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ADBI-Ewha IDHS Policy Workshop

Gender Dimension in Health


and
Sustainable Development Goal

Dr. Ramesh Kumar Kharel


MD,MPHM
Joint Secretory
Ministry of Health and Population Nepal
The views expressed in this presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank
Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments they represent. ADBI does not guarantee the accuracy
of the data included in this paper and accepts no responsibility for any consequences of their use. Terminology used may not necessarily be consistent 25th March, 2019
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with ADB official terms. Seoul, Republic of Korea
Nepal at a Glance
• Land linked country in South Asia
(28°00′ 𝑁𝑁𝑁𝑁𝑁00’E)
• Surrounded by India on three sides and
China on North
• Area : 147,181 sq. km
• 7 provinces and 753 Local Governance
Unit
• Independent, sovereign, secular, federal
democratic republican state.
• Geographically divided into three belts:
Terai, Hill and Mountain
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Nepal is the country where……..

Lord Buddha was born The world's highest peak is located

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Population Characteristics
• Total Population: 29.3 Million

• Average Annual Population Growth Rate: 1.35


( Population doubling time:52 years)

• Sex Ratio: 94.2 males per 100 females

• Average Household Size: 4.88

• Life expectancy: 70.25


Source: Census 2011,Nepal
*National Demographic Health Survey, 20164
Key Development Indicators

• Human Development Index: 0.574 ( 149th in world)

• Per Capita Income: 1003 USD

• Gender Equality Index: 0.49

• Gender Development Index: 0.57

• Overall Literacy rate: 66%

• Female Literacy: 57 % while that for Nepali men is 75 %.


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Gender Related Scenario in Nepal

• Third highest rate of child marriage in South Asia, after Bangladesh


and India.

• 37% of women get married before 18

• 10% get married before 15

• The ratio of women to men among professional and technical workers


is 0.24.
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Total Fertility Rate in Nepal
Targets

Nepal NHSS: 2020 2.1


SDG: 2030 2.1
2.3
At or Below 2020 target
Sudur Paschim
2.2 Karnali At or Lower than national average
2.8
Higher than national average

Highest among the 7 Provinces


Gandaki
2.0
Province 5
2.4 Province 3
1.8
Province 1
2.3
Province 2
3.0

Source: NDHS 2016 7


Maternal Mortality Ratio in Nepal
Pregnancy related deaths per 100,000 live births
600
539
500
NDHS 2016:
Maternal mortality ratio: 239
400

300 281
259

200
125
99
100
70
0
1996 2006 2016 Target 15th Plan- Target
2020 Target 2023 2030
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Child Mortality Rate in Nepal
118
Under-5 mortality 54% of under 5 deaths are neonates
40% of neonatal deaths are within the first 24 hours
91 Infant Mortality Ratio: 32 per thousand live birth
% of birth assisted by Skilled Health Provider : 58%

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54
50
39 39
33 33
28
21 24
Neonatal mortality
18 20
14 12

1996 NFHS 2001 NDHS 2006 NDHS 2011 NDHS 2016 NDHS NHSS 2020 15th Plan 2023 Target 9SD 2030
Target Target
• % of Pregnant Women Received Antenatal Care from Skilled Provider :
84%
• Contraceptive prevalence rate (CPR)
- Any Method : 52.6%
- Any Modern Method : 42.8%
• Unmet need for family planning: 24% ( highest in adolescents aged
15-19 years : 34.9%)

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RH Morbidity Status
• Pelvic organ prolapse : 6.4% *
• Cervical pre cancerous lesion : 1.6% *
• HPV 16/18 : 5.4% *
• Obstetric fistula : 200-400 cases per year
• Cervical Cancer: 16.6% of all cancer among women

* Source: RH Morbidity study, 2016

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Gender based violence
• 26 % of women aged 15-49 year experience physical or sexual
violence
• Domestic violence is predominant, followed by:
• Girls trafficking
• Physical/sexual abuse, social abuses
• Malpractices such as allegation of witchcraft, Chhaupadi, dowry
which are often fatal.

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Chhaupadi

Witchcraft

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Position held by Women in Nepal
• In the elections of 2017, over 40 percent of elected officials
were women in local governments, and there is a
constitutional guarantee that at least 33 percent of the
members of parliament must be women.
• Between October 2015 and June 2016, Nepal received its
first women in powerful positions—the President, the
Speaker of Parliament, and the Chief Justice of the Supreme
Court.

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Recent Interventions towards Gender
Equality, Health and Sustainable
Development Goals

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The Constitution of Nepal 2015
Article 35 of the Constitution of Nepal 2015 clearly mentioned about
Right relating to Health that consists of 4 rights.

1) Right to free basic health service from the state to every citizen
and no one shall be deprived of emergency service.
2) Right to information about their medical treatment
3) Every citizen shall have equal access to health service
4) Every citizen shall have access to clean drinking water and
sanitation
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The Constitution of Nepal 2015
Article 38 of the Constitution of Nepal 2015 clearly mentioned about
Right relating to Health that consists of 6 rights.
• Every woman have equal lineage right without gender based discrimination.

• Right to safe motherhood.

• No form of violence is tolerated.

• Right to participate in all bodies of state

• Right to Special Opportunity in education, health, employment and social


security.

• Equal right to property and family affairs.


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Safe Motherhood and Reproductive Health
Right Bill 2018

• Provision related to Antenatal care, delivery services, postnatal care


and abortion services.

• Privacy maintenance during service delivery, no discrimination,


disability friendly service.

• Although Act has been passed, still regulation is not formulated yet.

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Targets of Sustainable Development Goals

• Elimination of wage discrimination for similar work.

• Eliminating all harmful practices.

• Elimination of physical/ sexual violence.

• Increasing seats held by women in the national parliament to 40%

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Targets of Sustainable Development Goals

• Increasing women’s share in public service decision making positions


to 33% in 2030.

• The Gender Inequality Index is targeted to decline to 0.05 in 2030

• Gender Empowerment Measure is expected to rise to 0.69 by 2030

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Key Innovation
• National Adolescent Health and Development Strategy 2018/19
initiated.
• Declaration of all health facilities of 3 districts providing 5 Family
Planning Services.
• Preparation of safe motherhood roadmap as a game changing
initiative.

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Challenges

• Deep rooted cultural and traditional beliefs.

• Context of federalism can be taken both as opportunities and


Challenges

• Implementation mechanism of the existing policy is relatively weak.

• Increase in teenage pregnancy, decrease in TFR among high quantile


population.
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Conclusion
• Human Development Index 0.574 ( 149th in world)
• Female Literacy 49 %
• Third highest rate of child marriage in South Asia
• Total fertility rate 2.3
• Maternal mortality rate 239 deaths per 100,000 live births.
• 26% of women aged 15-49 year experience physical or sexual
violence
• women in powerful positions—the President, the Speaker of
Parliament, and the Chief Justice of the Supreme Court.
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