Nepal Fertility Research Articles

Estimation and Projection of Fertility in Nepal

The text discusses the importance of indirect estimation techniques in understanding population dynamics, particularly in countries with limited or flawed data like Nepal. Indirect methods offer valuable insights into fertility and mortality rates when direct measures are unavailable or unreliable. Techniques like Brass P/F ratio and the logistic curve function are explored for estimating fertility trends and projecting Total Fertility Rates (TFR). These methods involve meticulous analysis and adjustment for data inconsistencies. Indirect estimation plays a crucial role in bridging data gaps and informing demographic analysis and planning, especially in regions undergoing demographic transition. Through these techniques, researchers gain valuable insights into fertility dynamics, contributing to a better understanding of population trends. The text explores fertility estimation in Nepal using Arriaga's method, analyzing data from the 2011 and 2021 censuses. It reveals disparities in lifetime fertility indices, particularly after age 20, with higher rates among women aged 20-24 and 25-34, tapering towards the end of the reproductive span. Arriaga's adjustments address issues like misreporting of children's ages, aiming to rectify discrepancies and estimate the Total Fertility Rate (TFR) for both years. Additionally, the study discusses fertility projections for 2026 and 2031, highlighting the importance of trend extrapolation models and the logistic curve for accurate estimation. The findings underscore the significance of meticulous adjustments and reliable methodologies in understanding fertility dynamics in Nepal.

Mathematical Analysis of Fertility in Nepal Using Arriaga's Approach

This article has judged how well the P/F changing ratio technique and Arriaga's approach forecast fertility levels in Nepal. The study's goal was accomplished and the logistic curve function was legalized by estimating national fertility rates. Using information from the 2011 till 2021 censuses together with Arriaga's methodology, the following factual investigates the calculation of fertility rates in Nepal. By using cutting edge indirect fertility estimation techniques on a national level, this study seeks to evaluate the fertility change in Nepal. Utilizing information from the 2011 and 2021 Censuses, fertility estimates were produced with an emphasis on last-year births. The findings show that Nepal's fertility rates have recently dropped.

Impact of Sumadhur intervention on fertility and family planning decision-making norms: a mixed methods study

BackgroundMindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making.MethodsIn 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically.ResultsSumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges.ConclusionsEntrenched social norms surrounding fertility and family planning contrasted with participants’ personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

Impact of Female Education on Fertility Status of Muslim Community of Susta Rural Municipality: Kudiya, Nawalparasi

Background: This study explores the impact of female education on fertility status. Nepal has been experiencing a fertility decline over the last few decades. Although many factors have been shown to influence women’s childbearing, socioeconomic factors such as education and religion are some of the prime factors that mainly influence women’s fertility in Nepal. The major objective of this study is to examine the relationship between education and fertility behavior of the respondents. Methods: This study is descriptive in nature. Sample of this study consist the 218 married Muslim women randomly selected out of 689 families from Susta Rural Municipality of Parasi. Data were analyzed using the statistics like frequencies, percentages and mean value. Results: Level of education has inverse relation to fertility. The CEB between illiterate, literate, SLC and intermediate attainment women was found significantly different. Moreover, it was also found that most of the women had knowledge of family planning but they were reluctant to use family planning method. Conclusion: Major conclusion of this study indicated the inverse relationship between level of education and fertility behavior of Muslim women. Hence, fertility behavior can be changed through education policy intervention over Muslim women in rural area.

Effect of biochar blended organic fertilizers on soil fertility, radish productivity and farm income in Nepal

Declining soil fertility and nutrient availability are one of the major threats to reducing crop productivity in Nepal. A field experiment was conducted to assess the potential of biochar (10 t ha-1) blended with organic and inorganic fertilizers on improving soil fertility and radish productivity in Morang district, Nepal. Biochar was prepared from locally available twigs, branches, and wood using the soil pit “Kon tiki” method. The experiment was laid out in Randomized Complete Block Design with 7 treatments having four replications viz., control (CK), biochar (BC), biochar + cattle manure (CM), biochar + poultry manure (PM), biochar + cattle urine (CU), biochar + commercial biofertilizers (BF) and biochar + inorganic fertilizers (urea-N). The nitrogen rate used in all the treatments was equivalent to 100 kg ha-1. The agronomic effect of biochar blended organic amendments was compared with control and inorganic urea-N treatments. Biochar amended plots showed significantly higher soil pH (6.5), organic matter (4%), total N% (0.8%), available P (80.1 kg ha-1), and K (203.6 kg ha-1) compared with control. CM increased marketable yield by 320% (63 t ha-1) and biomass yield by 198% (100 t ha-1) compared with control (15.0 t ha-1 and 34 t ha-1) of marketable and biomass yield, respectively. CM increased marketable yield by 44% compared with the urea-N treatment (44 t ha-1). Moreover, net return was observed highest with CM treatment among all the organic and urea-N treatments. The study suggests that the combination of biochar with locally produced cattle manure has the potential to increase radish productivity and could compete with mineral nitrogen fertilizers while producing similar or even higher crop yields and economic returns.

Estimation of Cohort Fertility Using Parity Progression Ratio

This study attempts to analyze the levels and patterns of cohort fertility in Nepal in 2016 using data on parity progression ratios (PPRs). Simple PPRs, rather than synthetic PPRs or birth history of women, are used in this study from distribution of women by age and children ever born. Data on PPRs are used from 2016 Nepal Demographic and Health Survey to estimate cohort fertility of currently married and all women separately. Fertility is analyzed for different birth cohorts of women, specifically for birth cohorts of age groups 45-49, 20-24, 25-29, and 30-34 years, beside overall span of reproductive ages (15-49) for different purposes. The PPRs data are employed in this study in three different ways such as PPRs itself, proportion of women with at least ‘N’ number of children ever born (CEB), and cohort fertility rates. All three measures are implied to estimate cohort fertility of both currently married and all women separately. Fertility patterns are almost similar in all the three methods and other the measures show that the level of cohort fertility is still a little higher in Nepal, although it is declining gradually over time. The completed cohort fertility is estimated at around 4 in Nepal in 2016. The contribution of this article will be to check fertility level by applying this simple, but less common, method in estimating cohort fertility.

Fertility, household size and poverty in Nepal

Population control policies keep attracting attention: by increasing the household size, having more children would directly contribute to a household’s poverty. Using nationally representative household level data from Nepal, we investigate the links between a household’s fertility decisions and variations in their size and composition. We show that the relationship between number of births and household size is positive when the mothers are young, but becomes negative as the mothers grow older. Elderly couples who had fewer children host, on average, more relatives who are outside the immediate family unit. This result sheds light on the heterogeneous relation between the number of children and household size over the life cycle. It also implies that reductions in a household’s fertility may have an ambiguous impact on its per capita consumption, which depends on how the household’s composition responds to new births and changes over time: in this sample, an old household’s per capita consumption is not affected by the number of births. We use the gender of the first-born child to instrument the total number of consecutive children.

Female Land Ownership and Fertility in Nepal

This paper examines the association between female land ownership and fertility in Nepal using propensity score methods. A female land owner is found to have an average of 0.26–0.47 fewer children than her non-owner counterpart. Such negative female land-fertility trends are observed for women in different age groups. Evidence indicates that female land ownership promotes women’s wealth and decision-making authority, which could be the pathways through which their fertility is influenced. These findings imply that female land ownership could have substantial welfare benefits for women and population implications for countries.

Female Land Ownership and Fertility in Nepal

This paper examines the association between female land ownership and fertility in Nepal using propensity score methods. A female land owner is found to have an average of 0.26–0.47 fewer children than her non-owner counterpart. Such negative female land-fertility trends are observed for women in different age groups. Evidence indicates that female land ownership promotes women’s wealth and decision-making authority, which could be the pathways through which their fertility is influenced. These findings imply that female land ownership could have substantial welfare benefits for women and population implications for countries.

The Determinants of Fertility among Women of Reproductive Age in Nepal

This study is conducted on determinants of fertility among women of reproductive age in Nepal. The study takes into account some demographic, socio-cultural, economic and spatial variables. Fertility trends are estimated from the date obtained in the 1996, 2001, and 2006 NDHS with information gathered in the 2011 NDHS. Fertility declined from 4.6 births per woman in the 1996 NFHS to 2.6 births per woman in the 2011 NDHS—a drop of two births per woman in the past 15 years. The decline in fertility is most pronounced in the five years between 2001 and 2006 (a one-child decline). Fertility has declined in every age group over the past 15 years, with largest decline seen among women 25-34 years. But over the past 5 years the largest decline is observed among women 20-24 years. Many factors may have contributed to this quick decline fertility in Nepal, including improved communication and greater access to modern methods of contraception. Extended spousal separations due to migrants seeking work in foreign countries, especially the Gulf countries and other Southeast Asian countries, may be another reason for the fertility decline (NDHS Report 2012). The multivariate analysis is used to show the strength of relationship of fertility with its correlates. It estimates the effect of socio–economic and demographic as well as spatial variables on total Children Ever Born (CEB). This study also attempts to find out variation of fertility among women by using frequency table, rate, ratio, percentage, cross tabulation, correlation and regression analysis and mean CEB. The result shows that when other factors remain unchanged, age of respondents at first birth and educational attainment have strong and significant negative impact on fertility. Similarly son who have died, daughter who have died, parity at sterilization and age at sterilization have strong and significant positive impact on fertility whereas regions, type of place of residence, age at marriage and destination India have weak positive impact on fertility. The Journal of Development and Administrative Studies (JODAS)Vol. 23(1-2), pp. 55-68

Spousal migration and human papillomavirus infection among women in rural western Nepal.

In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age.

Models for Assessing the Impact of Family Planning on Fertility

This paper tries to assess the impact of family planning (FP) on fertility in Nepal. Nepal Demographic and Health Survey data 2011 were used. Impact of sterilization was found to be highest (about 33 per cent births averted) followed by the combined effect of injectables, pills, condoms and all other traditional methods. The combined impact of sterilization and injectables was found to be 0.60 births per woman. The expected numbers of future children would be 3.09 (excluding sterilization), 3.27 (excluding sterilization or injectables), 3.36 (excluding sterilization or injectables or pills), 3.51 (excluding sterilization or injectables or pills or condoms) and 3.97 (non-user) for zero parity women. The combined impact of sterilization and injectables would be 0.60 births per woman. Findings may help researchers and policy-makers for designing effective FP policy of a country.Journal of Institute of Science and Technology, 2015, 20(2): 67-72

Prevalence and correlates of cervico-vaginal clinical syndromes among women attending a health camp in Lalitpur district of Nepal.

Sexual and reproductive health of women is a major public health problem in Nepal. Screening of cervico-vaginal clinical syndromes could potentially provide insights to the prevalence of sexually transmitted infections (STIs), which is not known. To investigate the prevalence and factors associated with cervico-vaginal clinical syndromes in the socio-behavioral, medical, and public health context of Nepal. Married women attending a clinical health camp held by the Nepal Fertility Care Centerin Khokana of Lalitpur district were recruited to the study. Seventy-three participants completed face-to-face questionnaires on basic socio-demographic, behavioral and reproductive health factors and underwent pelvic screening including clinical diagnosis of cervicitis and vaginitis. An univariate analysis was performed to determine if any of the self-reported variables were associated with abnormal pelvic examination (cervicitis and/or vaginitis). Vaginitis was diagnosed in three (4.4%) participants, while cervicitis was detected in 16 (23.5%) women. None of the participants reported any high risk sexual behavior. However, 28% of the participants reported having had STI diagnosis in the past and was associated (P<0.008) with abnormal pelvic results. Additionally, women with lower education were associated (p<0.02) with abnormal pelvic results. The high occurrence of cervicitis in our exploratory could indicate the high prevalence of STIs. However, while there could potentially be an unknown epidemic of STIs related to the clinical syndromes, point of care testing practice might help to understand the true prevalence of STIs in Nepali women and also reduce the health burden and consequences of over treatment based on the current symptomatic diagnosis.

Levels, trends and differentials of teenage fertility in Nepal: assessing universal coverage of adolescence sexual and reproductive health to achieve Sustainable Development Goal 5 in 2030

Introduction: Adolescence is a transition period from childhood to adulthood and is critically important especially for teenage girls as adolescent birth rate has remained high despite declining fertility in Nepal. Consequently, adolescents are more likely to drop out from the school thus losing the potential earning and leadership opportunities, which in turn, hampers their overall well-being. Thus it was included in the Millennium Development Goals and also in the Sustainable Development Goals (SDGs). Methods: The 1996, 2001, 2006 and 2011 Nepal Demographic Health and Survey (NDHS) datasets were used. Single age birth rates were derived using births histories whereas age-specific fertility rates of 15-19 years women were derived using Poisson regression. Regression-based standard errors and its confidence intervals were used to test the levels and trends statistically. Results: The adolescent birth rate was higher among 18-19 years than 15-17 years old females. Teenage fertility rate was 81 in 2011: second highest in South Asia. Urban adolescent birth rates were significantly different from rural areas and country for all the surveys. Adolescent birth rate was significantly lower than the national estimates for women with some secondary and beyond secondary levels of education. Eastern and Western Development regions had lower teenage fertility compared to other regions of Nepal. Conclusion: Nepal needs to use best practices and approaches from around the globe to systematically reduce its high teenage fertility as aspired by the Target 6, Goal 5 of the Sustainable Development Goals (SDGs) to be implemented between 2016-2030.

Knowledge and awareness of human papillomavirus (HPV), cervical cancer and HPV vaccine among women in two distinct Nepali communities.

This study assessed human papillomavirus (HPV), cervical cancer, and HPV vaccine knowledge and awareness among women in two sub-populations in Nepal - Khokana, a traditional Newari village in the Lalitpur District about eight kilometers south of Kathmandu, and Sanphebagar, a village development committee within Achham District in rural Far-Western Nepal. Study participants were recruited during health camps conducted by Nepal Fertility Care Center, a Nepali non-governmental organization. Experienced staff administered a Nepali language survey instrument that included questions on socio-demographics, reproductive health and knowledge on HPV, cervical cancer, and the HPV vaccine. Of the 749 participants, 387 (51.7%) were from Khokana and 362 (48.3%) were from Sanphebagar. Overall, 53.3% (n=372) of women were aware of cervical cancer with a significant difference between Khokana and Sanphebagar (63.3% vs 43.0%; p=0.001). Overall, 15.4% (n=107) of women had heard of HPV and 32% (n=34) of these women reported having heard of the HPV vaccine. If freely available, 77.5% of the women reported willingness to have their children vaccinated against HPV. Factors associated with cervical cancer awareness included knowledge of HPV (Khokana: Odds Ratio (OR)=24.5; (95% Confidence Interval (CI): 3.1-190.2, Sanphebagar: OR=14.8; 95% CI: 3.7-58.4)) and sexually transmitted infections (Khokana: OR=6.18; 95% CI: 3.1-12.4; Sanphebagar: OR=17.0; 95% CI: 7.3- 39.7) among other risk factors. Knowledge and awareness of HPV, cervical cancer, and the HPV vaccine remains low among women in Khokana and Sanphebagar. Acceptance of a freely available HPV vaccine for children was high, indicating potentially high uptake rates in these communities.

Assessment of High-Risk Human Papillomavirus Infections Using Clinician- and Self-Collected Cervical Sampling Methods in Rural Women from Far Western Nepal

IntroductionNepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening.MethodsStudy participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.ResultsOf 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3–13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43–0.81), indicating a “good” level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%).ConclusionThis is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.

Female Autonomy and Fertility in Nepal

We explore the effect of female autonomy on individual fertility in Nepal. We find that families where wives have high level of autonomy have fewer children than other families. Using gender of the first child as a natural experiment, we also find that son preferences are present in Nepal. Moreover, the results indicate that women have more influence when the first born is a boy, compared to when the first child is a girl. We discuss policy implications with respect to the problem of excess children due to son preference.

Effect of socioeconomic characteristics on age at marriage and total fertility in Nepal.

In societies where childbearing prior to marriage is not socially acceptable, postponement of marriage contributes significantly to a reduction in fertility level by shortening the total reproductive life of women. This, in turn, reduces the number of children a woman is likely to have and has a negative impact on the population growth rate of a country. This paper examined the effect of socioeconomic characteristics on age at marriage and on total fertility rates in Nepal using a household-level dataset. The estimated results showed that an increase in age at marriage significantly reduced total fertility of women. An increase in the number of children who died had a statistically significant effect on total fertility (child replacement effect). The estimation results also emphasized the role of female education in reducing total fertility and increasing age at marriage. Moreover, female educational effect had a strong inter-generational effect on age at marriage, and this effect was stronger than the effect of male educational attainment. One implication of these results is that from the policy point of view, all other things being equal, governments should accord a significant priority to female education and, in particular, a higher priority compared to male schooling.

The neighborhood history calendar: a data collection method designed for dynamic multilevel modeling.

"This paper presents a new data collection method, called the Neighborhood History Calendar, designed to collect event histories of community-level changes over time. We discuss the need for and the uses of this method. We describe issues related to the design of instruments, collection of data, and data entry. We provide detailed examples from an application of this method to the study of marriage, contraception, and fertility in rural Nepal. The paper addresses applications of this same technique to other settings and research problems. We also extend the technique to collection of other forms of contextual-history data, including school histories and health service histories. Finally, we discuss how Geographic Information System (GIS) technology can be used to link together multiple sources of contextual-history data."

Declining fertility in Nepal

Abstract After substantial efforts by population and family planning programmes, fertility in Nepal has begun to decline.