Engendering a New Nepal: Contribution of the Family Planning Association of Nepal

Statement by Kul Chandra Gautam

Guest of Honour, at Golden Jubilee Celebration of FPAN

Kathmandu, 22 July 2008

I join all others in congratulating most warmly the Family Planning Association of Nepal (FPAN) as it begins the countdown to its golden jubilee today.

It is both wonderful and symbolic that FPAN’s golden jubilee coincides with Nepal’s historic transformation into a progressive, inclusive, republican democracy.

While the FPAN would not claim any credit for this historic transformation, I would dare say that some of its work, especially its advocacy for the empowerment of women and youth; its tireless efforts to raise awareness about sexual and reproductive health as a basic human right; its information, education and communication campaign sustained over 5 decades, not just in support of family planning but also against gender-based violence and discrimination, definitely contributed to people’s awareness and demand for broader democratic rights.

Indeed, as I studied FPAN’s history and the catalogue of its many pioneering and innovative initiatives; its impressive outreach and its actual achievements, I realized that FPAN is probably one of Nepal’s best kept secrets.

We Nepalis suffer from a common disease called excessive cynicism. We tend to complain endlessly about our failures, and rarely acknowledge, much less celebrate, our successes. These days, it is fashionable to make sweeping statements that nothing good ever happened in this country over the past half century. That, of course, is not true. A proof is the good work and achievements of FPAN.

I recall going to international conferences and reading comparative progress reports, for example, on the Millennium Development Goals. I feel proud that, unlike many other least developed countries, and countries in conflict, Nepal is actually on track to achieve quite a few of the MDGs.

I also recall going to Nepal’s villages and hearing many village elders acknowledge how much things have changed – mostly for the better – in their life-time. But it is uncommon and it seems politically incorrect in Kathmandu and even among Nepalis in the Diaspora to speak about such progress.

We Nepalis prefer to see the glass as half-empty rather than as half-full.

Yes, Nepal has very high rates of poverty, malnutrition, illiteracy and inequality. Yes, it is still burdened with the legacy of feudalism. But compared to the time of the founding of FPAN 50 years ago, there has also been tremendous progress.

From almost the total absence of basic services in the 1950s, today 80 percent of children attend primary school, adult literacy rate is also approaching 80 percent, 90 percent of children are immunized, and 90 percent of the people have access to drinking water. Access to the road network, electricity and telecommunications is expanding dramatically.

We do have serious problems of inequality and disparities, between men and women, rural and urban populations, rich and poor, and different ethnic and geographic groups. But such problems are not unique to Nepal. Unlike a Burma or North Korea or Zimbabwe, we are not going backwards, but are moving ahead.

And the recent political changes augur well for more accelerated, inclusive and equitable progress.

Closer to the area of FPAN’s work, for example, in the 1960s Nepal’s U5MR was over 250 per 1000 live births. By 1990 it had declined to about 150. And then it further declined sharply to just 59 in 2007. In other words, 50 years ago when FPAN was founded, 400,000 babies were born every year of whom 100,000 died before the age of 5. Last year 800,000 babies were born, but only 50,000 died.

What do these figures tell us? On the surface, it seems that Nepal has done a bad job in family planning, but a good job in child survival.

Now that may not sound like such good news for FPAN. But hold it, behind these figures lies another deep truth – not widely understood: that parents tend to have many children when child mortality rates are high. And they begin to voluntarily reduce family size only when they feel confident that their first children have a good chance of survival.

In Nepal, we began to see this parental confidence that their first children will survive around 1990 when child mortality rates had declined by 50 % compared to those of the 1960s. Then, we started seeing a steep decline in both fertility and mortality rates.

Thus, a typical family had 6 children in 1960, 5 children in 1990 but only 3 children by 2007. Steady decline in child mortality rate therefore had quite a direct, though slightly delayed, impact in fertility rates.

What is especially remarkable is that during the last decade, when we had a terrible civil war, with thousands of civilian deaths each year, destruction of infrastructure, interruption of many basic services in rural areas, both child deaths and child birth rates, and even maternal mortality rates continued to decline sharply.

In all of this, FPAN played a very important role.

The FPAN was founded 50 years ago by a small group of concerned medical doctors and social workers, before there was an official family planning programme. Those were the days when family planning was an alien concept, considered contrary to Nepal’s religious and socio-cultural values.

Older Nepalis here will recall that a common blessing given by elders to their youngsters on all auspicious occasions went like this: “Santaanle danda kanda dhakun” or “May you bear many children who will inhabit all across the hills and forests of this land”. Certainly, to advocate for “a small family norm” or “saano parivar, sukhi parivar” would have seemed like a curse, not a blessing.

Yet that is precisely what FPAN set out to do. Distributing condoms and pills and inserting loops, it started educating people on the importance of family planning. Along the way, it became more sophisticated and adopted an “integrated” approach, combining family planning with community development and maternal and child health.

Following the historic 1994 Cairo International Conference on Population and Development, the emphasis of FPAN, as that of the International Planned Parenthood Federation (IPPF), and the whole UN system, evolved to embrace a more comprehensive sexual and reproductive health approach.

Today, FPAN provides a range of sexual and reproductive health information and services – from all modern methods of family planning, to treatment of sexually transmitted diseases, prevention of HIV/AIDS, to protection of women against gender-based violence.

FPAN’s courageous advocacy, later supported by many feminist groups, health professionals and rights activists led to the liberalization of Nepal’s abortion law. It is partly credited for the recent trend in rapid reduction of maternal mortality.

Perhaps the most important recent contribution of FPAN has been youth-friendly counseling and services, including through a network of several thousand peer educators.

With over 11,000 grassroots volunteers, FPAN today has a network of health promoters that is second only to Nepal’s highly acclaimed 48,000 female community health volunteers who are credited for the impressive coverage of Vitamin A, immunization, and other life-saving interventions that have put Nepal on track to achieving MDGs 4 and 5.

Working together, and in a harmonized manner, the FPAN youth volunteers and the FCHV can mutually reinforce each others’ work, just as child survival and family planning programmes pursued together can achieve even more impressive and sustainable results.

Dear friends,

As we congratulate the FPAN for its many successes, let us recall the profound observation that ultimately, education – especially girls’ education – is the best contraceptive, and also the most effective strategy to combat poverty.

As we know, an educated girl tends to marry later. She is more likely to space her pregnancies. She will seek medical care for herself and for her children. She will demand sexual and reproductive health services as her right. She will have better income-earning capacity and she will fight for better political representation in her community and government. She will ensure that her own children, especially her daughters, attend school.

This is not just theory, but there is plenty of empirical evidence to support it. I recall last year at the Women Deliver Conference in London, The Lancet magazine presented the findings of a 30 year longitudinal study in Matlab, Bangladesh that showed that maternal mortality was 3 times lower among women who had 8 years of education compared to those who had no formal education. Abortion-related mortality was 11 times lower among educated women compared to those who had no education.

Investment in education of girls and women is therefore the most effective way to empower women and prevent the intergenerational transmission of poverty.

Friends, as we know, progress sometimes has its unintended negative consequences, just like even good medicines sometimes have bad side-effects. In that context, let me add a cautionary note on one of FPAN’s great success stories, Nepal’s liberalized abortion law, which on the whole we consider progressive and positive.

I am not worried here about the conservative, religious and other so-called pro-life groups’ concerns, or the gag rules of certain governments. I am referring here to what we all pro-choice professionals and activists need to worry about in terms of the possible negative impact of readily available abortion in a society like ours with a strong son-preference.

We have seen in parts of India, and in other countries, that along with the decline in fertility and the ready availability of abortion, there has been an increase in female foeticide. In India as a whole, the sex ratio in the age group 0 to 6, worsened from 962 in 1981 to 927 in 2001. But in some of the more prosperous districts of Punjab and Haryana, it dipped to a shocking 80 girls for 100 boys.

Let us make sure that ready availability of abortion services in Nepal does not lead us towards such unintended, anti-girl and women consequences.

We all want to create a situation where the need for abortion is rare, that it is not used as a method of family planning, or abused for sex selection, but that when needed to avoid unintended pregnancies, it is safe and readily available.

As we have entered an era of a more inclusive democracy in Nepal, better representation, participation and empowerment of women is already high on our national agenda. Both as a matter of human rights and as a spur for human development, the New Nepal must give high priority to women’s health, education and empowerment.

In this respect, FPAN stands on good ground, based on its solid track record to help build a New Nepal of greater gender equality and empowerment of women.

Let us recall that family planning, and even improvement of sexual and reproductive health, are the means, and our short-term objectives. Our long-term goal is to create a world, where every man and woman, starting with every child, can lead a life of dignity; where their basic needs are met, their human rights are honoured, and they can all aspire to live up to their full human potential in a peaceful, democratic society.

Perhaps the greatest obstacle for that in our country still remains deeply entrenched gender inequality and oppression of women. Our concern for gender equality and women’s empowerment should not be seen as some modern development fad or a foreign concept. Even our ancient scriptures recognized this in the profound statement: “Yatra naryastu pujyante, ramante tatra devata” or “Gods rejoice where women are cherished”. Over time, we have betrayed that ancient wisdom from our own culture.

I hope, as it begins its second half century, FPAN, with support from all of us, will be in the vanguard of a new, vigorous movement to recapture that old wisdom in the new Nepal of 21st century.

Ladies and gentlemen,

Before concluding, let me take the occasion to acknowledge the presence here among us of so many leaders of IPPF from this region and its HQ. I have had the pleasure to work with several global leaders of IPPF when I was working at UNICEF both in the field and during various high level United Nations conferences.

I admire IPPF’s courageous and principled leadership on so many sensitive issues. It stands as a trusted partner of the United Nations and a beacon of hope and solidarity for the world’s women.

I would urge and count on IPPF, and all other donors and partners here to provide the strongest support we can to FPAN at this historic juncture of both its Golden jubilee, and the golden opportunity that we all have to contribute to the development of a New Nepal that exudes greater gender equality, a peaceful and thriving democracy committed to accelerating human progress for all its citizens.

Thank you.

( Mr. Gautam, a citizen of Nepal, is former Assistant Secretary-General of the United Nations, and Deputy Executive Director of UNICEF)