be relatively un- common, with only two in five women and one in two men who know of a contraceptive method having discussed family planning with their spouse in the year before the survey. The contraceptive prevalence rate among cur- rently married Nepalese women is 39 percent. There has been an impressive increase in the use of contraception in Nepal over the last 25 years, with the increase in current use highest in the most recent five-year perioda 35 percent in- crease between 1996 and 2001. During this pe- riod, the use of modern methods increased from 26 percent to 35 percent among currently mar- ried women, with the increase largely attributed to the increase in the use of injectables and fe- male sterilization. There has been a twofold in- crease in the share of temporary methods over all modern methods in the last decade and a decline in the share of permanent methods overall. Nev- ertheless, there continues to be a marked discrep- ancy between ever use of contraception and cur- rent use. One in two currently married women has ever used a modern method of family plan- ning, compared with only one in three who is currently using. Similarly, three-fifths of cur- rently married men have ever used a modern, method compared with slightly more than two- fifths who are current users. The most widely used modern method is female sterilization (15 percent among currently married women), followed by injectables (8 percent) and male sterilization (6 percent). Currently married men report a higher use of contraceptives with the largest male/female discrepancy in the use of condoms, with twice as many currently married men as currently married women reporting using condoms (6 percent versus 3 percent). Men also report a much higher use of female sterilization (17 percent) and injectables (10 percent). The government sector supplies four in five fe- male current users, with more than one in four users obtaining their method from government hospitals and clinics and another one in four from mobile camps (serving sterilization users alone). Fourteen percent of female users obtain their method from sub-health posts. The most important nongovernment supplier of contracep- tives is the Family Planning Association of Ne- pal (FPAN), which serves 5 percent of users, while the private medical sector supplies contra- ceptives to 7 percent of users, most of whom (6 Summary of Findings * xxiii percent) obtain their supplies from pharmacies. Among the three main sectors serving users, the private medical sector is the most sensitive to client needs. Two-thirds of women who ob- tained their method for the first time from the private medical sector were informed about side effects or problems of the method used, 56 per- cent were informed about what to do if they ex- perienced side effects, and one in two were in- formed of other methods that could be used. The government sector is the least responsive to cli- ent needs, with only about one in three women being adequately informed. The two most important reasons for not intend- ing to use contraception in the future among cur- rently married women are subfecun- dity/infecundity and fear of side effects, with more than one in four women and one in five women, respectively, citing these reasons. One in ten women also cites religious opposition as an important reason for nonuse in the future. More than one in two currently married men do not intend to use a method in the future because of their wife’s menopause or hysterectomy, one in ten cites religious opposition, and 6 percent cite fear of side effects. In spite of the marked increase in the use of con- traceptives in Nepal, there continues to be con- siderable scope for increased use of family plan- ning. Twenty-eight percent of currently married women in Nepal have an unmet need for family planning services, of whom 11 percent have a need for spacing and 16 percent have a need for limiting. At the same time, among women cur- rently using a method, 36 percent are using for limiting and 4 percent are using for spacing. Taken together, two in three Nepalese women have a demand for family planning. However, only three-fifths of these women’s demand is currently being met. If all women with unmet need were to use family planning, the contracep- tive prevalence rate would increase from 39 per- cent to 67 percent. CHILD HEALTH One in every 11 children born in Nepal dies be- fore reaching age five. Slightly more than two in three under-five deaths occur in the first year of lifeinfant mortality is 64 deaths per 1,000 live births, and child mortality is 29 deaths per 1,000 live births. During infancy, the risk of neonatal deaths (39 per 1,000) is one and a half times as high as the risk of postneonatal death (26 per 1,000). According to data collected in the 2001 NDHS, mortality levels have declined rapidly since the early 1980s. Under-five mortality in the five years before the survey is 58 percent of what it was 10-14 years before the survey. Comparable data for child mortality (50 percent) and infant mortality (60 percent) indicate that the pace of decline is somewhat faster for child mor- tality than for infant mortality. The correspond- ing figures for neonatal and postneonatal mortal- ity are 61 percent and 58 percent, respectively. This decline in childhood mortality levels is con- firmed by data from other sources. Sixty percent of children are fully vaccinated by 12 months of age, 83 percent have received the BCG vaccination, and 64 percent have been vaccinated against measles. Coverage for the first dose of DPT is 83 percent, but this drops to 77 percent for the second dose and further to 71 percent for the third dose. Polio coverage is much higher at 97 percent for the first dose, 96 percent for the second dose, and 90 percent for the third dose. The percentage of children age 12-23 months fully immunized by age one has increased in the last five years by 67 per- cent. The corresponding increases in the third dose of DPT and polio are 39 percent and 87 percent, respectively, while BCG coverage in- creased by 13 percent and measles vaccination increased by 41 percent. The much higher in- crease in polio coverage was primarily due to the success of the intensive national immuniza- tion day campaigns and other polio eradication activities. The prevalence of symptoms of acute respira- tory infection (ARI) among children under five years of age in the two weeks before the survey was 23 percent, while 32 percent of children below age five had a fever in the preceding two weeks. Use of a health facility for the treatment of symptoms of ARI and/or fever is low, with less than one in four children taken to a health facility. xxiv * Summary of Findings One in five children suffered from diarrhea at some time in the two weeks before the survey. Among these children, only one in five was taken to a health facility for treatment. Nearly one in two children received oral rehydration therapy, with 32 percent treated with oral rehy- dration salts and 27 percent receiving increased fluids. Nevertheless, more than one-third of children with diarrhea were not given any treatment at all. MATERNAL HEALTH One in two pregnant women receives antenatal care in Nepal, with 28 percent receiving care from a doctor or nurse, midwife, or auxiliary nurse midwife. In addition, 11 percent of women receive antenatal care from a health as- sistant or auxiliary health worker, 3 percent re- ceive care from a maternal and child health worker, and 6 percent receive care from a vil- lage health worker. Most Nepalese women who receive antenatal care get it at a relatively late stage in their pregnancy and do not make the minimum recommended number of antenatal visits. Only one in seven women (14 percent) makes four or more visits during their entire pregnancy, while 16 percent of women report that their first visit occurred at less than four months of pregnancy. About half of mothers who receive antenatal care report that they were informed about the signs of pregnancy compli- cations, while three in five women report that their blood pressure was measured as part of their routine antenatal care checkup. Forty-five percent of women receive two or more doses of tetanus toxoid injections during their most re- cent pregnancy. Institutional deliveries are not common in Ne- pal. Less than one in ten births in the five years preceding the survey took place in a health fa- cility. Thirteen percent of births were attended at delivery by a medical professional, with only 8 percent of births attended by a doctor and 3 percent attended by a nurse, midwife, or auxiliary nurse midwife. Nearly one in four births was attended by a traditional birth attendant. Safe delivery kits were used in 9 percent of births delivered at home. Postnatal care, an important component of ma- ternity care, is crucial for monitoring and treat- ing complications within the first two days after delivery. Only 17 percent of mothers receive postnatal care within the first two days after de- livery. Even more troubling is that nearly four in five mothers did not receive postnatal care at all. BREASTFEEDING AND NUTRITION Breastfeeding is nearly universal in Nepal, and the median duration of breastfeeding is long (34 months). Nearly one in three children is breast- fed within one hour of birth, while two out of three babies are breastfed within one day of birth. This is an improvement over the last five years. However, contrary to the World Health Organization’s recommendation, only two- thirds of children less than six months of age are exclusively breastfed. The use of a bottle with a nipple is relatively rare in Nepal, with only 4 percent of children under six months of age and 2 percent of children 6-9 months of age given something to drink from a bottle. Micronutrient deficiency is an important cause of childhood morbidity and mortality. Informa- tion gathered in the 2001 NDHS shows that four in five children age 6-59 months received vita- min A supplementation in the most recent dis- tribution. However, slightly more than one in three children under three years of age con- sumed fruits and vegetables rich in vitamin A at least once in the seven days preceding the sur- vey. Undernutrition is significant in Nepal, with one in two Nepalese children under five years of age stunted (short for their age), 10 percent wasted (thin for their age), and 48 percent underweight. A comparison of the 2001 NDHS data with other data on the nutritional status of children collected in previous years shows that there has been little improvement in the nutritional status of children over the last decade. The 2001 NDHS also collected information on mother’s nutritional status. Survey results show that the level of chronic energy deficiency in Nepal is relatively high. One in four women Summary of Findings * xxv (27 percent) falls below the 18.5 cutoff for the body mass index (BMI), which utilizes both height and weight to measure thinness. One in seven women is shorter than 145 centimeters and can be considered to be at nutritional risk. Overall, 10 percent of recent mothers received vitamin A postpartum, while 8 percent of women reported night blindness during their last pregnancy. Three in four women who gave birth in the five years preceding the survey re- ported not having taken iron/folic acid tablets during their pregnancy, and another 14 percent reported taking these tablets for less than 60 days during their pregnancy. HIV/AIDS Only one in two women (50 percent), compared with nearly three in four men (72 percent), has heard of AIDS. At the same time, 38 percent of women and 67 percent of men believe there is a way to avoid HIV/AIDS. The depth of women’s knowledge of HIV/AIDS is also much lower than that of men. One in three women and one in two men know of two or more programmati- cally important ways to avoid HIV/AIDS. About one in three women mentioned use of condoms and limiting the number of sexual partners as specific ways to avoid HIV/AIDS, compared with 63 percent and 54 percent of men, respectively. In addition, about two-fifths of women and three-fifths of men say a healthy- looking person can have AIDS and that HIV/AIDS can be transmitted from a mother to her child. Fourteen percent of women and 23 percent of men have discussed HIV/AIDS with their spouse. An important component of AIDS prevention programs is the promotion of safe sex. The NDHS sought to determine the proportion of men who had sexual relationship with women other than their wife. The data show that the overwhelming majority of married Nepalese men (98 percent) did not have sex with anyone else other than their wife in the 12 months pre- ceding the survey. Knowledge of condoms is important information from the program’s per- spective. Although 70 percent of currently mar- ried women know where to obtain condoms, only half of them could get condoms by them- selves. Eighty-four percent of currently married men know of a source of condoms. Condom use is much less common with a spouse than with a noncohabiting partner. Only 6 percent of men have used a condom with a spouse, com- pared with 45 percent of men who have used a condom with a noncohabiting partner. WOMEN’S STATUS The 2001 NDHS also sheds some light on the status of women in Nepal. Only 4 percent of currently married women are in a polygynous union, with older women more likely to have cowives than younger women. However, poly- gyny appears to have been on the decline over the last five years, falling from 6 percent in 1996. Women in Nepal are generally less educated than men, with a median of less than 1 year of schooling, compared with 1.4 years among males. This gap in gender has not narrowed in recent years. The net attendance ratio, which indicates participation in primary schooling among those age 6-10 years and secondary schooling among those age 11-15 years, shows a 13 percentage point difference at the primary- school level and an 8 percentage point differ- ence at the secondary-school level. Female employment is high in Nepal, with more than four-fifths of women employed at the time of the survey. The more educated a woman, the less likely she is to be currently employed. Most working women (91 percent), however, are in the agricultural sector. Only 15 percent of working women earn cash for their work, while the majority of working women (71 percent) are not paid. One-third of working women are self- employed. Four-fifths of women (79 percent) enjoy a degree of autonomy in spending their cash earnings, while more than one-fifth of working women have no say in how their earn- ings should be used. Fifty-four percent of women contribute to half or more of the house- hold expenditures. With the exception of what food to cook, hus- bands in Nepal have a greater say in decision- making than wives. One in two currently mar- xxvi * Summary of Findings ried women stated that their husband alone has a final say in their health care, two in five women stated that their husband makes the sole decision on the purchase of large household items, while one in three stated that they needed their husband’s permission to visit family or relatives and to make daily household pur- chases. Twenty-nine percent of ever-married women believe that a husband is justified in beating his wife for at least one reason. One in four agrees that wife beating is justified if a woman neglects her children, and 12 percent agree that a husband is justified in beating his wife if she goes out without telling him. Never- theless, less than 10 percent of women feel that a husband is justified in beating his wife if she refuses to have sex with him, burns the food, or argues with him. An overwhelming majority of Nepalese women (90 percent) agree that a woman can refuse sex with her husband if she knows that he has a sexually transmitted dis- ease, if he has sex with other women, if she has recently given birth, or if she is not in the mood. NEPAL CHINA INDIA Mountains Hills Terai EASTERN REGION CENTRAL REGION WESTERN REGION MID-WESTERN REGION FAR-WESTERN REGION GORKHA SOLUKHUMBU SANKHUWASABHA TAPLEJUNG RA ME CH HA P RASUWA NUWAKOT DHANKUTA ILAM PA NC HT HA R TE RH AT HU M BHOJPURKHOTANG OKHALDHUNGA DOLAKHA UDAYAPUR SINDHULI MAKAWANPUR KABHREPALANCHOK LALITPUR BHAKTAPUR KATHMANDU Ecological Regions SINDHUPALCHOK Introduction * 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY GEOGRAPHY Nepal is a landlocked country nestled in the foothills of the Himalayas. It occupies an area from 26°22' to 30°27' north latitude and 80°4' to 88°12' east longitude (Central Bureau of Statistics, 2001b). It shares its northern border with the Tibetan Autonomous Region of the People’s Republic of China and its eastern, southern, and western borders with India. Nepal is rectangular in shape and averages 885 kilometers in length (east to west) and 193 kilometers in width (north to south). The total land area of the country is 147,181 square kilometers and its population, according to the 2001 Census preliminary report, is approximately 23.2 million. Nepal is predominantly rural with only about 14 percent of the population living in urban areas (Central Bureau of Statistics, 2001a). Topographically, Nepal is divided into three distinct ecological zones. These are the mountains, hills, and terai (or plains). The mountain zone ranges in altitude from 4,877 meters to 8,848 meters above sea level and covers a land area of 51,817 square kilometers. Because of the harsh terrain, transportation and communication facilities in this zone are limited and only about 7 percent of the total population lives there. In contrast, the hill ecological zone, which ranges in altitude from 610 meters to 4,876 meters above sea level, is densely populated. About 44 percent of the total population of Nepal lives in the hill zone, which covers an area of 61,345 square kilometers. This zone also includes a number of fertile valleys such as the Kathmandu and Pokhara valleys. Although the terrain is also rugged in this zone, because of the higher concentration of people, transportation and communication facilities are much more developed there than in the mountains. Unlike the mountain and hill zones, the terai zone in the southern part of the country can be regarded as an extension of the relatively flat Gangetic plains. This area, which covers 34,019 square kilometers, is the most fertile part of the country. Although it constitutes only about 23 percent of the total land area in Nepal, 49 percent of the population lives there. Because of its relatively flat terrain, transportation and communication facilities are more developed in this zone than in the other two zones of the country, and this has attracted newly emerging industries. In Nepal, climatic conditions vary substantially by altitude. In the terai, temperatures can go up to 44° Celsius in the summer and fall to 5° Celsius in the winter. The corresponding temperatures for the hill and mountain areas are 41° Celsius and 30° Celsius, respectively, in the summer, and 3° Celsius and far below 0° Celsius, respectively, in the winter. The annual mean rainfall in the kingdom is about 1,500 millimeters (Central Bureau of Statistics, 1996). For administrative purposes, Nepal has been divided into five development regions, 14 zones, and 75 districts. Districts are further divided into village development committees (VDCs) and sometimes into urban municipalities. A VDC consists of nine wards, while the number of wards in an urban municipality depends on the size of the population as well as on political decisions made by the municipality itself. At present, there are 3,914 VDCs and 58 municipalities in Nepal. 2 * Introduction Nepal is a multiethnic and multilingual society. The 1991 Census identified 60 caste or ethnic groups and subgroups of the population. Some of the major groups consist of the following percentages of the population: Chetri and Thakuri (18 percent), Brahmins (14 percent), Magar (7 percent), Tharu and Rajbanshi (7 percent), Newar (6 percent), Tamang (6 percent), Kami—a major occupational group that originated in the hills (5 percent), Yadav and Ahirs (4 percent), Muslims (4 percent), Rai and Kiranti (3 percent), and Gurung (2 percent) (Central Bureau of Statistics, 1995).1 The 1991 Census of Nepal lists 20 different languages or dialects prevalent in the country (Central Bureau of Statistics, 1995). These languages originated from two major groups: the Indo- Aryans, who constitute about 80 percent of the population, and the Tibetan-Burmese, who constitute about 17 percent of the population. Nepali is the official language of the country and is the mother tongue of more than 50 percent of the population. However, it is used and understood by most of the population and is the national language of Nepal. The other two major languages are Maithili and Bhojpuri, spoken by about 8 percent and 5 percent of the population, respectively. Nepal is a Hindu kingdom with more than 86 percent of its population following the Hindu religion. The second largest religious group is Buddhists (8 percent), and Muslims constitute about 4 percent of the total population (Central Bureau of Statistics, 1995). ECONOMY The estimated per capita gross domestic product (GDP) for the year 1999/2000 is US $244 (Central Bureau of Statistics, 2001b). About 80 percent of the Nepalese population continues to rely on agriculture for their livelihood. The recent Human Development Indicators (HDI) report from the United Nations Development Program (UNDP) shows marginal growth in agricultural productivity in the country. This is predominantly due to fragmentation of land, poor access to technology, and poor rural accessibility (UNDP, 2001). On the other hand, growth in the nonagricultural sector, which is largely driven by growth in the urban service sector, is notable. Therefore, Nepal’s overall economic growth is mainly due to growth in the nonagricultural sector, which now contributes about 60 percent of the GDP, compared with 40 percent 15-20 years ago (UNDP, 2001). Because of variations in the climatic and rainfall conditions, agricultural production varies by ecological zones. In the terai, rice is the main crop, followed by wheat and corn. In the hills, the major crops are corn and rice, followed by wheat, and in the mountains, corn, rice, and wheat are grown (Central Bureau of Statistics, 1995). Forty-eight percent of the GDP comes from the service sector, and the agricultural sector accounts for 42 percent of the GDP. The manufacturing sector accounts for 10 percent of the economy (Ministry of Finance, 1996). 1.2 POPULATION Table 1.1 provides a summary of the basic demographic indicators for Nepal from census data for 1971, 1981, 1991, and 2001. The population has doubled in 30 years. The population growth rate increased from 2.1 in 1971 to 2.6 in 1981, then declined to 2.1 in 1991 (Central Bureau of Statistics, 1995) and increased to 2.3 in 2001 (Central Bureau of Statistics, 2001a). The population 1 More recent information from the 2001 Population Census is not available at the time of publication of this report. The distribution of the population by ethnicity and religion is not expected to differ much from the findings in the 1991 Population Census. Introduction * 3 density has doubled over three decades from 79 persons per square kilometer in 1971 to 158 persons per square kilometer in 2001. Nepal is predominantly rural; nevertheless, the urban proportion has increased steadily over the last 30 years, from 4 percent in 1971 to 14 percent in 2001. The life expectancy in Nepal is improving, increasing by about 13 years for males and females between 1971 and 1991. Male life expectancy is slightly higher than female life expectancy. Table 1.1 Basic demographic indicators Selected demographic indicators for Nepal, 1971-2001 Indicator 1971 Censusa 1981 Censusa 1991 Censusa 2001 Censusb Population (millions) Intercensal growth rate (percent) Density (pop./km2) Percent urban Life expectancy Male Female 11.6 2.1 79 4.0 42.0 40.0 15.0 2.6 102 6.4 50.9 48.1 18.5 2.1 126 9.2 55.0 53.5 23.2 2.3 158 14.2 u u u = Unknown (not available) a Central Bureau of Statistics, 1995 b Central Bureau of Statistics, 2001a 1.3 POPULATION AND REPRODUCTIVE HEALTH POLICIES AND PROGRAMS EVOLUTION OF POPULATION POLICY Family planning emerged as one of the major components of Nepal’s planned development activities in 1968 with the implementation of the Third Five-Year Development Plan (1965-1970). This is when the Nepal Family Planning and Maternal and Child Health Project (FP/MCH) under the Ministry of Health was launched in the government sector. Until then, family planning activities were undertaken by the Family Planning Association of Nepal (FPAN), which was established in 1959 to create awareness among the people about the need and importance of family planning. Very little was done to directly regulate population growth until 1965 when a family planning project was established under the maternal and child health section of the Ministry of Health. Limited family planning services were offered through the existing maternal and child health clinics. The Fourth Development Plan (1970-1975) targeted the provision of family planning services to 15 percent of married couples by the end of the plan period. From the Fifth Five-Year Development Plan (1975-1980) onward, family planning services were greatly expanded through outreach workers and serious attempts were made to reduce the birth rate by direct and indirect means. To coordinate the government’s multisectoral activities in population and reproductive health, a population policy coordinating board was established in 1975 under the National Planning Commission. In 1978, this board was upgraded to become the National Commission on Population (NCP). It was further reorganized under the chairmanship of the prime minister and maintained its own secretariat to plan, monitor, and coordinate population activities both at the government and private-sector levels. 4 * Introduction Subsequent development plans dealt with the population issue from both a policy and programmatic point of view. From the Fifth Plan until the end of the Seventh Plan (1985-1990), population policies and programs not only emphasized family planning issues in the short term but also focused on long-term concerns to encourage the small family norm through education and employment programs aimed at raising women’s status and decreasing infant mortality. This included launching population-related programs in reproductive health, agriculture, forestry, urbanization, manpower and employment, education, and women’s development, as well as community development programs. In 1990, the NCP was dissolved and its role was given to the Population Division of the National Planning Commission. In 1995, the Ministry of Population and Environment (MOPE) was established as a separate ministry for population-related activities and is viewed as the reflection of a strong government commitment to population programs. The ministry is primarily responsible for formulating and implementing population policies, plans, and programs and for monitoring and evaluating those programs. This ministry, along with the Ministry of Health, is also responsible for implementing programs of action recommended by the International Conference on Population and Development (ICPD). The implementation of health-related population programs in reproductive health such as family planning, safe motherhood, adolescent reproductive health, sexually transmitted diseases (STDs), and infertility nevertheless falls under the purview of the Ministry of Health. In 1996, the government established a National Population Committee composed of ministers from various ministries and chaired by the prime minister to provide strong political leadership and guidance in formulating population policies and coordinating, implementing, monitoring, and evaluating population activities. The Eighth Development Plan (1992-1997) continued with the integrated development approach taken in earlier development plans. The Eighth Plan emphasized the family planning and maternal and child health program, the main objectives of which were to control the growth of the population in a planned way and to improve the standard of living of people by minimizing the possible adverse effects of population growth on the economic and social development of the country (Ministry of Population and Environment, 1998). The Ninth Development Plan (1997-2002) was developed with a vision for a 20-year, long- term plan. Poverty alleviation is the main thrust of the Ninth Plan. Major strategies adopted by the plan include reduction in population growth through social awareness, expansion of education, and family planning programs. The long-term objective of the plan is to lower fertility to replacement level in the next 20 years. The immediate objectives of the Ninth Plan are to attract couples to adopt a two-child family norm, to implement various programs to lower the fertility rate to replacement level, and to make high-quality family planning and maternal and child health services easily available and accessible. In agreement with the goals stated in Cairo by the ICPD and in Beijing by the Women’s Conference, the Ninth Plan has adopted a policy of improving the quality of services. The current plan is geared toward creating demand for FP/MCH services, safer motherhood, postnatal and antenatal care, client satisfaction, and increased male responsibility for reproductive health. It is also focused on the involvement of nongovernmental organizations and community- based organizations in the promotion of high-quality and effective services (Ministry of Population and Environment, 1998). Introduction * 5 FAMILY PLANNING PROGRAMS Family planning services in Nepal were started by the FPAN in 1959. Initially, its services were limited to the Kathmandu valley. The pioneering work of the FPAN led to the establishment of the semiautonomous Nepal Family Planning and Maternal and Child Health Project (NFP & MCH Project) in November 1968 at the government level. This project was gradually expanded to cover all 75 districts in Nepal. Family planning services have become an integral part of government health services. Currently, temporary family planning methods (condoms, the pill, and injectables) are provided on a regular basis through national, regional, zonal, and district hospitals, primary health care centers or health centers, health posts, sub-health posts and peripheral health workers, and volunteers. Services such as Norplant implants and IUD insertions are only available at a limited number of hospitals, health centers, and selected health posts where trained manpower is available. Depending on the district, sterilization services are provided at static sites (21 districts) through scheduled “seasonal” or mobile outreach services. At the central level, the Family Health Division in the Department of Health Services is responsible for planning, supervising, and implementing family planning activities. The National Health Training and Regional Training Centers are responsible for training fieldworkers for reproductive health services. Information, education, and communication (IEC) activities on reproductive health are carried out by the National Health Education, Information, and Communication Center in the Department of Health Services and by the IEC section of MOPE. Besides government programs, a number of nongovernmental organizations (NGOs) are also involved in the delivery of family planning services at the grass-roots level. These include FPAN, the Contraceptive Retail Sales (CRS) Company, the Nepal Red Cross Society, Save the Children Fund (UK and USA), the Adventist Development Relief Agency (ADRA), Marie Stopes International (MSI), the United Mission to Nepal (UMN), the Nepal Fertility Care Center (NFCC), the Center for Development and Population Activities (CEDPA), the Asia Foundation (TAF), and CARE. Among these NGOs, FPAN, NFCC, MSI, UMN, and ADRA deliver the most sterilization services, while CEDPA, TAF, CRS, Save the Children, and CARE deliver a significant number of services for temporary methods and referrals for sterilization. These NGOs are located throughout the country, serving the most densely populated districts as well as some of the most remote areas of Nepal. In addition to service delivery, NGOs like World Education, Inc., are involved in behavior change communication programs including IEC and adult literacy classes with a focus on family planning. Although the number of users of family planning who receive services from NGOs are modest compared with those served by the public sector, they complement the Ministry of Health’s ongoing efforts to expand the availability of family planning methods. 1.4 OBJECTIVES AND ORGANIZATION OF 2001 NDHS SURVEY The main objective of the 2001 Nepal Demographic and Health Survey (NDHS) is to generate reliable information on fertility; child mortality; knowledge of, use of, and demand for contraception; utilization of maternal and child health services; nutrition; and knowledge of HIV/AIDS. This information is useful for policy formulation, planning, monitoring, and evaluation of programs both 6 * Introduction at the national and regional levels. The 2001 NDHS is the sixth in a series of national-level population and health surveys. It is the second nationally representative, comprehensive survey conducted as part of the global Demographic and Health Survey (DHS) program, the first being the 1996 Nepal Family Health Survey (NFHS). The 2001 NDHS data are comparable to data collected in DHS surveys in other developing countries. The survey collected demographic and health information from a nationally representative sample of ever-married women and men in the reproductive age groups of 15-49 and 15-59, respectively, and provides updated information at the national, regional, and subregional levels, as well as for urban and rural areas separately. The 2001 NDHS is the first in the history of demographic and health surveys conducted in Nepal that included a male sample. The 2001 NDHS was carried out under the aegis of the Family Health Division of the Department of Health Services, Ministry of Health, and was implemented by New ERA, a local research organization, which also conducted the 1996 NFHS. ORC Macro provided technical support through its MEASURE DHS+ Project. The survey was funded by the U.S. Agency for International Development (USAID) through its mission in Nepal. A total of 257 enumeration areas (EAs)215 in the rural areas and 42 in the urban areaswere selected using probability proportional to size. Of the total rural clusters sampled, six could not be covered due to security concerns, reducing the total number of EAs to 251. A complete household listing operation of the sampled clusters was conducted before the main survey from which individual households were selected. Three types of questionnaires were used to gather demographic and health data: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content and design of the questionnaires were based on the MEASURE DHS+ Model B Questionnaire. The English questionnaires were circulated among the various organizations for feedback and later translated into the three main local languagesNepali (the national language), Maithali, and Bhojpuri. They were finalized after pretesting. A four-week training course was organized for field supervisors, interviewers, field data editors, quality control teams, and data processing staff on various aspects of the survey such as questionnaire content, interviewing techniques, field procedures, and monitoring of data quality. Data were collected by 11 teams, each team comprising a field supervisor, three female interviewers, a male interviewer, and a data editor. Data quality was monitored through constant field supervision and from the results of field check tables that were produced periodically from data entered onto computers. The fieldwork was conducted from the fourth week of January to the end of June 2001. Of the total 8,864 households selected, 8,634 were found to be valid, occupied households and 8,602 households were successfully interviewed, giving a response rate of nearly 100 percent (Table 1.2). From these households, 8,885 eligible women (ever-married women age 15-49) were identified and 8,726 were successfully interviewed yielding a response rate of 98 percent. Every third household was selected for the male survey, and from these households, 2,353 eligible men (ever-married men age 15-59) were identified. Of these, 2,261 men were successfully interviewed, yielding a response rate of 96 percent. Survey operational procedures and sample design are discussed in greater detail in Appendix A. Introduction * 7 Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Nepal 2001 Residence Result Urban Rural Total Household interviews Households selected 1,271 7,593 8,864 Households occupied 1,223 7,411 8,634 Households interviewed 1,218 7,384 8,602 Household response rate 99.6 99.6 99.6 Interviews with women Number of eligible women 1,191 7,694 8,885 Number of eligible women interviewed 1,154 7,572 8,726 Eligible woman response rate 96.9 98.4 98.2 Interviews with men Number of eligible men 329 2,024 2,353 Number of eligible men interviewed 304 1,957 2,261 Eligible man response rate 92.4 96.7 96.1 Household Population and Housing C 2HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS This chapter provides a summary of the demographic and socioeconomic characteristics of the household population in the 2001 Nepal Demographic Health Survey (NDHS). It provides valuable input for social and economic development planning and is also useful in understanding and identifying the major factors that determine or influence the basic demographic indicators of the population. In this chapter, the 2001 NDHS data have, in some instances, been compared with data from the 1991 and 2001 Censuses and the 1996 Nepal Family Health Survey (NFHS). The 2001 NDHS collected information about all usual residents of a selected household (the de jure population) and persons who had slept in the selected household the night before the interview (the de facto population). The difference between these two populations is very small, and since past surveys have looked at the de facto population, for comparison purposes, all tables in this report refer to the de facto population, unless otherwise specified. A household is defined as a person or group of persons who live and eat together. 2.1 AGE AND SEX COMPOSITION OF THE HOUSEHOLD POPULATION Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. In general, a cross-classification with sex is useful for the effective analysis of all forms of data obtained in surveys. In most developing countries, age is of little significance to the majority of the population and especially to those living in rural areas. Because it is well documented that in Nepal ages are poorly reported, considerable emphasis was placed during interviewer training on obtaining accurate age information. There are also several built-in checks in the questionnaire that allowed interviewers to verify the accuracy of the information recorded on age. An examination of the quality of the data in relation to age reporting indicates that there is some preference for ages ending in 0 and 5, and as expected, this “age heaping” is more severe at older ages (Table C.1 and Figure 2.1). The typical pattern of heaping on age 12 is also evident. Nevertheless, age reporting in the 2001 NDHS is better than age data from most other sources and shows no serious biases in reporting. Information on the age and sex of each household member was obtained from the household head or some other responsible adult member of the household. Age reporting appears to be better among women and men in the reproductive age groups of 15-49 and 15-59, respectively, presumably because most of these women reported their own age in the individual questionnaires, as opposed to only one-third of the men who live in households selected for the men’s survey. Another measure of the quality of the age data is the very small number of persons whose ages were recorded as not known or missingtwo males and two females (Table C.1). haracteristics * 9 Household Population and Housing Characteristics * 11 The overall sex ratio, the number of males per 100 females, is 90, which is lower than that obtained in the 2001 Census (100) and the 1996 NFHS (93).2 The sex ratio differs by residence (Table 2.1). Urban areas have a higher sex ratio (97) than rural areas (89). The sex ratio is markedly lower among the working-age population, which was also the case in the 1996 NFHS. A low sex ratio among the working-age population, particularly in rural areas, may be attributed to the high rate of out-migration of males to the urban areas of Nepal, as well as to other countries, including India, in search of short- and long-term employment. The age structure of the household population observed in the survey is typical of a youthful population (see population pyramid in Figure 2.2). Nepal has a pyramidal age structure due to the high fertility levels prevailing in the past. Children under 15 years of age account for more than two- fifths of the population, a feature of populations with high fertility levels (Table 2.1). Fifty-two percent of the population is in the age group 15-64 and 4 percent are over 65. The distribution of the population by age group is similar to that in the 1996 NFHS. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Nepal 2001 Urban Rural Total Age Male Female Total Sex ratio Male Female Total Sex ratio Male Female Total Sex ratio <5 10.7 9.9 10.2 104.9 16.6 15.3 15.9 96.4 15.9 14.7 15.3 97.0 5-9 13.3 11.6 12.4 111.6 16.6 14.4 15.4 102.1 16.2 14.1 15.1 102.8 10-14 13.2 13.4 13.3 95.5 14.6 12.2 13.3 106.8 14.5 12.3 13.3 105.6 15-19 10.5 11.6 11.1 87.7 9.1 10.3 9.8 78.9 9.3 10.4 9.9 79.8 20-24 10.2 11.7 10.9 84.3 6.2 8.4 7.3 65.4 6.6 8.7 7.7 67.9 25-29 9.0 8.4 8.7 103.8 5.7 7.5 6.7 67.7 6.1 7.6 6.9 71.5 30-34 7.3 7.0 7.2 101.9 5.3 6.5 5.9 73.2 5.5 6.5 6.1 76.1 35-39 5.6 5.8 5.7 93.0 4.9 5.2 5.1 83.8 5.0 5.3 5.1 84.8 40-44 4.4 4.9 4.7 86.8 4.0 4.4 4.2 80.8 4.1 4.5 4.3 81.4 45-49 4.3 3.9 4.1 107.2 3.7 3.6 3.7 91.8 3.8 3.6 3.7 93.4 50-54 2.7 3.0 2.8 88.7 3.2 3.7 3.5 74.8 3.1 3.7 3.4 75.9 55-59 2.7 2.7 2.7 95.0 2.8 2.5 2.6 98.7 2.8 2.5 2.7 98.3 60-64 2.5 2.0 2.3 121.7 2.5 2.2 2.4 102.5 2.5 2.2 2.3 104.2 65-69 1.5 1.9 1.7 77.4 2.1 1.7 1.9 112.0 2.0 1.7 1.8 108.2 70-74 0.9 0.9 0.9 107.6 1.3 1.0 1.1 109.7 1.2 1.0 1.1 109.5 75-79 0.6 0.5 0.5 106.5 0.8 0.6 0.7 109.2 0.8 0.6 0.7 109.0 80 + 0.5 0.8 0.6 69.0 0.5 0.4 0.5 102.7 0.5 0.5 0.5 97.5 Total 100.0 100.0 100.0 97.0 100.0 100.0 100.0 89.0 100.0 100.0 100.0 90.0 Number 2,172 2,240 4,412 4,412 18,661 21,013 39,674 39,674 20,833 23,253 44,086 44,086 2 The marked difference in the sex ratio between the 2001 Census and the 2001 NDHS could be because the sex ratio from the census is based on the de jure population, whereas the sex ratio obtained from the 2001 NDHS is based on the de facto household population. 12 * Household Population and Housing Characteristics Figure 2.2 Population Pyramid, Nepal, 2001 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 Nepal 2001 Age Male Percent Female 2.2 HOUSEHOLD COMPOSITION Table 2.2 presents the distribution of households by selected background characteristics. This information is useful for several reasons. For example, female-headed households are often found to be poorer than male-headed households and the size and composition of a household influences the allocation of limited resources and affects the living conditions of individuals in the household. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Nepal 2001 Residence Characteristic Urban Rural Total Sex of head of household Male 83.3 83.9 83.9 Female 16.7 16.1 16.1 Total 100.0 100.0 100.0 Number of usual members 1 5.1 3.8 4.0 2 8.7 8.1 8.2 3 12.9 11.3 11.5 4 17.8 16.7 16.8 5 19.1 18.5 18.5 6 14.3 14.8 14.7 7 9.2 10.7 10.6 8 4.7 6.3 6.1 9+ 8.1 9.7 9.6 Total 100.0 100.0 100.0 Number of households 900 7,702 8,602 Mean size 5.0 5.3 5.3 Note: Table is based on de jure members, of household, i.e., usual residents Household Population and Housing Characteristics * 13 Households in Nepal are predominantly headed by males regardless of the type of residence (84 percent). The average household size is 5.3 persons, which is slightly lower than in the 1996 NFHS (5.5). The average household size is slightly larger in rural areas (5.3) than in urban areas (5.0). 2.3 EDUCATION OF HOUSEHOLD MEMBERS EDUCATIONAL ATTAINMENT OF THE HOUSEHOLD POPULATION The level of education attained by the population is an important indicator of social development. In addition, education has been found to influence reproductive behavior, the use of contraceptives, the health of mothers and children, and hygienic habits. Tables 2.3.1 and 2.3.2 show the distribution of the male and female household population age six years and above by the level of education attended or completed according to age, residence, ecological zone, development region, and subregion. In this report those who have never been to school are categorized as having no education. About one-third of males (32 percent) and three out of five females (60 percent) have no education. Overall, 35 percent of males and 23 percent of females have some primary education only, while 7 percent of males and 4 percent of females have completed primary education and gone no further. Likewise, 18 percent of males and 9 percent of females have only some secondary education, while three times as many males (9 percent) as females (3 percent) have completed secondary education. The median number of years of schooling is 1.4 for males and less than 1 year for females (the median for females is not shown because more than 50 percent of the female household population in most of the categories have no education). An examination of the level of education by age group reveals that there has been an improvement over time in the educational attainment for both sexes. The proportion of males who have never been to school declines from 88 percent among the oldest age group (65 years or more) to 10 percent among those age 10-14 years. The comparable proportion among females is 99 percent and 28 percent, respectively. Nevertheless, the gender gap remains large. For example, 21 percent of males in the age group 6-9 have not been to school, compared with 34 percent among females in the same age group. Data also indicate that there is a wide gap between urban and rural areas in educational attainment. Thirty-four percent of males and 63 percent of females in rural areas have never attended school, compared with 14 percent of males and 36 percent of females in urban areas. For both sexes, this difference is more pronounced at higher levels of education, presumably because of insufficient numbers of higher educational facilities, inaccessibility, and less affordability in rural areas. Among both women and men, the percentage with no education is lowest in the hill ecological zone and almost the same in the terai and mountain zones. More than one-third of males residing in the Central region (36 percent) reported having no education. Among females, the highest percentage reporting no education is in the Far-western region (67 percent), followed closely by the Central region (65 percent) and the Mid-western region (64 percent). 14 * Household Population and Housing Characteristics Table 2.3.1 Educational attainment of household population: male Percent distribution of the de facto male household population age six and over by highest level of education attended or completed, according to background characteristics, Nepal 2001 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number of men Median number of years Age 6-9 20.8 78.7 0.1 0.0 0.0 0.0 0.3 100.0 2,706 0.0 10-14 10.4 64.2 12.1 13.2 0.1 0.0 0.0 100.0 3,018 2.4 15-19 13.3 18.8 10.7 47.8 7.4 2.0 0.1 100.0 1,935 5.6 20-24 16.2 17.2 9.3 32.7 13.4 11.2 0.0 100.0 1,371 6.3 25-29 24.4 16.6 7.5 27.9 10.9 12.4 0.3 100.0 1,266 5.4 30-34 33.6 17.3 6.1 23.4 9.6 9.9 0.1 100.0 1,155 3.8 35-39 37.0 21.3 7.4 18.9 7.3 7.8 0.2 100.0 1,041 2.5 40-44 47.6 19.0 7.5 13.7 4.8 7.2 0.1 100.0 846 0.4 45-49 48.1 20.0 6.7 14.5 5.0 5.5 0.1 100.0 792 0.0 50-54 60.2 17.6 5.8 9.2 3.3 3.5 0.4 100.0 648 0.0 55-59 75.5 9.3 4.5 4.9 3.2 2.1 0.5 100.0 580 0.0 60-64 80.5 11.6 1.6 3.5 1.4 1.2 0.2 100.0 528 0.0 65+ 88.3 6.2 1.3 2.6 0.6 0.7 0.3 100.0 947 0.0 Residence Urban 14.1 28.8 6.5 23.8 10.6 15.7 0.4 100.0 1,880 5.1 Rural 33.7 35.9 6.9 16.8 3.9 2.7 0.1 100.0 14,954 1.0 Ecological zone Mountain 33.4 40.2 6.2 14.9 3.6 1.8 0.0 100.0 1,193 0.7 Hill 26.1 38.6 7.6 18.4 4.6 4.7 0.1 100.0 6,925 2.0 Terai 35.6 31.6 6.3 17.3 4.9 4.0 0.3 100.0 8,716 1.1 Development region Eastern 29.0 35.7 6.6 19.1 5.4 4.0 0.2 100.0 4,348 1.8 Central 36.1 32.5 6.1 14.5 5.0 5.5 0.3 100.0 5,325 0.7 Western 27.8 35.5 7.8 20.5 4.5 3.8 0.1 100.0 3,357 2.1 Mid-western 32.9 36.4 6.3 17.9 3.4 3.0 0.1 100.0 2,261 1.1 Far-western 29.1 39.5 8.6 17.1 3.6 2.0 0.1 100.0 1,543 1.3 Subregion Eastern Mountain 27.0 37.7 7.1 18.4 5.9 3.8 0.0 100.0 310 1.9 Central Mountain 35.0 43.6 5.6 12.4 2.9 0.5 0.0 100.0 400 0.1 Western Mountain 36.2 38.9 6.0 14.6 2.7 1.6 0.0 100.0 483 0.4 Eastern Hill 27.4 41.8 6.4 18.2 3.7 2.3 0.2 100.0 1,252 1.4 Central Hill 25.5 35.7 6.4 16.7 6.1 9.5 0.1 100.0 1,978 2.3 Western Hill 23.7 36.6 9.0 21.3 5.1 4.3 0.1 100.0 1,928 2.6 Mid-western Hill 28.3 43.0 7.8 16.6 2.8 1.5 0.1 100.0 1,151 1.3 Far-western Hill 28.9 39.4 9.2 18.1 2.9 1.3 0.2 100.0 616 1.1 Eastern Terai 30.0 32.7 6.6 19.5 6.1 4.8 0.2 100.0 2,786 2.0 Central Terai 43.3 28.9 6.0 13.2 4.6 3.5 0.5 100.0 2,947 0.0 Western Terai 33.5 34.1 6.2 19.4 3.6 3.2 0.1 100.0 1,429 1.4 Mid-western Terai 35.1 29.7 4.9 20.5 4.1 5.5 0.1 100.0 902 1.1 Far-western Terai 30.3 36.6 8.7 16.9 4.9 2.4 0.1 100.0 652 1.6 Total 31.6 35.1 6.8 17.6 4.7 4.1 0.2 100.0 16,834 1.4 Note: Total includes 2 men with missing information on age who are not shown separately. 1Completed grade 5 at the primary level 2Completed grade 10 at the secondary level Household Population and Housing Characteristics * 15 Table 2.3.2 Educational attainment of household population: female Percent distribution of the de facto female household population age six and over by highest level of education attended or completed, according to background characteristics, Nepal 2001 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number of women Age 6-9 33.7 66.0 0.1 0.0 0.0 0.0 0.1 100.0 2,629 10-14 28.2 52.4 9.4 10.1 0.0 0.0 0.0 100.0 2,858 15-19 37.6 17.2 8.0 30.3 5.7 1.0 0.1 100.0 2,423 20-24 55.6 10.5 5.1 17.5 6.4 4.7 0.1 100.0 2,019 25-29 67.6 10.2 4.7 10.3 4.6 2.6 0.0 100.0 1,771 30-34 75.4 9.6 3.2 7.7 3.0 1.1 0.0 100.0 1,517 35-39 86.2 5.8 2.0 4.3 1.0 0.8 0.0 100.0 1,228 40-44 87.5 6.3 2.2 2.5 0.8 0.7 0.0 100.0 1,039 45-49 92.7 2.8 0.8 2.4 0.7 0.5 0.2 100.0 849 50-54 94.3 2.3 1.3 1.6 0.4 0.2 0.0 100.0 854 55-59 97.2 1.5 0.5 0.4 0.3 0.0 0.0 100.0 589 60-64 97.8 0.8 0.0 1.0 0.3 0.0 0.1 100.0 506 65+ 98.9 0.8 0.0 0.0 0.0 0.0 0.2 100.0 883 Residence Urban 36.1 24.4 4.7 21.7 7.6 5.6 0.0 100.0 1,974 Rural 63.1 22.7 3.9 8.0 1.6 0.6 0.1 100.0 17,192 Ecological zone Mountain 66.1 24.3 2.5 5.9 1.1 0.2 0.0 100.0 1,361 Hill 53.7 27.3 4.8 10.2 2.5 1.4 0.0 100.0 8,296 Terai 65.3 18.9 3.5 9.1 2.2 1.0 0.1 100.0 9,509 Development region Eastern 55.5 24.0 4.9 12.1 2.4 1.1 0.0 100.0 4,840 Central 65.1 19.9 3.0 7.7 2.8 1.5 0.1 100.0 5,877 Western 53.8 25.8 5.3 11.7 2.3 1.1 0.1 100.0 4,019 Mid-western 64.4 22.6 3.4 7.3 1.5 0.7 0.0 100.0 2,573 Far-western 66.5 23.8 3.0 5.6 0.9 0.2 0.1 100.0 1,856 Subregion Eastern Mountain 48.6 30.9 4.3 13.4 2.2 0.6 0.0 100.0 343 Central Mountain 65.5 27.4 1.9 4.4 0.7 0.1 0.0 100.0 458 Western Mountain 77.4 17.7 1.9 2.4 0.6 0.0 0.0 100.0 560 Eastern Hill 52.4 30.6 5.8 9.5 1.1 0.6 0.0 100.0 1,455 Central Hill 50.3 26.2 4.1 11.4 4.6 3.3 0.0 100.0 2,234 Western Hill 45.9 29.8 6.3 14.0 2.8 1.2 0.1 100.0 2,449 Mid-western Hill 63.9 24.9 3.7 6.1 1.4 0.0 0.0 100.0 1,385 Far-western Hill 72.6 20.7 2.6 3.7 0.3 0.0 0.2 100.0 774 Eastern Terai 57.7 20.0 4.5 13.2 3.1 1.4 0.0 100.0 3,043 Central Terai 75.5 14.3 2.3 5.5 1.8 0.4 0.1 100.0 3,185 Western Terai 66.2 19.6 3.7 8.1 1.4 0.9 0.1 100.0 1,571 Mid-western Terai 60.2 21.6 3.6 10.4 2.2 1.9 0.1 100.0 962 Far-western Terai 57.7 28.2 3.5 8.7 1.5 0.4 0.1 100.0 748 Total 60.4 22.9 4.0 9.4 2.2 1.1 0.1 100.0 19,166 Note: Total includes 2 women with missing information on age who are not shown separately. 1Completed grade 5 at the primary level 2Completed grade 10 at the secondary level 16 * Household Population and Housing Characteristics The table shows the persistence of the gender gap in the level of education even among the subregions. Although among males, the percentage that have never been to school is less than 45 percent in all subregions, among females, the percentage who have never been to school exceeds 50 percent in most of the subregions and exceeds 75 percent in two of the thirteen subregions (Western mountain and Central terai). SCHOOL ATTENDANCE RATIOS The net attendance ratio (NAR) indicates participation in primary schooling for the population age 6-10 and secondary schooling for the population age 11-15. The gross attendance ratio (GAR) measures participation at each level of schooling among those of any age from 5 to 24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.3 An NAR of 100 percent would indicate that all those in the official age range of the level are attending at that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. Table 2.4 presents the NAR and GAR for the de jure household population by level of schooling of the male and female population age 5-24 years according to residence. The NAR is 73 percent at the primary level and 31 percent at the secondary level, while the GAR at the primary level is more than two times as high as at the secondary level. Male attendance ratios are much higher than female attendance ratios at both the primary and secondary levels. Attendance ratios are also much higher in urban areas than in rural areas. Attendance ratios at the primary and secondary levels are highest in the hill ecological region and the Western development region. At the primary level, they are lowest in the terai ecological zone and Central region, while at the secondary level, they are lowest in the mountain zone. 3 Students who are overage for a given level of schooling may have started school overage, may have repeated one or more grades in school, or may have dropped out of school and later returned. Household Population and Housing Characteristics * 17 Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex, according to background characteristics, Nepal 2001 Net attendance ratio 1 Gross attendance ratio2 Background characteristic Male Female Total Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 90.8 86.4 88.7 142.7 128.7 135.8 0.9 Rural 78.2 64.7 71.6 126.1 103.7 115.2 0.8 Ecological zone Mountain 83.9 64.3 73.9 140.9 100.7 120.3 0.7 Hill 87.2 79.1 83.2 140.9 127.9 134.5 0.9 Terai 72.2 56.2 64.5 114.8 87.9 101.8 0.8 Development region Eastern 82.6 66.3 74.9 133.3 113.0 123.6 0.8 Central 71.7 60.4 66.1 111.7 87.5 99.7 0.8 Western 83.8 77.6 80.7 135.6 123.9 129.8 0.9 Mid-western 78.7 62.6 71.1 129.3 103.9 117.3 0.8 Far-western 86.4 69.3 78.0 143.9 113.4 128.8 0.8 Subregion Eastern Mountain 84.5 79.7 82.1 164.1 143.4 153.7 0.9 Central Mountain 88.7 69.7 79.4 130.2 105.3 118.0 0.8 Western Mountain 79.5 53.5 65.6 137.5 77.7 105.6 0.6 Eastern Hill 84.4 77.2 80.9 143.8 141.5 142.7 1.0 Central Hill 84.9 81.7 83.2 132.4 116.4 124.1 0.9 Western Hill 94.0 91.3 92.6 152.4 149.9 151.2 1.0 Mid-western Hill 83.3 64.4 74.8 132.4 106.8 120.9 0.8 Far-western Hill 87.1 64.7 76.3 143.2 107.6 126.1 0.8 Eastern Terai 81.5 58.9 70.9 124.9 94.1 110.5 0.8 Central Terai 62.0 45.2 53.9 97.7 66.1 82.5 0.7 Western Terai 70.4 58.7 64.6 113.5 88.1 101.0 0.8 Mid-western Terai 75.3 67.6 71.6 125.5 111.9 119.0 0.9 Far-western Terai 83.8 76.1 79.9 144.5 132.1 138.3 0.9 Total 79.3 66.5 73.0 127.5 105.9 116.9 0.8 SECONDARY SCHOOL Residence Urban 48.8 51.5 50.2 72.6 75.0 73.9 1.0 Rural 33.5 23.6 28.7 56.5 39.2 48.0 0.7 Ecological zone Mountain 31.6 20.7 26.5 56.2 30.8 44.3 0.5 Hill 38.7 30.6 34.6 62.0 49.5 55.7 0.8 Terai 32.3 23.7 28.1 54.9 38.8 47.1 0.7 Development region Eastern 34.4 29.4 31.9 59.5 51.5 55.5 0.9 Central 32.8 24.4 28.8 50.9 38.9 45.1 0.8 Western 41.4 33.7 37.6 65.4 50.9 58.3 0.8 Mid-western 30.6 22.7 26.6 57.2 34.1 45.5 0.6 Far-western 35.4 16.4 26.0 60.6 30.0 45.6 0.5 Subregion Eastern Mountain 28.0 30.1 29.0 52.8 51.5 52.2 1.0 Central Mountain 31.9 21.3 26.9 52.9 31.5 42.7 0.6 Western Mountain 33.8 14.3 24.7 60.6 17.1 40.3 0.3 Eastern Hill 31.6 24.9 28.2 56.8 47.3 51.9 0.8 Central Hill 40.1 36.8 38.4 62.6 59.3 60.9 0.9 Western Hill 48.6 41.3 45.0 70.7 61.7 66.3 0.9 Mid-western Hill 31.4 21.6 26.5 52.7 33.8 43.2 0.6 Far-western Hill 31.9 10.0 20.9 61.0 22.3 41.6 0.4 Eastern Terai 36.7 31.7 34.2 61.8 53.7 57.8 0.9 Central Terai 28.5 15.1 22.5 43.3 23.9 34.6 0.6 Western Terai 30.3 22.2 26.3 57.1 34.6 46.0 0.6 Mid-western Terai 30.8 28.8 29.8 66.2 40.9 53.3 0.6 Far-western Terai 36.4 19.4 27.9 57.2 38.1 47.6 0.7 Total 35.0 26.5 30.8 58.0 43.0 50.6 0.7 1The NAR for primary school is the percentage of the primary-school age (6-10 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (11-15 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3The Gender Parity Index for primary school is the ratio of the primary school GAR for females to the GAR for males. The Gender Parity Index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. 18 * Household Population and Housing Characteristics The repetition rate is the percentage of students in a given grade the previous school year who are repeating that grade in the current school year. Likewise, the dropout rate is the percentage of students in a given grade in the previous school year not attending school. By asking about the grade that children were attending during the previous school year, it is possible to calculate dropout rates and repetition rates. Table 2.5 indicates that the repetition rate is high in grade one (about one-third), which may be related to the teachers’ decision to ensure a more uniform preparedness before promoting children to grade two. The repetition rate declines significantly after grade one. Table 2.5 also shows that as the school grade rises, the dropout rate generally increases. Only 1 percent of children drop out of school after attending grade one, compared with a dropout rate of 3 percent at grades four and five. Table 2.5 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background characteristics, Nepal 2001 Repetition rate1 Dropout rate2 School grade School grade Background characteristic 1 2 3 4 5 1 2 3 4 5 Sex Male 31.6 10.1 7.1 6.0 6.4 1.2 1.5 2.1 3.2 3.0 Female 34.0 9.2 8.1 6.8 5.8 1.7 1.0 1.7 2.3 2.0 Residence Urban 15.4 4.8 2.1 3.9 3.4 0.6 2.0 2.5 4.3 1.8 Rural 34.0 10.3 8.2 6.7 6.5 1.5 1.2 1.9 2.6 2.7 Ecological zone Mountain 36.0 16.6 9.1 14.6 12.7 0.7 1.1 3.9 2.3 4.1 Hill 36.9 12.1 7.0 6.3 6.1 1.9 1.8 2.0 3.1 3.0 Terai 26.6 6.3 8.0 5.2 5.2 1.0 0.9 1.5 2.6 1.9 Development region Eastern 30.1 13.1 11.9 6.1 8.2 1.7 0.5 1.4 2.7 2.8 Central 39.8 10.7 8.0 8.2 4.4 1.4 1.9 3.6 4.2 5.4 Western 28.3 6.2 5.7 4.4 5.2 0.5 1.2 0.5 0.6 1.4 Mid-western 36.1 6.8 3.9 3.0 8.7 2.4 1.9 2.5 4.0 0.0 Far-western 20.9 10.0 6.0 11.5 4.1 1.4 1.5 1.9 2.9 0.7 Subregion Eastern Mountain 34.6 15.1 3.4 3.8 19.1 1.6 1.4 1.7 1.9 4.3 Central Mountain 44.2 20.0 10.5 23.8 12.9 0.8 0.0 3.5 2.4 9.7 Western Mountain 29.9 14.6 12.0 15.0 7.5 0.0 2.1 6.0 2.5 0.0 Eastern Hill 42.6 18.5 9.9 6.6 8.3 1.6 0.0 0.0 4.0 2.8 Central Hill 38.9 16.1 9.7 8.6 6.4 3.1 3.2 5.2 7.0 6.1 Western Hill 32.0 7.1 6.2 5.1 3.7 0.5 1.3 0.7 0.9 2.0 Mid-western Hill 43.0 10.0 4.3 2.6 8.9 3.4 3.3 2.8 2.6 0.0 Far-western Hill 16.9 9.5 1.5 10.4 4.7 0.0 0.0 0.0 0.0 2.3 Eastern Terai 16.5 10.1 14.8 6.2 6.8 1.8 0.6 2.4 2.1 2.7 Central Terai 39.7 3.8 4.8 4.2 0.0 0.0 0.9 1.6 1.6 3.6 Western Terai 21.1 4.2 4.3 2.0 8.8 0.7 1.0 0.0 0.0 0.0 Mid-western Terai 21.9 1.2 1.6 2.9 7.9 0.9 0.0 1.1 6.2 0.0 Far-western Terai 20.8 8.8 7.1 9.8 2.7 3.7 2.0 1.8 4.5 0.0 Total 32.7 9.7 7.5 6.4 6.2 1.4 1.3 2.0 2.8 2.6 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. Household Population and Housing Characteristics * 19 Repetition among rural children is higher than among urban children at all grade levels. However, after grade one, rural children are less likely to drop out than urban children. With the exception of grade one, children from the mountain ecological zone are more likely repeat a grade at every level. Differentials in the dropout rate by ecological zone are small. Figure 2.3 shows the percentage of the de jure household population age 5-24 years attending school by age and sex. The age-specific attendance rate indicates participation in school at any level from primary to higher levels of education. Only 40 percent of girls and 47 percent of boys are attending school at age five, indicating that a majority of children in Nepal at that age have not entered the school system. The minimum official age for school attendance is six years. A higher proportion of males than females attend school at every age, but this difference is significantly higher after age ten. School attendance drops substantially after age 15 for females and after age 17 for males. This sudden drop may be partly due to lack of financial resources to continue schooling and partly due to the need to work to support the family. Figure 2.3 Age-Specific School Attendance Rates 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 21 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female Nepal 2001 Note: Figure shows percentage of the de jure household population age 5-24 years attending school. 2.4 HOUSING CHARACTERISTICS The physical characteristics of households are important in assessing the general socioeconomic condition of the population. In the 2001 NDHS, respondents were asked about access to electricity, sources of drinking water and time taken to the nearest source, type of toilet facility, main material of the floor, and type of cooking fuel. 20 * Household Population and Housing Characteristics Table 2.6 provides information on selected housing characteristics by residence. Overall, 25 percent of households have electricity. This is a 37 percent increase over the last five years according to data obtained in the 1996 NFHS. There is a considerable difference between urban and rural households in the availability of electricity. Eighty-six percent of urban households have electricity, compared with only 17 percent of rural households. Table 2.6 Housing characteristics Percent distribution of households by background characteristics, according to residence, Nepal 2001 Residence Background characteristic Urban Rural Total Electricity Yes 85.7 17.4 24.6 No 14.3 82.6 75.4 Total 100.0 100.0 100.0 Source of drinking water Piped water 55.2 33.0 35.4 Dug well 10.9 3.8 4.6 Tubewell/borehole 30.8 38.1 37.4 Surface water 3.1 24.9 22.7 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 93.0 74.1 76.1 Median time to source 0.0 4.8 4.6 Sanitation facility Flush toilet 58.3 6.1 11.5 Traditional pit toilet 14.6 17.1 16.8 Ventilated/improved pit latrine 7.0 1.5 2.1 No facility/bush/field 20.1 75.3 69.5 Other 0.1 0.1 0.1 Total 100.0 100.0 100.0 Type of cooking fuel Firewood, charcoal, dung 39.1 94.1 88.3 Biogas 3.5 1.5 1.7 LPG gas 20.5 0.6 2.7 Electricity 0.3 0.0 0.1 Kerosene 35.8 2.3 5.8 Other 0.8 1.5 1.4 Total 100.0 100.0 100.0 Flooring material Earth, mud, dung 34.4 91.7 85.7 Wood planks 4.9 2.7 2.9 Linoleum, carpet 16.3 0.6 2.3 Ceramic tiles, marble chips 1.1 0.0 0.1 Cement 42.2 4.6 8.5 Other 1.1 0.3 0.4 Total 100.0 100.0 100.0 Number of households 900 7,702 8,602 Note: Total includes households for which information on flooring material is missing. Household Population and Housing Characteristics * 21 Information on the source of drinking water and accessibility to the source was also collected in the 2001 NDHS. Safe drinking water is important for health and sanitation. Table 2.6 shows that only 35 percent of households (55 percent in urban areas and 33 percent in rural areas) have access to piped drinking water, a small increase from the1996 level. Tubewells and boreholes are the major source of drinking water used by 37 percent of households; this source is important for both urban and rural households (31 percent and 38 percent, respectively). One-fourth of households in rural areas reported surface water as their main source of drinking water. Households with no access to drinking water within their own premises were also asked about the time required to fetch water. Overall, 76 percent of households have access to water within 15 minutes. As expected, there is better access to water in urban areas than in rural areas. The majority of households (70 percent) do not have sanitation facilities. Lack of sanitation facilities is more common in rural areas (75 percent) than in urban areas (20 percent). Nineteen percent of households have a traditional pit toilet or ventilated/improved pit latrine (22 percent in urban areas and 19 percent in rural areas). Twelve percent of households have flush toilets, which are predominantly located in urban households (58 percent). Traditional fuels such as firewood, charcoal, and dung are the most commonly used (88 percent) type of cooking fuel in Nepal (39 percent in urban areas and 94 percent in rural areas). Use of kerosene and gas for cooking is only common in urban households (36 percent and 21 percent, respectively). Smoke inhalation from burning firewood, charcoal, or dung during the process of cooking is one of the common causes of respiratory illnesses among women. The 2001 NDHS collected information on the number of households that have improved smokeless chulos, that is, households with a fireplace that has an outlet for the smoke to escape. Only 1 percent of households using firewood, charcoal, or dung have improved smokeless chulos (data not shown). Most households (86 percent) have earth, mud, or dung floors. Such traditional floors are almost universal in rural households (92 percent), while one in three urban households has this type of flooring. Nine percent of all households have a cement floor, which is more common in urban households (42 percent) than in rural households (5 percent). Information on the possession of various durable goods was also collected at the household level. Table 2.7 shows that overall, 44 percent of households have radios, one-fourth have bicycles, 13 percent have televisions, and 3 percent have telephones. There is a vast difference between urban and rural households, with urban households much more likely to own these consumer durable items than rural households. The urban-rural difference is especially pronounced for ownership of televisions and telephones. Overall, the possession of these items has increased over the last five years; this is reflected in the decrease in the percentage that possesses none of these items from 53 percent in 1996 to 42 percent in 2001. Table 2.7 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Nepal 2001 Residence Durable consumer goods Urban Rural Total Radio 61.0 41.4 43.5 Television 58.9 7.7 13.1 Telephone 18.0 0.6 2.5 Bicycle 44.0 24.0 26.1 None of the above 17.0 44.9 42.0 Number of households 900 7,702 8,602 Respondents’ Characteristics and Status * 23 3 RESPONDENTS’ CHARACTERISTICS AND STATUS The purpose of this chapter is to provide a descriptive summary of the demographic and socioeconomic characteristics of the individual respondents in the 2001 Nepal Demographic and Health Survey (NDHS). Information on the basic characteristics of women and men interviewed in the survey is essential for the interpretation of the findings and serves as an approximate indicator of the representativeness of the survey. It also provides valuable input for social and economic development planning. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 shows the distribution of respondents by selected background characteristics including age, marital status, residence, region, education, religion, and caste. Respondents are ever- married women age 15-49 and ever-married men age 15-59 who slept in a selected household the night before the interview. Relatively high proportions of respondents are in the younger age groups, with almost half of them under age 30. The proportion of eligible women declines after age 25-29. This is true of eligible men as well, with the proportion of eligible men declining after age 30-34. Respondents are mostly concentrated in the age group 20-39. The age distribution of ever-married women in the 2001 NDHS is consistent with the age distribution in the 1996 NFHS (Pradhan et al., 1997). The majority of women and men are currently married with a very small minority divorced, separated, or widowed. Most respondents (90 percent) live in rural areas. One in two respondents lives in the terai, two in five in the hills, and 7 percent in the mountains. The distribution of respondents by development region shows that one-third are from the Central region, one-quarter are from the Eastern region, one-fifth are from the Western region, and about one in ten each is from the Mid-western and Far-western regions. The subregional distribution shows the highest concentration of eligible women and men in the Central terai subregion (19 percent and 18 percent, respectively), followed by the Eastern terai (16 percent and 17 percent, respectively) and the Central and Western hill subregions (about 10 to 12 percent each). In each of the remaining subregions, the proportion of women and men is less than 10 percent. Men are much more educated than women. Nearly three in four women and two in five men have never attended school. Fifteen percent of women and 30 percent of men have some primary education only, while 9 percent of women and 20 percent of men have some secondary education, and 4 percent of women and 13 percent of men have completed their School Leaving Certificate (SLC). Most respondents are Hindu (about 85 percent), 7 percent of women and 9 percent of men are Buddhist, and 5 percent of respondents are Muslim. One in five respondents belongs to the occupational caste group, which is designated on the basis of the type of work done (with blacksmiths, tailor, cobbler, sweeper, laundry man, etc. being the most prominent in the rural settings). The Chettris make up about 17 percent of the population and the Brahmins comprise 13 percent. 24 * Respondents’ Characteristics and Status Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Nepal 2001 Number of women Number of men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 10.8 941 916 3.1 70 70 20-24 19.0 1,658 1,651 13.0 295 291 25-29 19.1 1,666 1,646 15.0 340 334 30-34 16.4 1,427 1,458 15.2 344 343 35-39 13.4 1,168 1,184 14.2 322 329 40-44 11.8 1,030 1,021 11.5 261 267 45-49 9.6 837 850 10.7 243 239 50-54 na na na 9.6 216 219 55-59 na na na 7.6 171 169 Marital status Married 95.6 8,342 8,324 97.2 2,198 2,193 Divorced/separated 1.5 132 142 0.8 17 19 Widowed 2.9 252 260 2.0 46 49 Residence Urban 9.6 841 1,154 10.0 227 304 Rural 90.4 7,885 7,572 90.0 2,034 1,957 Ecological zone Mountain 6.9 602 1,188 6.7 151 307 Hill 41.4 3,615 3,243 39.6 896 793 Terai 51.7 4,509 4,295 53.7 1,214 1,161 Development region Eastern 24.0 2,098 2,068 25.8 583 570 Central 32.1 2,804 2,392 33.2 750 633 Western 20.3 1,771 1,556 19.3 436 390 Mid-western 13.7 1,197 1,142 13.0 295 293 Far-western 9.8 855 1,568 8.7 197 375 Subregion Eastern Mountain 1.4 126 330 1.5 33 86 Central Mountain 2.4 209 395 2.6 59 117 Western Mountain 3.1 267 463 2.6 59 104 Eastern Hill 6.6 580 528 7.1 161 147 Central Hill 10.8 945 873 12.3 278 238 Western Hill 12.3 1,075 851 10.4 235 182 Mid-western Hill 7.4 648 395 6.3 143 91 Far-western Hill 4.2 368 596 3.5 80 135 Eastern Terai 16.0 1,393 1,210 17.2 389 337 Central Terai 18.9 1,651 1,124 18.3 413 278 Western Terai 8.0 696 705 8.9 201 208 Mid-western Terai 5.0 438 554 5.6 126 155 Far-western Terai 3.8 331 702 3.7 85 183 Education No education 72.0 6,279 6,269 37.7 852 846 Primary 14.8 1,294 1,274 29.7 670 674 Some secondary 9.3 814 832 20.0 452 455 SLC and above 3.9 339 351 12.7 287 286 Religion Hindu 85.5 7,462 7,485 84.1 1,902 1,918 Buddhist 7.1 621 660 8.5 193 196 Muslim 4.7 407 355 4.6 104 87 Christian 0.7 60 54 0.7 15 14 Other 2.0 177 172 2.0 46 46 Caste/ethnic group Brahmin 12.8 1,117 1,122 13.0 295 292 Chhetri/Thakuri/Rajput 17.8 1,553 1,831 17.0 384 440 Newar 4.8 421 424 5.2 117 116 Gurung 1.3 116 110 1.1 25 24 Magar 6.9 600 524 5.9 133 121 Tamang/Sherpa 6.2 542 564 7.2 164 160 Rai/Limbu 4.7 408 456 4.8 107 120 Muslim/Churaute 4.6 405 354 4.6 104 87 Tharu/Rajbanshi 6.9 598 708 8.1 184 218 Yadav/Ahir 3.2 279 220 4.0 90 72 Occupational 21.1 1,840 1,722 20.0 452 441 Other hill origin 2.6 223 198 2.7 61 51 Other terai origin 7.1 623 493 6.4 145 119 Total 100.0 8,726 8,726 100.0 2,261 2,261 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. SLC = School Leaving Certificate Respondents’ Characteristics and Status * 25 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Tables 3.2.1 and 3.2.2 show the educational level of female and male respondents by selected background characteristics. The median years of schooling for men is 2.5 years, and it is close to 0 for women (the median for women is not shown because more than 50 percent of women in most of the categories have no education and, therefore, a median of less than 1 year of schooling). Table 3.2.1 Educational attainment of women Percent distribution of women by highest level of schooling attended or completed, according to background characteristics, Nepal 2001 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of women Age 15-19 52.2 20.2 5.9 18.5 2.8 0.4 100.0 941 20-24 59.2 13.6 4.6 15.6 4.7 2.3 100.0 1,658 25-29 67.8 12.8 3.5 9.8 4.5 1.7 100.0 1,666 30-34 74.2 11.2 2.8 8.5 2.1 1.2 100.0 1,427 35-39 83.9 8.2 1.6 4.5 1.1 0.7 100.0 1,168 40-44 86.8 7.7 1.8 2.7 0.6 0.4 100.0 1,030 45-49 88.9 6.6 1.2 2.1 0.7 0.6 100.0 837 Residence Urban 42.9 14.7 4.5 23.9 8.3 5.6 100.0 841 Rural 75.1 11.4 3.0 7.8 2.1 0.7 100.0 7,885 Ecological zone Mountain 81.1 10.5 1.7 4.7 1.6 0.4 100.0 602 Hill 67.0 14.4 3.8 10.4 3.0 1.4 100.0 3,615 Terai 74.7 9.6 2.8 9.1 2.5 1.2 100.0 4,509 Development region Eastern 67.0 12.7 3.8 12.0 3.0 1.5 100.0 2,098 Central 74.6 11.3 2.6 7.2 3.0 1.4 100.0 2,804 Western 62.0 15.4 4.5 13.3 3.3 1.5 100.0 1,771 Mid-western 80.1 8.6 2.2 6.9 1.7 0.6 100.0 1,197 Far-western 84.8 6.9 2.0 5.1 1.1 0.1 100.0 855 Subregion Eastern Mountain 57.9 19.1 3.9 13.3 4.8 0.9 100.0 126 Central Mountain 80.3 14.2 1.5 2.5 1.0 0.5 100.0 209 Western Mountain 92.7 3.7 0.9 2.4 0.4 0.0 100.0 267 Eastern Hill 67.2 16.9 5.4 8.4 1.1 1.0 100.0 580 Central Hill 63.8 14.9 2.7 10.7 5.1 2.8 100.0 945 Western Hill 53.1 18.7 5.7 16.8 4.0 1.6 100.0 1,075 Mid-western Hill 81.6 9.8 2.1 4.9 1.6 0.0 100.0 648 Far-western Hill 89.6 4.6 1.7 3.8 0.5 0.0 100.0 368 Eastern Terai 67.7 10.4 3.1 13.4 3.6 1.8 100.0 1,393 Central Terai 80.1 8.9 2.6 5.7 2.0 0.7 100.0 1,651 Western Terai 75.6 10.2 2.7 7.8 2.2 1.4 100.0 696 Mid-western Terai 73.7 8.6 2.7 11.1 2.1 1.7 100.0 438 Far-western Terai 76.9 10.4 2.8 7.7 1.9 0.3 100.0 331 Total 72.0 11.7 3.1 9.3 2.7 1.2 100.0 8,726 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level 26 * Respondents’ Characteristics and Status Table 3.2.2 Educational attainment of men Percent distribution of men by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Nepal 2001 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of men Median years of schooling Age 15-19 14.0 24.3 23.5 33.6 4.7 0.0 100.0 70 4.5 20-24 13.9 23.3 13.8 35.0 9.8 4.3 100.0 295 4.9 25-29 23.2 24.1 6.7 28.8 9.1 8.2 100.0 340 4.4 30-34 34.4 20.4 7.1 20.2 10.6 7.2 100.0 344 3.3 35-39 37.3 23.1 8.5 17.8 6.8 6.5 100.0 322 2.0 40-44 44.4 23.9 6.5 13.7 5.5 6.0 100.0 261 1.1 45-49 45.1 20.8 9.0 15.1 5.1 5.1 100.0 243 1.0 50-54 58.9 17.3 5.8 9.8 3.9 4.3 100.0 216 0.0 55-59 77.0 10.6 4.1 4.2 2.0 2.1 100.0 171 0.0 Residence Urban 20.7 14.8 7.0 25.5 14.4 17.6 100.0 227 6.8 Rural 39.6 22.0 8.5 19.4 6.3 4.3 100.0 2,034 2.1 Ecological zone Mountain 44.6 27.2 5.9 14.1 6.0 2.3 100.0 151 0.4 Hill 30.7 25.6 8.4 21.7 7.4 6.2 100.0 896 3.2 Terai 41.9 17.3 8.7 19.5 7.0 5.6 100.0 1,214 2.1 Development region Eastern 37.9 20.0 7.0 21.7 8.2 5.2 100.0 583 2.3 Central 40.9 20.3 9.2 14.9 6.9 7.9 100.0 750 2.1 Western 29.9 24.0 9.8 22.9 8.1 5.3 100.0 436 3.4 Mid-western 41.0 20.2 4.6 25.3 5.5 3.4 100.0 295 2.0 Far-western 37.0 24.2 12.2 19.9 4.6 2.0 100.0 197 2.4 Subregion Eastern Mountain 33.7 19.8 10.5 20.9 9.3 5.8 100.0 33 3.0 Central Mountain 44.4 32.5 3.4 13.7 4.3 1.7 100.0 59 0.1 Western Mountain 51.0 26.0 5.8 10.6 5.8 1.0 100.0 59 0.0 Eastern Hill 34.9 28.7 6.2 21.2 6.2 3.0 100.0 161 1.9 Central Hill 30.4 24.8 8.1 16.8 7.9 12.0 100.0 278 3.3 Western Hill 28.0 23.7 11.1 21.4 9.4 6.4 100.0 235 3.8 Mid-western Hill 29.1 28.5 3.4 31.8 5.6 1.6 100.0 143 3.1 Far-western Hill 33.9 23.0 14.7 22.5 5.3 0.5 100.0 80 2.6 Eastern Terai 39.5 16.4 7.0 22.0 8.9 6.1 100.0 389 2.4 Central Terai 47.4 15.6 10.7 13.7 6.5 6.0 100.0 413 1.2 Western Terai 32.0 24.5 8.2 24.6 6.6 4.1 100.0 201 2.8 Mid-western Terai 49.7 12.3 6.0 21.0 4.7 6.3 100.0 126 0.0 Far-western Terai 38.7 20.4 11.8 21.0 4.4 3.6 100.0 85 2.8 Total 37.7 21.3 8.4 20.0 7.1 5.6 100.0 2,261 2.5 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level Respondents’ Characteristics and Status * 27 As expected, level of education decreases with increasing age, reflecting an improvement in educational attainment over time. The urban-rural difference in education is marked and is relatively wider among men than among women. Two-fifths (43 percent) of women in urban areas have no education, compared with three-fourths of rural women. Twice as many rural men as urban men have no education. The urban advantage is especially obvious at higher levels of education for women but not for men. For example, although the urban-rural difference among women who have only some secondary education is 16 percentage points, it is 6 percentage points among men. Women and men residing in the mountain ecological zone are least educated, while those residing in the hill zone are most educated. One-third of women and two-thirds of men residing in the hills have some education. Women residing in the Western region are more likely to have some education than women residing in the other regions, while those residing in the Far-western region are the least educated. Similarly, men residing in the Western region are most likely to be educated, while men residing in the Central and Mid-western regions are the least educated. Educational differences by subregions are marked. The proportion of women who have never attended school ranges from a low of 53 percent in the Western hill subregion to a high of 93 percent in the Western mountain subregion. The proportion of men having no education ranges from 28 percent in the Western hill subregion to 51 percent in the Western mountain subregion, indicating similar patterns for both men and women. In the Central hill subregion, 8 percent of women and 20 percent of men completed at least secondary education, which is highest among all subregions. 3.3 LITERACY In the 2001 NDHS, literacy was determined by a respondent’s ability to read part or all of a sentence in any language that the respondent knew. The questions assessing literacy were asked only of respondents who had not attended school or who attended primary school only. Literacy is widely acknowledged as benefiting both the individual and society and is associated with a number of positive outcomes for health, nutrition, and status of both men and women. Tables 3.3.1 and 3.3.2 show that men are twice as likely to be literate as women (70 percent and 35 percent, respectively). As expected, literacy is much lower among rural women and men than among those living in the urban areas. A higher proportion of women (43 percent) and men (79 percent) living in the hill ecological zone are literate, compared with those in the mountain and terai zones. Women living in the Western development region and men living in the Western and Mid-western regions are more likely to be literate than those living in the other development regions. The percentage of literate women is highest in the Western hill subregion (62 percent), while literacy is highest among men residing in the Mid-western hill subregion (87 percent). Nepal has an active literacy program. Consequently, the 2001 NDHS added a question to ascertain the proportion of women and men who have attended a literacy program. Tables 3.3.1 and 3.3.2 show that women are much more likely to have participated in a literacy program than men, with 19 percent of women and 5 percent of men having done so. 28 * Respondents’ Characteristics and Status Table 3.3.1 Literacy of women Percent distribution of women by level of schooling attended and by level of literacy, percent literate, and percentage who have participated in a literacy program, according to background characteristics, Nepal 2001 Primary school or no schooling Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Total Number of women Percent literate1 Percent who have participated in a literacy program Age 15-19 21.7 21.6 9.0 47.2 0.5 100.0 941 52.3 19.4 20-24 22.6 18.7 7.1 51.4 0.2 100.0 1,658 48.4 20.2 25-29 15.9 16.8 7.0 60.2 0.1 100.0 1,666 39.7 19.5 30-34 11.8 16.3 7.4 64.1 0.3 100.0 1,427 35.5 21.8 35-39 6.3 11.8 4.5 77.1 0.2 100.0 1,168 22.7 18.7 40-44 3.7 11.3 5.6 79.1 0.2 100.0 1,030 20.7 16.3 45-49 3.3 7.8 5.6 83.3 0.0 100.0 837 16.7 16.3 Residence Urban 37.9 18.7 7.4 35.8 0.2 100.0 841 64.0 13.8 Rural 10.6 15.1 6.6 67.5 0.2 100.0 7,885 32.2 19.8 Ecological zone Mountain 6.6 10.9 6.5 76.0 0.0 100.0 602 24.0 22.1 Hill 14.8 20.4 8.1 56.7 0.0 100.0 3,615 43.2 25.2 Terai 12.8 12.0 5.6 69.2 0.4 100.0 4,509 30.5 14.0 Development region Eastern 16.5 15.4 6.3 61.4 0.5 100.0 2,098 38.1 14.7 Central 11.5 10.5 5.9 72.1 0.0 100.0 2,804 27.9 14.5 Western 18.1 26.9 5.9 48.8 0.3 100.0 1,771 50.9 26.9 Mid-western 9.2 12.9 10.4 67.4 0.1 100.0 1,197 32.4 25.7 Far-western 6.3 11.5 6.6 75.6 0.0 100.0 855 24.4 21.0 Subregion Eastern Mountain 19.1 20.9 9.7 50.3 0.0 100.0 126 49.7 17.0 Central Mountain 4.1 13.4 8.4 74.2 0.0 100.0 209 25.8 35.9 Western Mountain 2.8 4.3 3.5 89.4 0.0 100.0 267 10.6 13.6 Eastern Hill 10.5 21.2 7.2 61.1 0.0 100.0 580 38.9 21.0 Central Hill 18.6 16.9 8.2 56.1 0.1 100.0 945 43.7 23.0 Western Hill 22.4 31.7 7.5 38.4 0.0 100.0 1,075 61.6 30.5 Mid-western Hill 6.6 11.8 10.7 70.9 0.0 100.0 648 29.1 26.8 Far-western Hill 4.2 10.1 5.8 79.9 0.0 100.0 368 20.1 19.4 Eastern Terai 18.8 12.4 5.6 62.5 0.7 100.0 1,393 36.7 11.8 Central Terai 8.4 6.4 4.3 80.9 0.0 100.0 1,651 19.1 6.9 Western Terai 11.5 19.6 3.4 64.9 0.7 100.0 696 34.4 21.3 Mid-western Terai 15.0 16.4 11.5 56.7 0.4 100.0 438 42.9 26.2 Far-western Terai 9.9 16.6 9.3 64.2 0.0 100.0 331 35.8 27.3 Total 13.2 15.4 6.7 64.5 0.2 100.0 8,726 35.3 19.2 1Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Respondents’ Characteristics and Status * 29 Table 3.3.2 Literacy of men Percent distribution of men by level of schooling attended and by level of literacy, percent literate, and percentage who have participated in a literacy program, according to background characteristics, Nepal 2001 Primary school or no schooling Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Total Number of men Percent literate1 Percent who have participated In a literacy program Age 15-19 38.3 37.2 7.9 16.6 0.0 100.0 70 83.4 2.2 20-24 49.0 28.9 6.6 15.5 0.0 100.0 295 84.5 3.0 25-29 46.1 22.6 7.6 23.7 0.0 100.0 340 76.3 3.6 30-34 38.0 22.8 9.2 29.7 0.2 100.0 344 70.1 4.2 35-39 31.1 27.5 6.4 34.5 0.4 100.0 322 65.1 5.6 40-44 25.1 31.3 12.4 31.1 0.0 100.0 261 68.9 5.9 45-49 25.2 31.0 5.7 38.1 0.0 100.0 243 61.9 5.5 50-54 18.1 32.4 12.8 36.1 0.6 100.0 216 63.3 9.1 55-59 8.3 31.0 13.5 47.1 0.0 100.0 171 52.9 8.7 Residence Urban 57.5 19.6 8.5 14.4 0.0 100.0 227 85.6 3.4 Rural 29.9 29.0 8.9 32.0 0.2 100.0 2,034 67.8 5.4 Ecological zone Mountain 22.3 30.9 11.1 35.7 0.0 100.0 151 64.3 6.9 Hill 35.3 36.0 7.9 20.5 0.3 100.0 896 79.2 4.9 Terai 32.0 21.9 9.3 36.7 0.1 100.0 1,214 63.2 5.3 Development region Eastern 35.1 23.1 9.3 32.5 0.0 100.0 583 67.5 3.6 Central 29.6 29.1 6.6 34.7 0.0 100.0 750 65.3 6.1 Western 36.3 32.1 7.6 23.4 0.6 100.0 436 76.0 5.6 Mid-western 34.2 28.2 13.5 23.8 0.3 100.0 295 75.9 7.1 Far-western 26.6 30.1 12.0 31.4 0.0 100.0 197 68.6 2.9 Subregion Eastern Mountain 36.0 31.4 8.1 24.4 0.0 100.0 33 75.6 4.7 Central Mountain 19.7 40.2 9.4 30.8 0.0 100.0 59 69.2 11.1 Western Mountain 17.3 21.2 14.4 47.1 0.0 100.0 59 52.9 3.8 Eastern Hill 30.3 30.8 10.3 28.7 0.0 100.0 161 71.3 2.7 Central Hill 36.7 37.2 7.0 19.1 0.0 100.0 278 80.9 5.3 Western Hill 37.2 36.7 6.6 18.4 1.1 100.0 235 80.5 5.8 Mid-western Hill 39.0 39.7 7.8 13.5 0.0 100.0 143 86.5 6.7 Far-western Hill 28.4 33.7 10.9 27.1 0.0 100.0 80 72.9 1.3 Eastern Terai 37.1 19.2 9.1 34.7 0.0 100.0 389 65.3 3.9 Central Terai 26.3 22.1 5.9 45.7 0.0 100.0 413 54.3 5.9 Western Terai 35.3 26.8 8.7 29.2 0.0 100.0 201 70.8 5.4 Mid-western Terai 32.0 19.2 19.7 28.4 0.7 100.0 126 70.9 7.6 Far-western Terai 29.1 26.1 12.2 32.7 0.0 100.0 85 67.3 4.8 Total 32.7 28.1 8.9 30.2 0.2 100.0 2,261 69.6 5.2 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 30 * Respondents’ Characteristics and Status 3.4 EXPOSURE TO MASS MEDIA The 2001 NDHS collected information on the exposure of respondents to both the broadcast and print media. Women were asked whether they usually read a newspaper or magazine at least once a week, listen to the radio daily, and watch television at least once a week. This information is important because it provides some indication of the extent to which Nepalese women are exposed to family planning and health messages in the mass media. As shown in Table 3.4.1, only 7 percent of women read a newspaper or magazine at least once a week, 23 percent watch television at least once a week, and 39 percent listen to the radio daily. Only 4 percent of women are exposed to all three media, and 51 percent have no access to any of the three media. Data from the 1996 NFHS show that there has been considerable improvement in women’s exposure to the media over the last five years. For example, exposure to television nearly doubled between 1996 and 2001, from 12 percent to 23 percent. During the same period, the percentage of women not exposed to any of the three media declined from 59 percent in 1996 to 51 percent in 2001. Generally, men have more exposure to the mass media than women (Table 3.4.2). Thirteen percent of men are exposed to all three media, and only 32 percent of men have no access to any of the three media. The radio is the most common media source for both women and men. Exposure to the media does not vary much by women’s age. In the case of men, exposure to mass media is highest among those age 20-24. Urban women and men have greater exposure to all types of media than rural women and men. In urban areas, 50 percent of women listen to the radio daily, 77 percent watch television at least once a week, and 28 percent read a newspaper or magazine at least once a week, while the corresponding data for rural women are 37 percent, 18 percent, and 5 percent, respectively. A similar pattern is observed for men. Irrespective of the region, the level of exposure of respondents to radio broadcasts is greater than to all other media sources, except in the Central terai subregion for women and the Eastern terai and Central terai subregions for men, where weekly television exposure is greater than daily radio exposure. Access to media sources is lowest in the mountain ecological zone, the Far-western development region and the Western mountain subregion for both women and men. Not surprisingly, media exposure is highly related to the educational level of respondents. Three-fifths of women and half of men with no education have no exposure to the mass media in contrast to 5 percent of women and 4 percent of men who have completed their School Leaving Certificate (SLC). Educated women and men also have greater access to all three media sources. Whereas 36 percent of women and 49 percent of men who have completed their SLC are exposed to all three media sources, women and men with no education have almost no exposure. Less educated women and men are more likely to be exposed to the radio than to other media, but even then, only one in three women and two in five men with no education listen to the radio daily. The lower level of exposure to the media among uneducated women and men, who are also more likely to be poor, may be because they cannot afford radios, televisions, and newspapers. Respondents’ Characteristics and Status * 31 Table 3.4.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio every day, by background characteristics, Nepal 2001 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio every day All three media No media Number of women Age 15-19 10.3 21.9 41.8 3.8 48.2 941 20-24 9.6 25.2 40.3 4.7 48.8 1,658 25-29 7.9 23.4 36.6 4.4 52.4 1,666 30-34 8.0 23.8 40.9 5.0 49.0 1,427 35-39 4.7 21.9 36.1 2.5 53.6 1,168 40-44 3.9 22.1 35.8 2.3 53.9 1,030 45-49 3.9 22.0 38.6 3.0 52.5 837 Residence Urban 28.0 76.5 50.3 17.2 14.3 841 Rural 5.0 17.5 37.4 2.4 55.0 7,885 Ecological zone Mountain 2.4 4.4 33.6 1.2 64.8 602 Hill 8.8 17.2 48.3 4.3 46.1 3,615 Terai 6.5 30.5 31.5 3.8 53.2 4,509 Development region Eastern 9.2 35.7 48.3 5.5 38.6 2,098 Central 8.0 26.1 28.5 4.7 57.7 2,804 Western 7.7 20.2 46.1 3.3 45.1 1,771 Mid-western 4.9 8.9 41.0 2.3 55.6 1,197 Far-western 2.0 8.9 29.2 0.6 65.6 855 Subregion Eastern Mountain 8.2 12.4 52.7 4.5 44.5 126 Central Mountain 1.8 5.1 33.2 0.8 64.3 209 Western Mountain 0.2 0.2 24.8 0.0 74.7 267 Eastern Hill 7.4 16.9 52.3 2.3 42.5 580 Central Hill 17.8 35.8 49.5 10.9 37.9 945 Western Hill 8.5 15.9 58.8 3.3 36.7 1,075 Mid-western Hill 2.4 1.5 38.5 0.6 61.4 648 Far-western Hill 0.7 1.0 25.9 0.0 73.0 368 Eastern Terai 10.1 45.7 46.2 6.9 36.4 1,393 Central Terai 3.2 23.2 15.9 1.6 68.2 1,651 Western Terai 6.5 26.9 26.5 3.2 58.2 696 Mid-western Terai 9.8 22.0 49.8 5.2 40.9 438 Far-western Terai 4.1 21.7 33.7 1.5 54.6 331 Education No education 0.7 14.5 30.9 0.2 61.7 6,279 Primary 9.4 33.2 50.3 4.7 34.5 1,294 Some secondary 32.1 55.0 64.9 17.0 14.0 814 SLC and above 60.5 68.7 73.8 35.8 5.2 339 Total 7.2 23.2 38.6 3.9 51.0 8,726 SLC = School Leaving Certificate 32 * Respondents’ Characteristics and Status Table 3.4.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio every day, by background characteristics, Nepal 2001 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio every day All three media No media Number of men Age 15-19 22.1 34.7 50.7 10.3 31.5 70 20-24 31.9 45.7 63.3 17.8 20.8 295 25-29 32.9 38.9 56.1 12.9 25.7 340 30-34 27.0 36.4 52.3 16.0 33.8 344 35-39 28.7 32.7 54.7 13.3 34.0 322 40-44 24.6 28.9 51.5 12.9 36.9 261 45-49 21.5 33.8 54.8 14.3 33.2 243 50-54 17.8 24.9 49.5 8.4 41.5 216 55-59 12.2 19.4 55.2 7.5 38.2 171 Residence Urban 62.3 78.6 62.3 40.6 7.9 227 Rural 21.7 28.9 53.9 10.3 34.9 2,034 Ecological zone Mountain 14.4 7.0 48.6 4.2 48.2 151 Hill 26.5 24.5 64.2 13.5 29.0 896 Terai 26.6 44.1 48.4 14.3 32.6 1,214 Development region Eastern 28.3 44.1 54.3 15.3 29.2 583 Central 25.3 45.4 53.5 15.4 28.1 750 Western 30.3 25.7 56.1 14.6 34.0 436 Mid-western 20.6 9.9 57.6 6.5 39.7 295 Far-western 17.5 13.5 53.4 6.8 41.9 197 Subregion Eastern Mountain 19.8 10.5 45.3 7.0 51.2 33 Central Mountain 16.2 12.0 63.2 6.8 32.5 59 Western Mountain 9.6 0.0 35.6 0.0 62.5 59 Eastern Hill 22.1 22.8 64.2 10.9 32.1 161 Central Hill 34.1 45.8 69.3 22.0 17.3 278 Western Hill 33.3 20.1 63.2 14.8 29.7 235 Mid-western Hill 13.9 3.8 59.6 3.8 40.4 143 Far-western Hill 11.9 4.3 58.2 3.0 40.5 80 Eastern Terai 31.6 55.8 50.9 17.8 26.1 389 Central Terai 20.7 50.0 41.5 12.2 34.7 413 Western Terai 26.8 32.2 47.8 14.3 38.9 201 Mid-western Terai 28.9 19.0 60.6 11.0 33.8 126 Far-western Terai 28.1 27.3 54.5 13.0 35.9 85 Education No education 3.2 19.1 39.4 1.1 50.9 852 Primary 16.4 30.1 54.4 7.1 32.1 670 Some secondary 47.8 44.2 67.9 23.1 15.4 452 SLC and above 79.6 70.2 80.1 48.8 3.7 287 Total 25.8 33.9 54.7 13.3 32.2 2,261 SLC = School Leaving Certificate Respondents’ Characteristics and Status * 33 3.5 EMPLOYMENT STATUS In the 2001 NDHS, respondents were asked a number of questions about employment, including whether they were currently working, and, if not, whether they had worked during the 12 months before the survey. Those who were currently working were then asked a number of questions about the kind of work they were doing and whether they were paid in cash. Women who earned cash for their work were asked who made the decision about how their earnings were used. Table 3.5.1 and Figure 3.1 show current employment status by background characteristics of women. Eighty-three percent of women were working at the time of the survey, 1 percent were not currently employed but had worked in the 12 months prior to the survey, and 16 percent had not worked in the 12 months prior to the survey. The percentage currently employed rises with age from 71 percent among women age 15-19 to 89 percent among women age 40-49. Currently married women are less likely to be currently employed than women who are divorced, separated, or widowed. The proportion of women currently employed increases with the number of living children they have. Current employment is much higher among rural women than among urban women (86 percent and 55 percent, respectively). The proportion of women who are currently working is higher in the mountain ecological zone than in the terai and hill zones. The proportion of women currently employed is much higher in the Far-western development region than in the other regions. A similar pattern was observed in the 1996 NFHS. In a relatively less industrialized country like Nepal, education is no guarantee for employment. As observed in the 1996 NFHS, the 2001 NDHS also shows that the percentage of women currently employed decreases with the level of education. For example, 87 percent of women with no education are currently employed, compared with 56 percent of women with an SLC. This is perhaps because employment opportunities are limited in the service sector, where most educated persons seek employment, or because more educated women are wealthier and do not have to work. Table 3.5.2 shows employment information for men. Ninety-seven percent of men were working at the time of the survey, 1 percent worked in the 12 months prior to the survey, and 2 percent had not worked in the 12 months preceding the survey. Current employment is lowest among men age 15-19 because a relatively high percentage of men in this age group are still studying (11 percent). There is no difference in the employment status of men in the urban and rural areas. Similarly, there is hardly any difference in the employment status of men by ecological zone, development region, and subregion, with the exception the Western hills, where 8 percent of the men were not employed at the time of the survey. Unlike women, ever-married men are equally likely to be employed, regardless of their educational attainment. 34 * Respondents’ Characteristics and Status Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Nepal 2001 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Total Number of women Age 15-19 71.0 0.8 28.1 100.0 941 20-24 74.2 1.8 24.0 100.0 1,658 25-29 83.1 1.5 15.5 100.0 1,666 30-34 88.3 1.0 10.7 100.0 1,427 35-39 88.0 1.2 10.8 100.0 1,168 40-44 89.1 0.7 10.1 100.0 1,030 45-49 88.7 1.0 10.3 100.0 837 Marital status Married 82.5 1.2 16.3 100.0 8,342 Divorced/separated/widowed 91.5 1.5 7.1 100.0 384 Number of living children 0 73.9 1.3 24.8 100.0 1,051 1-2 78.5 1.5 20.0 100.0 3,101 3-4 86.3 0.9 12.8 100.0 3,016 5+ 91.0 1.1 7.9 100.0 1,557 Residence Urban 55.4 2.4 42.2 100.0 841 Rural 85.8 1.1 13.1 100.0 7,885 Ecological zone Mountain 97.1 0.7 2.2 100.0 602 Hill 92.0 1.1 7.0 100.0 3,615 Terai 73.7 1.4 25.0 100.0 4,509 Development region Eastern 78.6 1.6 19.8 100.0 2,098 Central 74.8 1.3 23.9 100.0 2,804 Western 88.1 1.5 10.4 100.0 1,771 Mid-western 90.6 0.6 8.8 100.0 1,197 Far-western 98.0 0.2 1.8 100.0 855 Subregion Eastern Mountain 94.2 0.6 5.2 100.0 126 Central Mountain 96.2 0.5 3.3 100.0 209 Western Mountain 99.1 0.9 0.0 100.0 267 Eastern Hill 96.6 0.2 3.2 100.0 580 Central Hill 83.7 1.7 14.6 100.0 945 Western Hill 89.9 1.8 8.2 100.0 1,075 Mid-western Hill 98.7 0.3 1.0 100.0 648 Far-western Hill 99.8 0.2 0.0 100.0 368 Eastern Terai 69.7 2.3 28.0 100.0 1,393 Central Terai 67.1 1.1 31.8 100.0 1,651 Western Terai 85.3 0.9 13.8 100.0 696 Mid-western Terai 76.6 0.8 22.6 100.0 438 Far-western Terai 95.0 0.3 4.7 100.0 331 Education No education 86.6 1.1 12.4 100.0 6,279 Primary 79.9 1.1 19.0 100.0 1,294 Some secondary 70.3 1.8 27.9 100.0 814 SLC and above 55.9 2.7 41.4 100.0 339 Total 82.9 1.2 15.9 100.0 8,726 SLC = School Leaving Certificate Respondents’ Characteristics and Status * 35 Table 3.5.2 Employment status : men Percent distribution of men by employment status, and if not employed, their main activity during the 12 months preceding the survey, according to background characteristics, Nepal 2001 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Going to school/ studying Looking for work Inactive Could not work/ handicapped Other Total Number of men Age 15-19 89.1 0.0 10.9 0.0 0.0 0.0 0.0 100.0 70 20-24 95.7 1.3 2.9 0.0 0.0 0.0 0.1 100.0 295 25-29 97.7 1.1 0.0 0.8 0.4 0.0 0.0 100.0 340 30-34 97.9 0.8 0.0 0.0 0.4 0.6 0.4 100.0 344 35-39 97.9 1.9 0.0 0.0 0.2 0.0 0.0 100.0 322 40-44 98.7 0.4 0.0 0.0 0.0 0.9 0.0 100.0 261 45-49 95.8 1.4 0.0 0.6 0.4 1.9 0.0 100.0 243 50-54 95.2 2.4 0.0 0.0 0.4 2.0 0.0 100.0 216 55-59 93.4 1.0 0.0 0.0 2.0 3.6 0.0 100.0 171 Residence Urban 96.6 1.5 0.3 0.0 1.1 0.4 0.1 100.0 227 Rural 96.6 1.2 0.8 0.2 0.3 0.9 0.1 100.0 2,034 Ecological zone Mountain 97.2 0.5 1.0 0.0 0.3 1.0 0.0 100.0 151 Hill 96.2 1.7 0.7 0.3 0.3 0.8 0.0 100.0 896 Terai 96.8 1.0 0.7 0.1 0.4 0.9 0.1 100.0 1,214 Development region Eastern 96.5 1.6 0.2 0.2 0.8 0.5 0.2 100.0 583 Central 97.4 0.3 0.7 0.2 0.1 1.3 0.0 100.0 750 Western 94.9 3.3 0.5 0.3 0.3 0.8 0.0 100.0 436 Mid-western 97.1 0.3 1.6 0.0 0.3 0.7 0.0 100.0 295 Far-western 96.8 0.5 1.4 0.0 0.3 0.8 0.2 100.0 197 Subregion Eastern Mountain 95.3 2.3 0.0 0.0 1.2 1.2 0.0 100.0 33 Central Mountain 97.4 0.0 1.7 0.0 0.0 0.9 0.0 100.0 59 Western Mountain 98.1 0.0 1.0 0.0 0.0 1.0 0.0 100.0 59 Eastern Hill 98.6 0.7 0.7 0.0 0.0 0.0 0.0 100.0 161 Central Hill 98.4 0.3 0.0 0.5 0.3 0.5 0.0 100.0 278 Western Hill 91.7 5.6 0.0 0.6 0.6 1.5 0.0 100.0 235 Mid-western Hill 96.2 0.0 2.7 0.0 0.0 1.1 0.0 100.0 143 Far-western Hill 97.0 0.0 1.5 0.0 0.8 0.8 0.0 100.0 80 Eastern Terai 95.7 1.9 0.0 0.3 1.1 0.6 0.3 100.0 389 Central Terai 96.7 0.4 1.1 0.0 0.0 1.9 0.0 100.0 413 Western Terai 98.5 0.5 1.0 0.0 0.0 0.0 0.0 100.0 201 Mid-western Terai 98.0 0.7 0.7 0.0 0.7 0.0 0.0 100.0 126 Far-western Terai 96.0 1.2 1.2 0.0 0.0 1.2 0.4 100.0 85 Education No education 96.7 1.2 0.0 0.0 0.4 1.7 0.0 100.0 852 Primary 98.1 0.9 0.1 0.2 0.0 0.8 0.0 100.0 670 Some secondary 94.7 2.2 2.2 0.0 0.9 0.0 0.1 100.0 452 SLC and above 95.5 0.8 2.1 0.9 0.3 0.0 0.4 100.0 287 Total 96.6 1.2 0.7 0.2 0.4 0.9 0.1 100.0 2,261 SLC = School Leaving Certificate 36 * Respondents’ Characteristics and Status Figure 3.1 Employment Status of Women Age 15-49 Nepal 2001 Currently employed 83% Not currently employed, but worked in last 12 months 1% Did not work in last 12 months 16% 3.6 OCCUPATION Tables 3.6.1 and 3.6.2 show data on employed women and men by their current occupation according to background characteristics. Agriculture is the dominant sector of the economy of Nepal. More women than men are involved in this sector (91 percent and 64 percent, respectively). The proportion of women in agricultural occupations reported in the 2001 NDHS is exactly the same as that found in the 1991 Census (Central Bureau of Statistics, 1991) and the 1996 NFHS. Four percent of employed women are in sales or service occupations. Men have more opportunities in the nonagricultural sector, thus reducing their involvement in the agricultural sector. Eleven percent of working men are involved in professional, technical, managerial, or clerical occupations. Nine percent of men are involved in the sales and service sector, while another 9 percent work at skilled manual jobs. As expected, rural women are more likely than urban women to be employed in the agricultural sector: 94 percent of rural women compared with 48 percent of urban women. The pattern is similar for men, with 70 percent of rural working men employed in the agricultural sector, compared with only 18 percent of urban men. About one-fifth of urban working women are in sales and services and 15 percent are in skilled manual occupations. Some 33 percent of working men in the urban areas are involved in the sales and service sector, compared with only 6 percent in the rural areas. Respondents living in the mountain ecological zone are slightly more likely to be working in the agricultural sector than those in the hill and terai zones. The highest proportion of women (one in four) engaged in the nonagricultural sector is in the Central hill subregion. This is not surprising since Kathmandu, the capital and largest urban center, is located there. There has been a slight increase in the proportion of women involved in the nonagricultural sector when compared with data from the 1996 NFHS. Respondents’ Characteristics and Status * 37 Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Nepal 2001 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Total Number of women Age 15-19 1.2 0.2 1.9 2.1 0.4 94.1 100.0 676 20-24 1.8 0.6 4.5 2.5 0.3 90.3 100.0 1,260 25-29 2.0 0.1 4.5 3.0 0.4 89.9 100.0 1,408 30-34 2.5 0.6 5.4 2.4 0.8 88.3 100.0 1,274 35-39 1.1 0.7 3.7 2.2 0.5 91.7 100.0 1,041 40-44 1.7 0.3 4.9 1.6 0.8 90.8 100.0 926 45-49 0.7 0.4 4.7 1.1 0.0 92.9 100.0 750 Marital status Married 1.7 0.4 4.2 2.2 0.4 91.1 100.0 6,979 Divorced/separated/ widowed 2.6 1.2 6.7 2.6 1.8 85.2 100.0 357 Number of living children 0 2.1 0.3 3.3 3.1 0.2 90.9 100.0 790 1-2 2.7 0.4 5.0 3.1 0.5 88.2 100.0 2,481 3-4 1.4 0.4 4.7 1.8 0.4 91.2 100.0 2,631 5+ 0.4 0.3 3.2 1.0 0.7 94.4 100.0 1,434 Residence Urban 8.7 3.8 21.4 14.8 3.2 47.7 100.0 486 Rural 1.2 0.2 3.2 1.3 0.3 93.8 100.0 6,850 Ecological zone Mountain 0.4 0.2 3.0 0.5 0.0 96.0 100.0 589 Hill 1.7 0.4 4.2 3.1 0.4 90.1 100.0 3,364 Terai 2.0 0.4 4.7 1.7 0.6 90.5 100.0 3,383 Development region Eastern 1.8 0.5 6.0 2.4 0.9 88.4 100.0 1,683 Central 1.9 0.8 5.5 4.2 0.4 87.2 100.0 2,135 Western 1.9 0.2 4.2 1.1 0.6 92.0 100.0 1,587 Mid-western 1.8 0.1 2.7 1.0 0.2 94.2 100.0 1,092 Far-western 0.4 0.1 0.9 0.8 0.1 97.6 100.0 840 Subregion Eastern Mountain 0.6 0.3 10.9 0.3 0.0 87.9 100.0 119 Central Mountain 0.5 0.3 1.8 0.0 0.0 97.4 100.0 202 Western Mountain 0.2 0.0 0.4 0.9 0.0 98.5 100.0 267 Eastern Hill 0.4 0.0 1.6 2.8 0.0 95.3 100.0 561 Central Hill 3.6 1.7 8.1 8.8 1.0 76.8 100.0 807 Western Hill 2.3 0.1 5.3 1.5 0.6 90.1 100.0 987 Mid-western Hill 0.4 0.0 1.8 0.3 0.0 97.6 100.0 641 Far-western Hill 0.1 0.0 1.0 0.1 0.2 98.6 100.0 368 Eastern Terai 2.8 0.7 7.8 2.4 1.5 84.6 100.0 1,003 Central Terai 0.9 0.3 4.3 1.6 0.0 92.9 100.0 1,126 Western Terai 1.2 0.3 2.3 0.4 0.5 95.2 100.0 600 Mid-western Terai 5.2 0.2 4.8 2.6 0.5 86.4 100.0 339 Far-western Terai 0.9 0.2 1.2 1.3 0.2 96.3 100.0 315 Education No education 0.4 0.3 2.9 1.3 0.6 94.5 100.0 5,502 Primary 1.0 0.4 5.6 3.9 0.3 88.8 100.0 1,047 Some secondary 4.6 1.1 13.4 6.5 0.1 74.2 100.0 587 SLC and above 33.2 2.0 11.7 5.2 0.0 47.5 100.0 199 Total 1.7 0.4 4.4 2.2 0.5 90.8 100.0 7,336 SLC = School Leaving Certificate 38 * Respondents’ Characteristics and Status Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Nepal 2001 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Don't know/ missing Total Number of men Age 15-19 0.0 0.0 9.3 23.0 13.2 53.6 0.9 100.0 62 20-24 3.2 5.3 8.3 12.7 11.6 58.9 0.0 100.0 286 25-29 4.9 6.3 9.3 10.6 9.5 59.3 0.0 100.0 336 30-34 7.1 5.1 12.2 7.8 6.8 61.1 0.0 100.0 340 35-39 7.3 6.8 9.3 8.3 6.6 61.7 0.0 100.0 321 40-44 7.1 6.8 7.9 7.9 6.1 64.2 0.0 100.0 258 45-49 7.8 1.5 8.1 8.1 6.6 67.9 0.0 100.0 236 50-54 4.5 4.5 6.5 4.8 3.8 75.9 0.0 100.0 211 55-59 4.1 0.6 6.4 7.1 1.3 80.6 0.0 100.0 161 Marital status Married 5.9 4.9 8.8 9.0 7.1 64.2 0.0 100.0 2,151 Divorced/separated/ widowed 0.0 2.5 9.7 9.4 8.9 69.5 0.0 100.0 60 Number of living children 0 2.2 4.6 8.0 11.1 7.2 66.8 0.2 100.0 372 1-2 6.2 5.3 9.8 11.7 8.6 58.4 0.0 100.0 784 3-4 7.3 5.1 8.9 6.7 6.3 65.7 0.0 100.0 727 5+ 4.8 3.3 7.4 5.8 5.9 72.8 0.0 100.0 330 Residence Urban 14.8 14.3 33.0 12.8 7.4 17.7 0.0 100.0 223 Rural 4.7 3.8 6.2 8.6 7.2 69.6 0.0 100.0 1,989 Ecological zone Mountain 4.2 2.0 6.6 10.5 3.1 73.2 0.4 100.0 147 Hill 6.7 5.6 7.6 10.5 5.1 64.4 0.0 100.0 877 Terai 5.1 4.6 10.0 7.8 9.2 63.2 0.0 100.0 1,187 Development region Eastern 6.7 4.6 9.7 9.1 9.9 59.9 0.0 100.0 572 Central 5.1 5.4 11.6 11.3 4.9 61.7 0.0 100.0 733 Western 5.6 5.8 8.0 8.5 10.1 62.0 0.0 100.0 428 Mid-western 6.2 1.9 4.8 4.9 5.3 76.8 0.2 100.0 287 Far-western 4.3 5.5 3.7 7.6 4.4 74.4 0.0 100.0 192 Sub-region Eastern Mountain 4.8 6.0 15.5 6.0 6.0 61.9 0.0 100.0 32 Central Mountain 5.3 0.9 5.3 17.5 3.5 67.5 0.0 100.0 58 Western Mountain 2.9 1.0 2.9 5.9 1.0 85.3 1.0 100.0 57 Eastern Hill 5.3 2.1 3.4 7.6 2.8 78.9 0.0 100.0 160 Central Hill 9.0 10.0 13.6 11.5 2.8 53.1 0.0 100.0 274 Western Hill 8.3 6.9 7.7 13.5 10.8 52.7 0.0 100.0 229 Mid-western Hill 3.5 0.0 3.5 7.5 4.7 80.9 0.0 100.0 137 Far-western Hill 2.9 3.1 2.3 9.9 2.6 79.1 0.0 100.0 78 Eastern Terai 7.5 5.6 11.9 10.0 13.2 51.8 0.0 100.0 380 Central Terai 2.4 2.9 11.2 10.3 6.5 66.7 0.0 100.0 401 Western Terai 2.5 4.5 8.3 2.8 9.3 72.6 0.0 100.0 199 Mid-western Terai 9.5 4.3 6.8 2.7 6.6 70.1 0.0 100.0 124 Far-western Terai 6.6 9.3 4.9 4.9 7.8 66.4 0.0 100.0 82 Education No education 0.5 3.8 4.4 8.7 8.0 74.6 0.0 100.0 834 Primary 0.8 4.1 7.8 11.7 9.7 65.9 0.0 100.0 663 Some secondary 2.7 8.2 13.4 7.4 5.1 63.1 0.1 100.0 438 SLC and above 37.7 4.5 17.7 6.4 2.0 31.7 0.0 100.0 276 Total 5.7 4.8 8.9 9.1 7.2 64.4 0.0 100.0 2,211 SLC = School Leaving Certificate Respondents’ Characteristics and Status * 39 It is clear that education influences the type of occupation. As one becomes more educated, employment opportunities in the nonagricultural sector increase. Among employed women who have passed their SLC, 35 percent are involved in professional or clerical occupations, and 12 percent are engaged in sales and services. Similarly, among men who have passed at least their SLC, 42 percent are involved in professional or clerical occupations and 18 percent are engaged in sales and services. 3.7 TYPE OF EMPLOYMENT Although employment is assumed to go hand in hand with payment, not all women and men who work get paid. Tables 3.7.1 and 3.7.2 show the type of employment for women and men. Among employed women, 71 percent are not paid (Figure 3.2). This is more common among women who work in the agricultural sector (77 percent). Only 15 percent of employed women receive cash earnings (including women who are paid in cash and in-kind). Among employed men, 43 percent are not paid; this is mostly true in the agricultural sector (64 percent). Forty-two percent of men receive cash for their work. Table 3.7.1 Type of employment: women Percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Nepal 2001 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 2.3 80.4 9.5 Cash and in-kind 5.0 4.5 5.0 In-kind only 15.7 1.8 14.4 Not paid 77.0 13.3 71.1 Total 100.0 100.0 100.0 Type of employer Employed by family member 53.5 15.8 50.1 Employed by nonfamily member 15.1 37.5 17.2 Self-employed 31.4 46.7 32.8 Total 100.0 100.0 100.0 Continuity of employment All year 77.0 84.9 77.7 Seasonal 20.9 6.2 19.6 Occasional 2.0 8.9 2.7 Total 100.0 100.0 100.0 Number of women 6,658 674 7,336 Note: Total includes 3 women with missing information on type of employment who are not shown separately. 40 * Respondents’ Characteristics and Status There has been some change in the type of employment women are involved in over the last five years. A comparison of data collected in the 1996 NFHS and 2001 NDHS shows that more women are self-employed now than five years ago (33 percent in 2001 compared with only 7 percent in 1996). Similarly, the proportion of women working for a nonfamily member has increased to 17 percent compared with only 9 percent in 1996. The proportion of women working for a family member has dropped from 84 percent in 1996 to 50 percent in 2001. This probably indicates that women have more options to go beyond family work in more recent years. More than three-quarters of employed women work all year, while 20 percent work seasonally. As expected, agricultural work is more likely to be seasonal than nonagricultural work. Table 3.7.2 Type of employment: men Percent distribution of men employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or nonagricultural), Nepal 2001 Type of earnings Agricultural work Nonagricultural work Total Cash only 4.5 85.4 33.3 Cash and in-kind 8.1 9.8 8.7 In-kind only 23.1 1.1 15.2 Not paid 64.3 3.7 42.7 Total 100.0 100.0 100.0 Number of men 1,423 788 2,211 Note: Total includes 1 man with missing information on type of employment who is not shown separately. Figure 3.2 Type of Earnings of Employed Women Age 15-49 Nepal 2001 Not paid 71% Cash only 10% Cash and in-kind 5% In-kind only 14% Respondents’ Characteristics and Status * 41 3.8 DECISION ON USE OF EARNINGS Access to income alone does not say much about the autonomy of women. They should be able to have control over their income. Employed women who earn cash for their work were asked about who primarily makes decisions on the use of their earnings. Table 3.8 shows that 43 percent of women who earn cash are solely responsible for decisions on the use of their earnings, while 36 percent of women report that they along with their husband or someone else jointly decide how the money should be spent. One in five women stated that they have no say in how their earnings are spent. The majority of women in this category are young women age 15-19. Being the sole decisionmaker rises with age. Married women are equally likely to decide on their own or jointly with their husband or someone else as to how their earnings are spent. On the other hand, women who are not currently married are the most likely to make their own decisions about spending their earnings. Urban women have more control over their income than rural women. For example, 58 percent of urban women make their own decisions, compared with only 39 percent of rural women. Women living in the hill ecological zone and those residing in the Central region have more autonomy over their earnings than women residing in the other regions. There are only slight differences in decisionmaking by educational level of women. Information on the contribution of the respondent’s income to the household expenditure was also gathered in the 2001 NDHS. It is expected that employment and earnings are more likely to empower women if their earnings are important for meeting the needs of their household. However, the income of women is often so small that it can barely meet household needs. Table 3.9 shows that the earnings of very young women (age 15-19) are less likely to contribute to a major share of household expenditures than those of older women (20-39 and 45-49). Not surprisingly, women who are divorced, separated, or widowed tend to contribute a major portion of household expenditure. As women’s level of education increases, their contribution to the household expenditure also increases. In general, men’s contribution to household expenditure is higher than that of women presumably because men are more likely to be employed for cash and usually earn more than women. 42 * Respondents’ Characteristics and Status Table 3.8 Decision on use of earnings Percent distribution of women who received cash earnings for work in the 12 months preceding the survey by person who decides how earnings are to be used, according to background characteristics, Nepal 2001 Person who decides how earnings are used Background characteristic Self only Jointly1 Someone else only2 Total Number of women Age 15-19 25.4 18.3 56.3 100.0 57 20-24 36.7 35.4 27.8 100.0 173 25-29 40.7 35.8 23.5 100.0 213 30-34 40.6 40.7 18.8 100.0 221 35-39 47.8 36.6 15.7 100.0 139 40-44 54.6 31.5 13.9 100.0 160 45-49 50.6 38.3 11.1 100.0 98 Marital status Married 38.8 38.4 22.8 100.0 968 Divorced/separated/widowed 88.2 5.6 6.2 100.0 93 Number of living children 0 39.2 28.4 32.4 100.0 104 1-2 42.9 32.5 24.6 100.0 414 3-4 45.6 39.6 14.9 100.0 382 5+ 40.4 38.3 21.3 100.0 161 Residence Urban 57.8 29.1 13.1 100.0 251 Rural 38.6 37.5 23.9 100.0 810 Ecological zone Mountain 30.0 54.9 15.1 100.0 33 Hill 46.0 31.3 22.7 100.0 452 Terai 41.6 37.7 20.7 100.0 577 Development region Eastern 44.0 38.1 17.9 100.0 367 Central 53.0 28.7 18.4 100.0 303 Western 40.0 33.1 26.9 100.0 246 Mid-western 22.3 47.2 30.5 100.0 113 Far-western 37.6 47.4 15.1 100.0 32 Education No education 41.7 34.6 23.8 100.0 664 Primary 43.3 34.5 22.2 100.0 162 Some secondary 46.8 37.8 15.4 100.0 137 SLC and above 47.5 40.4 12.1 100.0 98 Total 43.1 35.5 21.4 100.0 1,061 SLC = School Leaving Certificate 1 With husband or someone else 2 Includes husband Respondents’ Characteristics and Status * 43 Table 3.9 Contribution of earnings to household expenditures Percent distribution of women and men who received cash earnings for work in the 12 months preceding the survey by proportion of household expenditures met by earnings, according to background characteristics, Nepal 2001 Women Men Background characteristic Almost none/ none Less than half Half or more All Missing Total Number of women Almost none/ none Less than half Half or more All Total Number of men Age 15-19 29.7 30.0 25.4 15.0 0.0 100.0 57 (0.0) (14.5) (36.1) (49.4) 100.0 29 20-24 11.9 33.7 35.1 18.9 0.5 100.0 173 0.7 10.2 45.6 43.5 100.0 126 25-29 8.9 40.1 30.4 20.6 0.0 100.0 213 0.2 11.1 42.1 46.6 100.0 162 30-34 10.9 33.2 38.8 17.1 0.0 100.0 221 0.2 7.3 46.3 46.2 100.0 160 35-39 10.6 25.2 41.3 22.5 0.4 100.0 139 1.5 11.2 44.3 43.0 100.0 143 40-44 3.9 45.7 31.1 19.3 0.0 100.0 160 1.2 10.3 53.6 34.9 100.0 114 45-49 8.1 41.4 29.4 21.1 0.0 100.0 98 1.2 10.5 46.2 42.2 100.0 90 50-54 na na na na na na na 2.1 15.9 54.2 27.9 100.0 62 55-59 na na na na na na na (0.0) (13.6) (43.7) (42.6) 100.0 42 Marital status Married 10.7 36.8 34.4 18.1 0.1 100.0 968 0.8 10.6 46.8 41.8 100.0 908 Divorced/separated/ widowed 6.7 29.0 30.9 32.9 0.6 100.0 93 * * * * 100.0 22 Number of living children 0 20.9 32.0 27.6 19.5 0.0 100.0 104 0.9 17.9 44.3 36.8 100.0 142 1-2 11.6 33.0 34.8 20.3 0.2 100.0 414 0.4 9.4 39.8 50.5 100.0 376 3-4 7.7 36.0 36.5 19.7 0.1 100.0 382 1.2 9.1 52.0 37.7 100.0 303 5+ 6.4 46.9 30.6 16.1 0.0 100.0 161 1.2 10.2 54.3 34.3 100.0 109 Residence Urban 11.1 28.1 38.1 22.4 0.3 100.0 251 1.4 9.4 34.7 54.6 100.0 180 Rural 10.1 38.6 32.8 18.5 0.1 100.0 810 0.7 11.0 48.9 39.4 100.0 750 Ecological zone Mountain 4.4 22.1 28.3 45.3 0.0 100.0 33 2.8 9.5 51.9 35.8 100.0 41 Hill 8.6 33.4 38.5 19.3 0.2 100.0 452 1.3 13.2 46.5 39.0 100.0 340 Terai 12.0 39.0 30.9 18.0 0.1 100.0 577 0.3 9.3 45.5 44.8 100.0 549 Development region Eastern 11.4 37.7 32.5 18.4 0.0 100.0 367 0.8 14.0 52.0 33.2 100.0 291 Central 12.8 31.0 36.0 20.0 0.3 100.0 303 0.5 8.7 35.7 55.1 100.0 344 Western 8.1 46.0 32.7 13.3 0.0 100.0 246 1.8 11.1 54.7 32.4 100.0 181 Mid-western 4.9 20.7 39.4 34.9 0.0 100.0 113 0.0 8.5 50.4 41.0 100.0 66 Far-western 12.0 44.3 25.2 16.8 1.6 100.0 32 0.0 6.4 47.8 45.8 100.0 48 Education No education 9.9 42.7 32.1 15.3 0.1 100.0 664 0.9 9.9 51.8 37.4 100.0 303 Primary 7.9 29.0 38.1 24.9 0.0 100.0 162 1.0 9.5 50.5 39.0 100.0 260 Some secondary 14.3 22.1 35.8 27.2 0.6 100.0 137 0.8 13.3 41.4 44.5 100.0 169 SLC and above 11.7 22.6 38.4 27.3 0.0 100.0 98 0.5 11.3 35.9 52.3 100.0 198 Total 10.3 36.1 34.1 19.4 0.1 100.0 1,061 0.8 10.7 46.2 42.3 100.0 930 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable SLC = School Leaving Certificate 44 * Respondents’ Characteristics and Status Table 3.10 shows the percent distribution of currently married women who receive cash earnings by the person who decides how their earnings are used, according to their contribution to household expenditures. The table shows that a woman’s autonomy over her earnings increases as their contribution to the household expenditures declines. For example, more than one in two women who contribute almost nothing toward household expenditure have sole autonomy over their earnings. On the other hand, women whose earnings constitute a larger proportion of household expenditures are also more likely to have their husband involved in the decisionmaking. For example, 46 percent of women whose earnings constitute all of the household expenditures make joint decisions with their husband. Table 3.10 Women's control over earnings Percent distribution of currently married women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to proportion of household expenditures met by earnings, Nepal 2001 Person who decides how earnings are used Contribution to household expenditures Self only Jointly with husband Jointly with someone else Husband only Someone else only Total Number of women Almost none/ none 54.1 17.0 2.1 15.1 11.8 100.0 103 Less than half 43.3 32.1 2.6 14.4 7.6 100.0 356 Half or more 33.9 42.4 1.4 16.8 5.5 100.0 333 All 30.1 46.0 1.2 17.6 5.1 100.0 175 Total 38.8 36.5 1.9 15.9 6.9 100.0 968 Note: Total includes 1 woman with missing information on contribution to household expenditures who is not shown separately 3.9 WOMEN’S EMPOWERMENT AND STATUS Women’s status has a direct effect on the health and nutritional status of women and children. Therefore, it is important to review information on the status of women in Nepal. Besides other indicators like educational attainment, type of employment, and control over income, the 2001 NDHS also reviewed indicators like decisionmaking within the household, women’s attitudes toward wife beating, and their attitudes about the ability of married women to refuse sex with their husband. Women who have a greater say in household decisionmaking, women who do not believe that a man is justified in beating his wife for any reason, and women who feel women should be able to refuse sex with their husband for any reason are relatively more empowered. Respondents’ Characteristics and Status * 45 HOUSEHOLD DECISIONMAKING To assess women’s weight in household decisionmaking, respondents were asked who in their family usually has the final say on five different types of decisions, namely, their own health care, large household purchases, daily household purchases, visits to family or relatives, and what food to cook each day. The percent distribution of women according to the person who usually has the final say in different decisions is shown in Table 3.11. The data are presented separately for women who are currently married and women who are divorced, separated, or widowed. With the exception of what food to cook, husbands in Nepal have a greater say in decisionmaking than wives. For example, one in two married women states that their husband alone has final say in making decisions about the wife’s health care. In general women have a much greater say in what food to cook each day since cooking is often perceived as women’s work, with little male involvement. The data also show that two in five married women state that their husband makes the sole decision on the purchase of large household items, while one in three states that they need their husband’s permission to visit family or relatives and to make daily household purchases. The table also shows that currently married women are much less likely to have a final say in any of the five types of decisions than women who are divorced, separated, or widowed. Even so, about one in four previously married women has someone else making decisions for them. Similar questions were posed to men in the 2001 NDHS. Men’s responses closely reflected the situation indicated by women’s responses (data not shown). Table 3.11 Women’s participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to current marital status and type of decision, Nepal 2001 Currently married Divorced/Separated/Widowed Decision Self only Jointly with husband Jointly with someone else Husband only Someone else only Decision not made/ not applicable Total Number of women Self only Jointly with someone else Someone else only Decision not made/ not applicable Total Number of women Own health care 13.4 12.1 1.8 51.0 21.1 0.5 100.0 8,342 65.6 5.9 27.7 0.8 100.0 384 Large household purchases 13.0 17.3 1.7 41.1 26.6 0.3 100.0 8,342 65.4 5.8 28.1 0.7 100.0 384 Daily household purchases 26.8 14.6 1.9 30.3 26.3 0.1 100.0 8,342 70.8 2.4 26.8 0.0 100.0 384 Visits to family or relatives 15.0 21.2 2.6 33.7 27.4 0.1 100.0 8,342 69.7 5.9 24.2 0.2 100.0 384 What food to cook each day 71.0 1.5 8.5 1.3 17.6 0.0 100.0 8,342 72.1 9.4 18.5 0.0 100.0 384 Table 3.12 shows how women’s participation in household decisions varies by background characteristics. Note that women are considered as participating in a decision if they make decisions alone or jointly with their husband or someone else. Only one in five women has a say in all five decisions, while 15 percent have no say in any of the five decisions (Figure 3.3). 46 * Respondents’ Characteristics and Status Table 3.12 Women's participation in decisionmaking by background characteristics Percentage of women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Nepal 2001 Alone or jointly have final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives What food to cook daily All specified decisions None of the specified decisions Number of women Age 15-19 7.4 7.9 10.6 10.4 50.7 2.8 46.1 941 20-24 20.3 20.0 28.1 26.0 70.1 11.3 25.7 1,658 25-29 30.2 32.8 45.5 40.0 83.8 19.4 12.7 1,666 30-34 31.9 40.1 54.1 46.4 88.7 22.4 8.5 1,427 35-39 38.0 46.3 59.4 53.3 94.1 28.6 3.5 1,168 40-44 38.9 47.7 60.1 55.3 92.0 29.4 4.3 1,030 45-49 41.1 46.9 58.4 56.8 87.2 27.8 5.8 837 Marital status Married 27.3 32.1 43.3 38.8 81.1 17.8 15.4 8,342 Divorced/separated/widowed 71.5 71.2 73.2 75.6 81.5 61.8 11.1 384 Number of living children 0 11.8 13.7 17.1 16.0 55.0 5.9 40.6 1,051 1-2 27.8 29.8 39.0 35.5 75.8 17.9 20.1 3,101 3-4 34.9 42.4 56.4 50.1 89.8 24.9 6.7 3,016 5+ 33.1 38.6 52.0 47.9 92.5 23.0 4.7 1,557 Residence Urban 39.8 46.2 60.7 52.0 86.1 26.1 8.2 841 Rural 28.2 32.5 42.9 39.2 80.6 19.1 15.9 7,885 Ecological zone Mountain 22.5 22.2 30.8 31.6 83.0 14.2 15.1 602 Hill 33.2 35.5 47.0 44.4 81.2 22.4 14.7 3,615 Terai 27.1 33.9 44.7 38.4 80.8 18.4 15.6 4,509 Development region Eastern 27.6 38.1 50.4 39.3 84.8 19.3 11.4 2,098 Central 30.3 32.2 41.8 41.6 82.0 20.1 14.7 2,804 Western 33.3 38.1 46.8 42.0 75.7 21.4 18.9 1,771 Mid-western 29.3 29.8 45.4 43.9 81.6 21.2 16.2 1,197 Far-western 21.7 25.2 34.3 31.2 79.7 14.5 17.1 855 Subregion Eastern Mountain 31.5 39.4 50.9 42.1 88.2 22.7 10.3 126 Central Mountain 28.4 19.7 26.6 34.4 82.8 13.4 14.7 209 Western Mountain 13.6 16.0 24.6 24.4 80.8 10.8 17.7 267 Eastern Hill 26.0 35.6 44.2 35.2 84.2 18.4 12.4 580 Central Hill 38.8 35.3 44.8 46.1 82.5 22.9 12.0 945 Western Hill 37.0 42.4 53.2 46.9 76.1 25.0 18.1 1,075 Mid-western Hill 30.7 30.0 48.2 51.5 86.3 23.8 12.7 648 Far-western Hill 23.1 25.4 36.3 34.6 78.9 17.6 18.5 368 Eastern Terai 28.0 38.9 53.0 40.7 84.7 19.4 11.1 1,393 Central Terai 25.7 32.0 42.1 40.0 81.5 19.3 16.3 1,651 Western Terai 27.4 31.3 36.8 34.3 75.1 15.9 20.2 696 Mid-western Terai 30.8 33.0 44.1 35.2 74.4 20.1 21.3 438 Far-western Terai 24.3 29.2 39.9 33.7 80.6 12.6 14.6 331 Education No education 29.0 33.4 44.3 40.9 83.3 19.8 13.3 6,279 Primary 28.8 32.5 43.3 38.8 75.1 19.7 20.7 1,294 Some secondary 28.1 33.8 45.3 37.0 73.6 17.9 22.0 814 SLC and above 39.6 46.4 54.9 46.0 81.0 23.7 12.5 339 Employment Not employed 23.1 29.6 38.6 31.9 77.1 15.2 20.3 1,496 Employed for cash 45.5 54.2 67.7 56.4 88.8 32.7 5.7 1,009 Employed not for cash 28.2 31.5 42.4 39.9 80.8 18.8 15.5 6,220 Total 29.3 33.8 44.7 40.4 81.1 19.8 15.2 8,726 Note: Total includes 2 women with missing information on employment who are not shown separately. SLC = School Leaving Certificate Respondents’ Characteristics and Status * 47 15 31 12 12 10 20 0 1 2 3 4 5 Number of decisions 0 10 20 30 40 Percent Figure 3.3 Distribution of Women by Number of Decisions in Which They Participate Nepal 2001 Women’s participation in household decisionmaking increases with age. As observed earlier, divorced, separated, and widowed women have a greater say in decisionmaking than currently married women. A woman’s involvement in decisionmaking also increases with the number of children she has, presumably because in Nepal having children confers a higher status on women. Urban women have a greater say in household decisionmaking than rural women. Twenty- six percent of women in urban areas participate in all of the specified decisions, compared with 19 percent of rural women. Women residing in the hill ecological zone also seem to have more say in household decisionmaking than women residing in the terai or mountain zones. Women residing in the Far-western development region are less likely than women residing in other regions to have decisionmaking input. Women’s education has a slight relationship to household decisionmaking. Women’s employment status is related to level of participation in household decisions. Women who are employed and earn cash have more say in household decisionmaking than women who do not work and women who work but do not earn cash income. ATTITUDE TOWARD WIFE BEATING The 2001 NDHS gathered information on women’s and men’s attitudes toward wife beating, another proxy for women’s status. Women and men were asked whether a husband would be justified in beating his wife in each of five scenarios: if she burns food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses sex with him. The first five columns in Tables 3.13.1 and 3.13.2 show how the acceptance of wife beating varies for each reason. The sixth column gives the percentages of women and men who feel a husband is justified in beating his wife for at least one of the given reasons. Note that “empowerment” decreases as the value of this indicator increases. This means, the more reasons agreed with, the lower the level of women’s empowerment according to this indicator. 48 * Respondents’ Characteristics and Status Table 3.13.1 Women's attitude toward wife beating Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Nepal 2001 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Percentage who agree with at least one specified reason Number of women Age 15-19 6.3 11.2 12.5 28.0 3.2 32.1 941 20-24 5.6 9.1 13.6 26.2 2.7 29.8 1,658 25-29 4.5 8.7 12.4 27.6 2.7 31.0 1,666 30-34 3.6 7.4 10.7 25.0 3.3 28.5 1,427 35-39 5.1 7.9 11.4 23.2 2.9 26.6 1,168 40-44 4.6 8.0 12.3 23.2 3.8 26.2 1,030 45-49 6.0 9.6 12.7 20.5 3.4 25.2 837 Marital status Married 5.0 8.6 12.1 25.1 3.0 28.7 8,342 Divorced/separated/widowed 6.3 10.5 14.7 25.8 4.3 30.0 384 Number of living children 0 6.9 11.1 13.4 26.9 3.5 31.0 1,051 1-2 4.5 8.2 12.1 26.3 2.6 29.7 3,101 3-4 4.8 8.5 12.4 25.0 3.3 28.6 3,016 5+ 5.2 8.7 11.4 22.1 3.3 25.8 1,557 Residence Urban 3.9 8.0 13.2 29.0 2.7 33.2 841 Rural 5.1 8.8 12.1 24.8 3.1 28.3 7,885 Ecological zone Mountain 2.9 5.2 13.4 26.8 1.9 29.3 602 Hill 1.9 4.6 8.8 22.1 1.6 25.0 3,615 Terai 7.8 12.5 14.8 27.5 4.4 31.7 4,509 Development region Eastern 4.1 7.2 12.7 25.9 2.0 29.8 2,098 Central 9.3 13.3 13.3 22.8 4.7 26.5 2,804 Western 3.8 5.9 8.4 20.3 2.9 23.6 1,771 Mid-western 1.2 5.8 11.8 36.5 3.0 38.7 1,197 Far-western 1.2 7.5 15.8 25.4 0.9 30.4 855 Subregion Eastern Mountain 2.1 5.2 12.1 24.8 0.9 27.3 126 Central Mountain 2.5 3.5 7.8 17.5 1.3 20.3 209 Western Mountain 3.5 6.5 18.4 35.0 2.8 37.4 267 Eastern Hill 1.1 2.3 6.3 15.4 0.6 18.1 580 Central Hill 3.7 5.3 10.6 22.2 2.6 25.0 945 Western Hill 1.9 4.3 5.1 16.5 1.4 19.1 1,075 Mid-western Hill 0.6 5.3 11.0 35.7 2.2 38.0 648 Far-western Hill 0.7 6.2 15.0 24.3 0.3 30.0 368 Eastern Terai 5.5 9.5 15.5 30.3 2.7 34.9 1,393 Central Terai 13.3 19.1 15.6 23.8 6.4 28.3 1,651 Western Terai 6.7 8.4 13.5 26.1 5.2 30.4 696 Mid-western Terai 0.6 5.5 11.9 35.1 3.4 37.4 438 Far-western Terai 1.7 10.6 14.8 26.0 1.8 30.9 331 Education No education 5.9 9.4 12.9 24.8 3.8 28.4 6,279 Primary 4.0 8.6 12.5 26.2 2.0 30.6 1,294 Some secondary 1.6 5.8 8.6 26.6 0.9 29.6 814 SLC and above 0.8 3.2 7.7 24.5 0.0 26.2 339 Employment Not employed 7.6 12.9 15.0 28.2 3.9 32.2 1,496 Employed for cash 4.7 8.4 13.7 27.6 3.0 31.6 1,009 Employed not for cash 4.4 7.8 11.4 24.0 2.9 27.5 6,220 Number of decisions in which woman has final say1 0 5.8 10.2 12.9 25.9 3.2 29.8 1,327 1-2 4.3 8.2 12.2 24.7 3.1 28.4 3,761 3-4 6.9 10.4 13.2 28.1 3.5 31.9 1,914 5 3.8 6.9 10.6 22.4 2.6 25.4 1,725 Total 5.0 8.7 12.2 25.2 3.1 28.8 8,726 Note: Total includes 2 women with missing information on employment who are not shown separately. SLC = School Leaving Certificate 1 Either by herself or jointly with others Respondents’ Characteristics and Status * 49 Table 3.13.2 Men's attitude toward wife beating Percentage of men who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Nepal 2001 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Percentage who agree with at least one specified reason Number of men Age 15-19 3.4 21.8 21.7 39.2 7.2 46.3 70 20-24 3.4 19.8 19.4 33.3 11.2 40.7 295 25-29 3.3 17.0 17.0 29.6 9.7 37.9 340 30-34 3.1 18.7 15.5 27.3 6.1 34.5 344 35-39 5.2 14.4 15.3 24.8 8.8 30.1 322 40-44 3.4 15.0 15.8 26.0 8.6 31.2 261 45-49 3.1 17.5 18.2 22.8 9.2 30.3 243 50-54 3.1 17.2 13.7 25.8 7.5 31.6 216 55-59 1.6 18.2 12.3 23.1 5.7 29.6 171 Marital status Married 3.4 17.3 16.3 27.3 8.5 34.1 2,198 Divorced/separated/widowed 3.1 18.1 16.0 27.9 6.1 33.7 63 Number of living children 0 3.1 17.6 16.7 28.9 9.3 36.6 392 1-2 4.2 17.6 15.8 27.3 7.5 34.0 793 3-4 3.5 17.5 17.5 28.0 9.2 34.6 740 5+ 1.9 16.1 14.8 24.4 8.1 30.2 336 Residence Urban 0.6 11.1 10.2 20.0 5.1 25.5 227 Rural 3.7 18.0 17.0 28.2 8.8 35.0 2,034 Ecological zone Mountain 5.0 22.6 20.5 31.5 14.5 38.7 151 Hill 2.6 15.5 13.9 27.1 6.1 33.6 896 Terai 3.8 18.0 17.6 27.0 9.5 33.9 1,214 Development region Eastern 2.3 22.1 18.8 26.1 9.0 35.0 583 Central 2.3 11.2 9.8 17.3 4.1 21.1 750 Western 4.7 14.7 17.0 29.6 8.3 35.7 436 Mid-western 5.5 23.0 22.6 40.4 12.1 49.4 295 Far-western 4.9 24.2 23.2 44.7 18.1 54.2 197 Subregion Eastern Mountain 1.2 14.0 16.3 24.4 7.0 30.2 33 Central Mountain 1.7 4.3 6.0 6.8 2.6 9.4 59 Western Mountain 10.6 46.2 37.5 60.6 30.8 73.1 59 Eastern Hill 2.1 24.6 17.1 32.8 8.9 42.4 161 Central Hill 0.8 7.3 7.0 17.2 1.8 20.4 278 Western Hill 2.8 13.9 12.2 22.7 7.9 28.9 235 Mid-western Hill 5.6 26.2 28.0 38.1 7.8 49.8 143 Far-western Hill 3.8 11.6 11.4 43.3 6.8 46.3 80 Eastern Terai 2.6 21.7 19.7 23.5 9.3 32.4 389 Central Terai 3.3 14.8 12.2 18.9 5.9 23.3 413 Western Terai 6.9 15.6 22.5 37.6 8.9 43.5 201 Mid-western Terai 5.1 16.6 15.4 39.8 12.8 45.9 126 Far-western Terai 2.4 24.6 25.9 38.5 24.4 51.5 85 Education No education 4.8 22.8 20.8 32.6 10.5 40.1 852 Primary 3.7 19.9 18.7 30.1 9.6 37.9 670 Some secondary 2.2 11.9 12.1 23.5 6.5 30.6 452 SLC and above 0.2 3.8 4.2 11.5 2.8 12.8 287 Employment Not employed 0.0 14.1 11.8 17.6 12.4 24.0 77 Employed for cash 3.2 15.7 14.5 24.5 6.8 30.6 915 Employed not for cash 3.7 18.8 17.9 30.0 9.4 37.2 1,268 Number of decisions in which man has final say1 0 1.4 19.5 14.9 30.1 6.9 35.1 101 1-2 3.7 15.6 13.9 26.4 9.1 33.2 401 3-4 3.0 17.4 16.1 26.5 8.5 33.4 1,588 5 8.1 19.8 24.9 35.5 7.8 41.5 171 Total 3.4 17.3 16.3 27.4 8.5 34.1 2,261 SLC = School Leaving Certificate 1 Either by himself or jointly with others 50 * Respondents’ Characteristics and Status Twenty-nine percent of women age 15-49 in Nepal agree that a husband is justified in beating his wife for at least one reason (Table 3.13.1). One in four women agrees that wife beating is justified if a woman neglects her children, while 12 percent agree that a husband is justified in beating his wife if she goes out without telling him. Nevertheless, less than 10 percent of women feel that a husband is justified in beating his wife if she refuses to have sex with him, burns the food, or argues with him. Age has some influence on a wife’s empowerment as measured by this indicator; the older a woman, the less likely she is to believe that a husband is justified in beating his wife for a specified reason. Surprisingly, rural women are slightly less likely to agree that wife beating is justified for any reason at all than urban women, and education and employment play a small role in women’s attitudes toward wife beating. Women residing in the hill zone, in the Western region, and in the Eastern hill subregion are somewhat less likely than other women to agree that wife beating is justified for any reason. Participation in decisionmaking is related to women’s attitudes toward wife beating. Women who have a greater say in household decisionmaking are less likely to agree that wife beating is justified for any reason. To understand the environment in which women live, men were also asked their opinions about wife beating (Table 3.13.2). Men are more likely than women to feel that husbands are justified in beating their wives for at least one reason (34 percent and 29 percent, respectively). While the pattern for specific reasons is somewhat similar, men are twice as likely as women to say that a man is justified in beating his wife if she argues with him and three times more likely if she refuses to have sex with him. The pattern by age, marital status, number of living children, ecological region, and say in decisionmaking is similar to that seen for women. However, rural men are more likely than urban men to agree that wife beating is justified for at least one reason. More than one in two men living in the Far-western region agree with wife beating for at least one reason. Men living in the Central mountain region are much less likely than men living in any other subregion to condone wife beating. Men’s education is much more strongly related to attitude toward wife beating than women’s education. ATTITUDE TOWARD REFUSING SEX WITH HUSBAND Another proxy indicator to assess the status of women used in the 2001 NDHS was the respondents’ attitude toward women’s right and control over their own sexuality as measured by their opinion on a woman’s right to refuse sex with her husband. The opinion of both men and women was sought to derive a holistic picture. To measure the respondent’s attitude on a woman’s right to refuse sex with her husband, the 2001 NDHS asked respondents whether a wife is justified in refusing to have sex with her husband under four circumstances: she knows that her husband has a sexually transmitted disease, she knows that her husband has sex with other women, she has recently given birth, and she is not in the mood. These four circumstances were chosen because they combine women’s rights and women’s health issues. Table 3.14.1 shows the percentage of women who say that women are justified in refusing sex with their husband for specific reasons by background characteristics. Note that unlike the previous indicator of empowerment, this indicator is positively related to empowerment: the more reasons women agree with, the higher their “empowerment” in terms of their belief in women’s sexual rights. Respondents’ Characteristics and Status * 51 Table 3.14.1 Women's attitude toward refusing sex with husband Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Nepal 2001 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Percentage who agree with all of the specified reasons Percentage who agree with none of the specified reasons Number of women Age 15-19 95.8 94.1 97.2 96.4 90.6 1.1 941 20-24 95.8 94.0 97.7 97.2 90.9 1.0 1,658 25-29 95.3 93.5 97.3 96.4 89.1 1.0 1,666 30-34 95.9 93.8 97.4 96.7 90.3 1.2 1,427 35-39 94.3 94.0 96.8 96.1 89.7 1.5 1,168 40-44 94.8 94.2 97.6 96.3 89.4 1.1 1,030 45-49 94.2 93.5 97.3 96.8 90.0 1.3 837 Marital status Married 95.3 93.9 97.4 96.7 90.1 1.1 8,342 Divorced/separated/widowed 94.8 93.8 95.8 94.3 88.4 2.2 384 Number of living children 0 95.6 93.6 96.9 96.2 89.9 1.3 1,051 1-2 95.9 93.6 97.8 96.8 90.7 1.0 3,101 3-4 95.3 94.3 97.3 97.1 89.9 0.9 3,016 5+ 93.8 93.7 96.8 95.4 89.0 1.9 1,557 Residence Urban 95.1 92.1 97.2 94.6 88.5 1.6 841 Rural 95.3 94.0 97.4 96.8 90.2 1.1 7,885 Ecological zone Mountain 96.6 94.3 98.9 98.4 92.8 1.0 602 Hill 96.3 95.0 98.2 97.5 92.2 1.0 3,615 Terai 94.2 92.9 96.5 95.6 87.9 1.3 4,509 Development region Eastern 97.0 93.9 96.6 96.3 91.3 1.6 2,098 Central 95.4 94.8 96.5 96.0 91.0 1.5 2,804 Western 97.6 95.6 98.5 96.7 92.1 0.4 1,771 Mid-western 87.4 89.2 99.1 97.7 80.8 0.6 1,197 Far-western 96.8 93.7 97.4 97.3 91.8 1.3 855 Subregion Eastern Mountain 99.4 98.5 100.0 99.7 97.6 0.0 126 Central Mountain 96.5 96.5 97.7 97.7 95.4 2.3 209 Western Mountain 95.5 90.7 99.4 98.3 88.6 0.4 267 Eastern Hill 98.7 94.9 98.7 98.5 93.5 0.8 580 Central Hill 94.7 93.6 97.0 95.4 90.1 1.9 945 Western Hill 99.0 98.2 98.8 98.1 96.4 0.6 1,075 Mid-western Hill 92.0 92.5 99.2 98.2 87.1 0.5 648 Far-western Hill 96.8 93.5 97.4 97.9 91.8 1.0 368 Eastern Terai 96.1 93.1 95.5 95.1 89.9 2.1 1,393 Central Terai 95.6 95.3 96.0 96.0 91.0 1.3 1,651 Western Terai 95.5 91.5 98.0 94.6 85.5 0.0 696 Mid-western Terai 79.4 84.8 98.8 97.2 71.4 0.8 438 Far-western Terai 96.2 93.9 96.4 95.7 91.0 2.0 331 Education No education 94.4 93.8 96.9 96.3 89.3 1.3 6,279 Primary 96.9 93.9 98.2 97.3 91.4 1.0 1,294 Some secondary 98.3 94.6 98.9 97.8 92.9 0.6 814 SLC and above 97.4 93.7 98.4 95.4 90.8 1.3 339 Employment Not employed 94.6 92.2 96.3 95.7 88.5 1.7 1,496 Employed for cash 94.7 93.3 98.0 94.9 88.3 1.1 1,009 Employed not for cash 95.5 94.4 97.5 97.0 90.7 1.1 6,220 Number of decisions in which woman has final say1 0 95.1 93.0 97.7 97.4 90.0 1.1 1,327 1-2 94.8 93.2 97.6 96.4 89.3 1.2 3,761 3-4 95.8 95.5 97.4 96.8 91.1 1.0 1,914 5 95.6 94.2 96.6 96.0 90.2 1.4 1,725 Number of reasons wife beating is justified 0 96.1 95.0 97.6 97.1 91.9 1.2 6,216 1-2 93.7 90.8 96.8 95.4 85.5 1.2 1,940 3-4 91.8 91.3 96.6 94.4 83.9 1.0 457 5 91.2 95.5 98.9 97.1 85.7 0.0 113 Total 95.3 93.9 97.4 96.6 90.0 1.2 8,726 Note: Total includes 2 women with missing information on employment who are not shown separately. SLC = School Leaving Certificate 1 Either by herself or jointly with others 52 * Respondents’ Characteristics and Status Table 3.14.2 Men's attitude toward refusing sex with husband Percentage of men who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Nepal 2001 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Percentage who agree with all of the specified reasons Percentage who agree with none of the specified reasons Number of men Age 15-19 92.4 84.2 89.3 90.1 76.0 1.4 70 20-24 94.7 80.4 93.8 90.6 74.0 2.1 295 25-29 92.7 84.0 94.0 94.4 80.3 3.3 340 30-34 90.2 82.7 91.0 88.8 76.7 5.3 344 35-39 92.4 82.5 91.6 88.4 77.0 4.3 322 40-44 92.1 84.6 93.7 93.6 81.4 4.6 261 45-49 89.1 82.9 89.7 88.1 80.0 8.0 243 50-54 87.1 81.7 89.2 89.7 77.5 7.6 216 55-59 82.6 76.9 86.4 87.1 71.9 9.8 171 Marital status Married 91.2 82.8 91.7 90.4 78.0 5.0 2,198 Divorced/separated/widowed 76.8 66.2 84.9 86.8 59.2 7.3 63 Number of living children 0 88.9 80.5 88.5 88.5 73.6 6.1 392 1-2 91.1 81.8 92.0 90.1 76.7 4.7 793 3-4 91.7 83.5 92.6 90.7 79.4 5.1 740 5+ 90.3 83.0 91.5 91.9 79.6 4.8 336 Residence Urban 92.1 81.4 91.6 90.5 76.7 3.8 227 Rural 90.6 82.4 91.5 90.3 77.6 5.2 2,034 Ecological zone Mountain 89.9 85.2 96.3 94.8 82.4 2.3 151 Hill 92.8 78.3 91.6 90.6 74.1 4.8 896 Terai 89.4 84.9 90.9 89.5 79.4 5.6 1,214 Development region Eastern 95.2 91.3 96.7 93.4 87.1 2.4 583 Central 94.1 87.8 94.1 93.7 83.4 2.7 750 Western 88.3 71.9 86.9 90.2 66.0 5.2 436 Mid-western 76.6 63.2 82.1 76.1 56.7 14.8 295 Far-western 91.9 86.9 90.4 89.5 83.6 6.8 197 Subregion Eastern Mountain 96.5 93.0 97.7 94.2 88.4 1.2 33 Central Mountain 90.6 88.0 95.7 96.6 86.3 3.4 59 Western Mountain 85.6 77.9 96.2 93.3 75.0 1.9 59 Eastern Hill 96.6 94.1 97.9 93.8 90.0 1.4 161 Central Hill 96.1 82.4 92.7 93.0 76.2 1.0 278 Western Hill 95.7 70.7 93.4 93.2 66.2 1.7 235 Mid-western Hill 83.2 66.4 85.4 84.3 65.2 14.6 143 Far-western Hill 82.5 76.5 80.3 78.7 74.2 16.7 80 Eastern Terai 94.5 90.0 96.2 93.2 85.7 3.0 389 Central Terai 93.2 91.4 94.8 93.7 87.8 3.8 413 Western Terai 79.8 73.2 79.3 86.7 65.8 9.4 201 Mid-western Terai 70.9 62.2 76.3 64.9 49.4 17.2 126 Far-western Terai 97.6 91.8 96.4 95.8 86.4 0.0 85 Education No education 84.5 78.9 87.9 87.3 74.1 8.6 852 Primary 94.9 85.1 93.8 92.4 80.7 2.5 670 Some secondary 93.1 83.3 92.6 92.3 79.6 4.1 452 SLC and above 96.1 84.5 95.1 91.3 76.9 2.1 287 Employment Not employed 90.8 81.2 89.4 87.1 71.3 3.5 77 Employed for cash 92.0 81.7 92.6 91.3 76.6 3.7 915 Employed not for cash 89.9 82.9 90.9 89.8 78.5 6.1 1,268 Number of decisions in which man has final say1 0 91.1 79.0 85.5 83.2 68.4 5.1 101 1-2 93.0 83.3 91.5 90.3 75.6 2.5 401 3-4 91.6 84.0 92.9 91.4 80.7 5.2 1,588 5 77.9 66.7 81.9 83.8 57.6 9.7 171 Number of reasons wife beating is justified 0 92.5 84.4 92.6 92.2 80.9 4.7 1,490 1-2 88.4 78.7 88.9 87.2 72.1 6.2 508 3-4 84.7 77.3 90.4 84.5 67.6 4.7 230 5 90.4 80.2 92.1 92.1 78.5 7.9 32 Total 90.8 82.3 91.5 90.3 77.5 5.1 2,261 SLC = School Leaving Certificate 1 Either by himself or jointly with others Respondents’ Characteristics and Status * 53 It is encouraging to note that most women (90 percent) in Nepal feel that women are justified in refusing sex with their husband for all four reasons given, with little variation by specific reason, background characteristics, or other women’s status indicators. It is important to assess men’s perceptions of women’s rights over their sexuality because it has implications for women’s reproductive health. In general, men are less likely than women to agree that a wife is justified in refusing sex with her husband for all reasons, with the biggest discrepancy for the reason “knows husband has sex with other women” (Table 3.14.2). Nevertheless, more than three-fourths of men (compared with nine-tenths of women) agree that a wife is justified in refusing sex with her husband for all four reasons. Men age 55-59; divorced, separated, or widowed men; men with no children; men living in the hill ecological zone, the Mid-western development region, and the Mid-western terai subregion; men with no education; men not currently employed; men who have a final say in the five household decisions; and men who believe that wife beating is justified for three to four reasons are less likely than their counterparts to agree that a wife is justified in refusing sex with her husband for all four reasons. 3.10 SMOKING AND ALCOHOL CONSUMPTION Smoking is associated with increased risk of lung and heart diseases and is also closely related to other behaviors risky to health, such as alcohol and drug use. Table 3.15 presents information on men’s smoking and alcohol consumption status. Nearly three-fourths of men smoke cigarettes, bidis, or other tobacco, two-thirds have ever consumed alcohol, and more than one in two both smoke and have consumed alcohol. Smoking and alcohol consumption is much less common among men in the youngest age group (15-19). Smoking and alcohol consumption is also less common among divorced, separated, or widowed men and men living in the terai ecological zone, Western development region, and Central terai subregion than among their counterparts. 54 * Respondents’ Characteristics and Status Table 3.15 Smoking and alcohol consumption Percentage of men who smoke cigarettes/bidis/tobacco and percentage of men who have ever consumed alcohol, by background characteristics, Nepal 2001 Background characteristic Smokes cigarettes/ bidis/tobacco Has consumed alcohol Smokes and has consumed alcohol Number of men Age 15-19 36.7 47.4 24.6 70 20-24 59.2 64.4 39.9 295 25-29 68.5 73.3 54.7 340 30-34 72.7 69.9 54.5 344 35-39 73.4 67.7 51.3 322 40-44 80.1 71.7 60.2 261 45-49 80.0 71.0 58.3 243 50-54 87.4 61.7 53.6 216 55-59 82.2 60.4 52.1 171 Marital status Married 72.9 67.6 52.2 2,198 Divorced/separated/widowed 77.5 64.7 45.7 63 Residence Urban 65.4 75.0 50.7 227 Rural 73.9 66.7 52.2 2,034 Ecological zone Mountain 76.5 72.7 58.0 151 Hill 69.2 77.0 55.8 896 Terai 75.5 59.9 48.5 1,214 Development region Eastern 70.4 67.8 50.7 583 Central 75.5 63.8 50.0 750 Western 66.4 67.7 46.9 436 Mid-western 76.4 70.0 57.4 295 Far-western 81.3 76.7 67.2 197 Subregion Eastern Mountain 60.5 81.4 52.3 33 Central Mountain 82.1 84.6 70.9 59 Western Mountain 79.8 55.8 48.1 59 Eastern Hill 70.6 87.0 63.1 161 Central Hill 65.9 84.8 56.5 278 Western Hill 63.7 68.4 45.9 235 Mid-western Hill 77.1 68.2 58.7 143 Far-western Hill 80.0 71.1 62.8 80 Eastern Terai 71.1 58.7 45.5 389 Central Terai 81.0 46.8 42.6 413 Western Terai 69.6 66.8 48.1 201 Mid-western Terai 73.8 73.4 56.8 126 Far-western Terai 84.8 92.4 80.4 85 Total 73.1 67.5 52.1 2,261 Fertility * 55 4 FERTILITY A major objective of the 2001 NDHS is to examine fertility levels, trends, and differentials in Nepal. This is important in view of the government’s policy to reduce the total fertility rate to 4.2 by the end of the Ninth Plan in the year 2002 and bring a balance between population growth and economic development. To meet this objective, ever-married women age 15-49 were asked about their pregnancy histories. Each woman was asked the number of sons and daughters living with her, the number of sons and daughters living elsewhere, the number of sons and daughters who died, and the number of pregnancies that did not result in a live birth. The woman was then asked to provide a complete pregnancy history including information such as the month and year of all live and nonlive births, sex of live births, and survival status. The structure of these questions is designed to improve the completeness and accuracy of the information. This chapter examines current fertility, differentials and trends in fertility, and cumulative fertility in Nepal. It also examines the length of birth intervals, age at first birth, and childbearing among adolescents. As is standard practice, the analyses of fertility presented here are based only on live births. The 2001 NDHS obtained reproductive histories only from ever-married women. It is assumed that births outside marriage are negligible in Nepal and that the pregnancies experienced by ever-married women represent all pregnancies. 4.1 CURRENT FERTILITY The level of current fertility is one of the most important indicators for health and family planning policymakers and professionals in Nepal because of its direct relevance to the population policy and programs. Table 4.1 presents age-specific fertility rates (ASFR),1 the total fertility rate (TFR) for women age 15-49, the general fertility rate (GFR) for women age 15-44, and the crude birth rate (CBR), by residence. All these rates pertain to the three-year period preceding the survey. A three-year rate is chosen because it provides current information, without unduly increasing sampling error. The TFR is the sum of the ASFRs and can be interpreted as the number of children a woman would have by the end of her childbearing age if she experienced the prevailing ASFRs. The GFR is defined as the total annual number of births per 1,000 women age 15-44, and the CBR is defined as the total number of live births in a year per 1,000 persons. 1 Numerators of the ASFRs are calculated as the total number of live births that occurred in the period 1-36 months preceding the survey (determined by the date of interview and the date of birth of the child), and classified by the age (in five-year age groups) of the mother at the time of the birth (determined by the mother’s date of birth). The denominators of the rates are the number of woman-years lived in each of the five-year age groups during the 1-36 months preceding the survey. Rates are expressed per 1,000 women. Since only ever-married women were interviewed in the 2001 NDHS, the number of women in the denominators of the rates was inflated by factors calculated from information in the Household Questionnaire on proportions ever-married in order to produce a count of all women. An implicit assumption in this calculation is that never-married women have not given birth. 56 * Fertility The TFR for Nepalese women age 15-49 is 4.1 births per woman. There is a large difference in fertility by urban-rural residence; the TFR among urban women (2.1) is 2.3 children less than that among rural women (4.4). The age pattern of fertility indicates that Nepalese women have high fertility in the early part of the childbearing period. At the current ASFRs, a woman in Nepal will have given birth to about three children by age 30. The ASFRs in both urban and rural areas peak at age 20-24. In urban areas, fertility rates decline rapidly after age 24, whereas in rural areas the fertility decline by age is more gradual. The ASFRs are consistently lower in urban areas than in rural areas, and women in urban areas of Nepal seem to almost stop having children after age 40. The GFRs for urban areas, rural areas, and for all of Nepal are 81, 156, and 148 per 1,000 women age 15- 44, respectively. The CBR for the three-year period before the survey is 34 per 1,000 population. Both these summary rates also indicate higher fertility in rural than in urban areas. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban- rural residence, Nepal 2001 Residence Age group Urban Rural Total 15-19 72 114 110 20-24 153 261 248 25-29 102 217 205 30-34 60 146 136 35-39 28 87 81 40-44 2 38 34 45-49 0 8 7 TFR 2.1 4.4 4.1 GFR 81 156 148 CBR 20.6 34.9 33.5 TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Note: Rates for age group 45-49 may be slightly biased due to truncation. FERTILITY DIFFERENTIALS AND TRENDS Table 4.2 summarizes the current level of fertility by area of residence, ecological zone, development region, and education. The TFR in the mountains (4.8) is highest among the three ecological zones, while the TFR in the hills (4.0) is about the same as in the terai ecological zone (4.1). By to development region, women in the Western and Eastern regions have on average one child fewer than women in the Mid-western and Far-western regions and half a child fewer than women in the Central region. There is a strong association between fertility and education, with the TFR declining as the level of education increases. The TFR of women with no education (4.8) is more than double that of women with at least an SLC level of education (2.1). Fertility * 57 The percentage of women who reported themselves as currently pregnant is also given in Table 4.2. Since women in the early stages of pregnancy may not be aware that they are pregnant and because some women may not want to reveal that they are pregnant, this percentage may be underestimated. Seven percent of women reported that they were pregnant at the time of the survey. The proportion pregnant is nearly twice as high in rural areas as in urban areas. The percentage of women who are pregnant is generally consistent with current fertility levels for each major population subgroup in that groups with higher fertility also tend to have higher percentages of women currently pregnant. Table 4.2 also shows the mean number of children ever born to women age 40-49, which is a measure of the average lifetime fertility experience of women age 40-49 (completed fertility). Although this measure is susceptible to omission, comparison of completed fertility among women age 40-49 with the current TFR indicates fertility decline for all major subgroups of the population. Overall, the results in Table 4.2 suggest that there has been a 24 percent decline in fertility levels during the past 20-25 years. Both the current and lifetime fertility indicate that fertility is lower in urban areas and among the more educated. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of all women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Nepal 2001 Background characteristic Total fertility rate1 Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 2.1 4.3 4.5 Rural 4.4 7.4 5.5 Ecological zone Mountain 4.8 7.2 6.1 Hill 4.0 7.3 5.4 Terai 4.1 6.9 5.3 Development region Eastern 3.8 6.6 4.9 Central 4.3 7.3 5.4 Western 3.5 6.3 5.3 Mid-western 4.7 7.4 6.4 Far-western 4.7 8.7 6.0 Education No education 4.8 7.5 5.6 Primary 3.2 6.7 4.5 Some secondary 2.3 6.1 3.7 SLC and above 2.1 5.7 2.6 Total 4.1 7.1 5.4 SLC = School Leaving Certificate 1 Women age 15-49 years 58 * Fertility Comparing the TFR obtained from three earlier surveys with the TFR obtained from the 2001 NDHS indicates a steady decline in fertility (Table 4.3 and Figure 4.1). Direct estimates of fertility for the three years preceding the survey have been used in this comparison because a three-year rate is more robust than rates based on a shorter or longer period. There was a 6 percent decline in TFR between 1984-1986 and 1989-1991, compared with a 3 percent decline between 1989-1991 and 1993-1995. Between 1994-1996 and 1998-2000, the percentage decline in fertility was 12 percent. Fertility trends have to be interpreted within the context of data quality and sample size. A discussion of these issues in relation to earlier surveys is beyond the scope of this report. As such, the fertility trend shown in Table 4.3 and Figure 4.1 has to be interpreted with caution. Table 4.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, Nepal 2001 Age group NFFS 1986a (1984-1986) NFHS 1991a (1989-1991) NFHS 1996b (1993-1995) NDHS 2001 (1998-2000) 15-19 99 101 127 110 20-24 261 263 266 248 25-29 230 230 229 205 30-34 200 169 160 136 35-39 114 117 94 81 40-44 68 55 37 34 45-49 49 26 15 7 TFR 5.11 4.79 4.64 4.10 Note: Rates are for the three years preceding the survey. a Pradhan, 1995:32 b Pradhan et al., 1997:37 5.1 4.8 4.6 4.1 1984-1986 (NFFS 1986) 1989-1991 (NFHS 1991) 1993-1995 (NFHS 1996) 1998-2000 (NDHS 2001) 0 1 2 3 4 5 6 Births per woman Figure 4.1 Trends in Total Fertility Rate 1984-2001 Note: Rates are for the three years preceding the survey. Fertility * 59 Information from birth histories in the 2001 NDHS allows the calculation of ASFRs for specified periods before the survey, which in turn provide further evidence of recent fertility decline. However, in situations in which the placement of births in time may not be reported correctly, trends in fertility could be distorted. Furthermore, ASFRs are progressively truncated as one moves into the past. Nevertheless, the results presented in Table 4.4 indicate an 18 percent decline in fertility among women age 15-29 from 3.6 births per woman during the period 15-19 years before the survey to 2.9 births per woman during the period 0-4 years before the survey. The largest decline in fertility (14 percent) took place between 5-9 and 0-4 years before the survey, versus only a 6 percent decline in fertility between 10-14 and 5-9 years before the survey and no change between 15-19 and 10-14 years before the survey. 4.2 PREGNANCY OUTCOMES The 2001 NDHS collected complete pregnancy histories from women and therefore provides information on pregnancy outcomes. It is important to note that collecting pregnancy histories is comparatively more difficult than collecting birth histories retrospectively, especially for information on pregnancies that were miscarried within the first few months after conception. Therefore, the total number of pregnancies and abortions are likely to be underestimated and caution should be exercised while interpreting these data. Stillbirths are probably more completely reported than abortions. Table 4.5 presents the pregnancy outcomes among ever-married women 0-9 years before the survey by age of the mother and urban-rural residence. Overall, 92 percent of pregnancies result in a live birth and 8 percent of pregnancies end as nonlive births2 percent as stillbirths, 5 percent as spontaneous abortions, and 1 percent as induced abortions. There is little variation in pregnancy outcomes across age groups, although older women (age 35 and above) are slightly more likely to have pregnancies resulting in nonlive births. Similar patterns are observed by urban-rural residence, with 91 percent of pregnancies in the urban areas and 93 percent of pregnancies in the rural areas resulting in live births. Abortions are more common in urban areas than in rural areas, especially induced abortions. Table 4.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Nepal 2001 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 116 148 144 136 20-24 260 289 307 303 25-29 213 247 274 283 30-34 144 180 212 [231] 35-39 84 125 [143] 40-44 36 [56] 45-49 [8] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 60 * Fertility Table 4.5 Pregnancy outcome Percent distribution of all pregnancies among ever-married women in the ten years preceding the survey by pregnancy outcome, according to age at end of pregnancy and residence, Nepal 2001 Pregnancy outcome Age at end of pregnancy Spontaneous abortion Induced abortion Still birth Live birth Total Number of pregnancies URBAN <20 5.5 0.6 2.0 91.9 100.0 257 20-24 5.9 1.8 1.5 90.7 100.0 406 25-29 2.8 3.3 1.1 92.8 100.0 251 30-34 5.0 4.0 2.7 88.3 100.0 120 35-39 7.0 4.0 1.5 87.6 100.0 61 Total 5.2 2.3 1.6 90.9 100.0 1,103 RURAL <20 5.2 0.3 2.1 92.5 100.0 2,657 20-24 4.2 0.4 2.1 93.3 100.0 4,684 25-29 3.7 0.7 2.4 93.3 100.0 3,301 30-34 5.6 0.8 1.8 91.8 100.0 1,999 35-39 6.8 1.2 2.7 89.3 100.0 1,126 40-44 8.5 1.9 2.6 87.0 100.0 317 Total 4.8 0.6 2.2 92.5 100.0 14,106 TOTAL <20 5.2 0.3 2.1 92.4 100.0 2,915 20-24 4.3 0.5 2.1 93.1 100.0 5,090 25-29 3.6 0.9 2.3 93.2 100.0 3,551 30-34 5.6 1.0 1.8 91.6 100.0 2,119 35-39 6.8 1.3 2.7 89.2 100.0 1,187 40-44 8.7 2.1 2.6 86.6 100.0 326 Total 4.8 0.7 2.1 92.3 100.0 15,210 Note: Pregnancy outcomes for age groups 40-44 (in urban only) and 45-49 are not shown because they are based on fewer than 25 pregnancies 4.3 CHILDREN EVER BORN AND LIVING Table 4.6 presents the distribution of all women and currently married women by age and number of children ever born (CEB) and the mean number of living children by age. Lifetime fertility reflects the accumulation of births over the past 30 years and, therefore, its relevance to the current situation is limited; nevertheless, information on the mean number of children ever born

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