Fertility Trends and Patterns in Nepal
The demographic profile of Nepal has undergone a significant transformation, marked by a substantial decline in both fertility and mortality rates over the past few decades. This shift has profound implications for the country’s socio-economic development and population structure.
Nepal has experienced a rapid fertility transition, with the Total Fertility Rate (TFR) falling sharply. The TFR, which was estimated to be around 5.2 children per woman in 1991, has since dropped significantly, approaching replacement level.
Key Fertility Indicators (CBR, TFR)
| Indicator | Approximate National Value (Latest Data) | Trend |
|---|---|---|
| Crude Birth Rate (CBR) | 14.2 per 1,000 population (2021 NPHC) | Declining |
| Total Fertility Rate (TFR) | Estimated to be around or slightly above 2.1 (replacement level) | Rapidly Declining |
| Age-Specific Fertility Rate (ASFR) | Highest in the 20-29 age group, but overall rates are declining across all reproductive ages. | Declining across all reproductive ages |
Fertility by Ecological Regions and Rural/Urban Areas
Fertility patterns exhibit considerable variation across different geographical and settlement types.
- Ecological Regions: In 2021, the Mountain region recorded a high CBR (15.8), followed by the Tarai (14.7), and the Hill region (13.3).
- Rural-Urban Divide: Rural municipalities consistently show a higher CBR (15.7) compared to Urban municipalities (13.6). This difference reflects variations in access to education, healthcare, family planning services, and differences in socioeconomic status.
Fertility by Province Level
There are stark disparities in fertility rates across Nepal’s provinces, largely mirroring the rural-urban and socioeconomic differences.
- Higher Fertility Provinces (High CBR, 2021 NPHC): Provinces in the Mid- and Far-Western regions often report the highest rates, with Karnali (18.7) and Sudurpashchim (17.3) provinces showing the highest CBRs. This is often associated with lower socioeconomic development, lower levels of female education, and limited access to health services.
- Lower Fertility Provinces (Low CBR, 2021 NPHC): The most developed provinces, which are typically more urbanized and have better access to services, exhibit the lowest fertility. Bagmati (11.5) and Gandaki (11.4) provinces have the lowest CBRs.
b. Causes of Fertility Decline
The sustained decline in Nepal’s fertility rate is a result of a complex interplay of demographic, socioeconomic, cultural, and policy-related factors.
- Increased Use of Contraceptives: This has been the primary proximate determinant of fertility decline. Government-led and non-governmental family planning programs have significantly increased the accessibility and utilization of both modern and traditional contraceptive methods.
- Rise in Female Education and Status:
- Higher female literacy is strongly and negatively correlated with fertility. Educated women are more likely to postpone marriage, desire smaller families, and have greater autonomy in making reproductive choices.
- Increased women’s employment outside the home provides economic independence and contributes to the preference for fewer children.
- Increased Age at Marriage: The median age at first marriage for women has steadily increased, moving childbearing years later and reducing the overall reproductive span.
- Male Out-Migration: The massive trend of young men migrating abroad for foreign employment results in prolonged spousal separation. This is an increasingly significant factor directly reducing coital frequency and, consequently, fertility.
- Legalization of Abortion: Since its legalization in 2002, the use of safe abortion services has played a role in the continued reduction of births.
- Socioeconomic Factors and Changing Norms:
- The shift from joint to nuclear family systems means less support for child-rearing.
- Increased cost of living, housing, and child-rearing (economic concerns) makes it financially difficult for couples to have large families.
- A preference for a smaller, ideal family size has become the new social norm.
c. Mortality Trends and Patterns in Nepal
Nepal has achieved remarkable success in reducing mortality rates across all age groups, leading to a substantial increase in life expectancy.
Key Mortality Indicators
| Indicator | Approximate National Value (Latest Data) | Trend |
|---|---|---|
| Crude Death Rate (CDR) | Has declined significantly from high levels in the mid-20th century. | Steadily Declining |
| Infant Mortality Rate (IMR) | Around 35 per 1,000 live births (2022 NDHS) | Steadily Declining |
| Maternal Mortality Ratio (MMR) | 151 per 100,000 live births (2021 NPHC) | Significant Decline |
| Life Expectancy at Birth | Around 70 years | Significantly Increasing |
Mortality by Ecological Regions and Rural/Urban Areas
Similar to fertility, mortality indicators show disparities based on location:
- Rural-Urban Divide (Infant Mortality): Neonatal Mortality Rate (NMR) in rural areas is notably higher than in urban areas, highlighting the inequality in access to essential perinatal and newborn care.
- Ecological Regions (Maternal Mortality): While the Mountain region sometimes reports lower MMR, this may be due to reporting issues. Generally, the Hill and Tarai regions show varying and sometimes higher rates, with the Tarai region, in particular, facing high challenges in health access.
Mortality by Province Level (Maternal Mortality Example)
Maternal Mortality Ratio (MMR) (2021 NPHC):
- Lower MMR Provinces: Bagmati Province (98) reports the lowest MMR, again reflecting better health infrastructure and access.
- Higher MMR Provinces: Lumbini (207) and Karnali (172) provinces show some of the highest MMRs, indicating persistent challenges in providing quality maternal and reproductive health services in these areas.
d. Causes of Mortality Decline and Increasing Life Expectancy
The dramatic decline in mortality and the corresponding increase in life expectancy are largely due to advancements in the health sector and broader socioeconomic development.
- Improved Public Health System and Health Care Access:
- Control of Communicable Diseases: Successful national campaigns for immunization (vaccination) have significantly reduced deaths from preventable diseases like measles and tuberculosis.
- Improvements in Maternal and Child Health: Increased rates of institutional deliveries (births in a health facility), higher coverage of antenatal and postnatal care, and the presence of more trained medical personnel have drastically reduced Infant and Maternal Mortality Rates.
- Expansion of Health Infrastructure: The establishment of health posts, primary health care centers, and hospitals, even in remote areas, has improved access to basic medical services.
- Socioeconomic Development and Living Standards:
- Better Nutrition and Sanitation: Improved access to safe drinking water and better sanitation facilities have reduced the incidence of diarrhoeal and waterborne diseases, historically major causes of infant and child deaths.
- Rising Education Levels: Education, particularly for mothers, is directly linked to better health-seeking behavior, improved hygiene practices, and better nutritional outcomes for children.
- Poverty Reduction: General economic growth and poverty reduction allow families to afford better food, housing, and healthcare, contributing to longevity.
- Shift in Disease Burden: As communicable, maternal, and nutritional diseases have declined, the cause of death has shifted toward Non-Communicable Diseases (NCDs) like ischemic heart disease, stroke, and chronic respiratory diseases—a typical transition seen in aging populations with longer life expectancies.
Would you like to explore the policy implications of these fertility and mortality trends, such as the challenges of an aging population or the need for sustained public health investment?
