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Nepal 2011Nepal2011Demographic and Health SurveyDemographic andHealth Survey

NepalDemographic and Health Survey2011Population DivisionMinistry of Health and PopulationGovernment of NepalKathmandu, NepalNew ERAKathmandu, NepalICF InternationalCalverton, Maryland, U.S.A.March 2012New ERAMinistry of Healthand Population

The 2011 Nepal Demographic and Health Survey (2011 NDHS) was implemented by New ERA under the aegisof the Ministry of Health and Population (MOHP). Funding for the survey was provided by USAID. ICFInternational provided technical assistance for the survey through the MEASURE DHS program, a USAIDfunded project providing support and technical assistance in the implementation of population and healthsurveys in countries worldwide. The opinions expressed herein are those of the authors and do not necessarilyreflect the views of the U.S. Agency for International Development.Additional information about the survey may be obtained from the Population Division, Ministry of Health andPopulation, Government of Nepal, Ramshahpath, Kathmandu, Nepal; Telephone: (977-1) 4262987; New ERA,P.O. Box 722, Kathmandu, Nepal; Telephone: (977-1) 4423176/4413603; Fax: (977-1) 4419562; E-mail:info@newera.wlink.com.np. Information about the DHS program may be obtained from MEASURE DHS, ICFInternational, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200, Fax:301-572-0999, E-mail: reports@measuredhs.com, Internet: http://www.measuredhs.com.Recommended citation:Ministry of Health and Population (MOHP) [Nepal], New ERA, and ICF International Inc. 2012. NepalDemographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, andICF International, Calverton, Maryland.

CONTENTSTables and Figures . ixForeword. xvAcknowledgments . xviiTechnical Advisory Committee and Technical Working Committee . xixContributors to the Report . xxiMillennium Development Goal Indicators . xxiiiMap of Nepal . xxivCHAPTER 11.11.21.31.41.51.61.71.81.91.101.11CHAPTER 22.12.22.32.42.52.62.72.82.92.10INTRODUCTION. 1History, Geography, and Economy . 11.1.1History . 11.1.2Geography . 11.1.3Economy . 3Population . 3Population and Health Policies and Programs . 4Objectives of the Survey . 5Organization of the Survey . 6Sample Design . 61.6.1Sampling Frame . 71.6.2Domains . 71.6.3Sample Selection . 7Questionnaires. 8Hemoglobin Testing . 8Listing, Pretest, Training, and Fieldwork . 91.9.1Listing . 91.9.2Pretest . 91.9.3Training of Field Staff . 91.9.4Fieldwork . 10Data Processing . 10Response Rates . 10HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 13Household Characteristics. 132.1.1Water and Sanitation. 132.1.2Housing Characteristics . 162.1.3Household Possessions . 18Socioeconomic Status Index . 19Household Population by Age and Sex . 20Migration Status . 22Household Composition . 25Birth Registration . 25Children’s Living Arrangements, Orphanhood, and School Attendance . 26Education of Household Population. 282.8.1Educational Attainment of Household Population . 282.8.2School Attendance Ratios . 302.8.3Early Childhood Development Centers . 33Possession of Mosquito Nets . 34Prevalence and Causes of Food Insecurity and Coping Strategies . 35Contents iii

CHAPTER 33.13.23.33.43.53.6CHARACTERISTICS OF RESPONDENTS . 41Characteristics of Survey Respondents . 413.1.1Spousal Separation. 43Educational Attainment by Background Characteristics . 44Literacy . 47Access to Mass Media. 493.4.1Access to Specific Radio and Television Programs . 513.4.2Preferred Media Source for Health-Related Programs . 53Employment . 543.5.1Employment Status . 543.5.2Occupation . 573.5.3Earnings, Employers, and Continuity of Employment . 60Use of Tobacco . 61CHAPTER 44.14.24.34.44.54.64.7MARRIAGE AND SEXUAL ACTIVITY . 65Current Marital Status . 65Polygyny . 66Age at First Marriage . 67Median Age at First Marriage . 68Age at First Sexual Intercourse . 70Median Age at First Sexual Intercourse . 71Recent Sexual Activity. 71CHAPTER 55.15.25.35.45.55.65.75.85.9FERTILITY. 75Current Fertility . 75Fertility Differentials. 76Fertility Trends. 77Children Ever Born and Living . 78Birth Intervals . 79Postpartum Amenorrhea, Abstinence, and Insusceptibility . 81Menopause . 82Age at First Birth . 82Teenage Pregnancy and Motherhood . 83CHAPTER 66.16.26.36.46.5FERTILITY PREFERENCES . 85Desire for More Children . 85Desire to Limit Childbearing by Background Characteristics. 86Ideal Family Size . 88Fertility Planning . 90Wanted Fertility Rates . 90CHAPTER 77.17.27.37.47.57.67.77.87.97.10FAMILY PLANNING . 93Knowledge of Contraceptive Methods . 94Current Use of Contraception . 94Current Use of Contraception by Background Characteristics . 95Trends in Current Use of Family Planning . 97Timing of Female Sterilization . 98Source of Contraception. 99Brands of Pills and Condoms Used . 100Informed Choice . 101Contraceptive Discontinuation Rates . 102Reasons for Discontinuation of Contraceptive Use . 102iv Contents

7.117.127.137.147.157.167.17Knowledge of Fertile Period . 103Need and Demand for Family Planning Services . 103Future Use of Contraception . 105Exposure to Family Planning Messages. 105Contact of Nonusers with Family Planning Providers . 107Counseling During Postpartum and Post-abortion . 108Men’s Attitudes towards Contraception . 110CHAPTER 88.18.28.38.48.58.6INFANT AND CHILD MORTALITY . 111Assessment of Data Quality . 112Levels and Trends in Infant and Child Mortality . 113Socioeconomic Differentials in Childhood Mortality . 114Demographic Differentials in Mortality . 115Perinatal Mortality . 116High-risk Fertility Behavior . 117CHAPTER 99.1MATERNAL HEALTH . 119Antenatal Care . 1199.1.1Number and Timing of Antenatal Visits . 121Components of Antenatal Care . 121Tetanus Toxoid Vaccination . 123Place of Delivery. 124Assistance during Delivery . 1269.5.1Care and Support during Delivery . 1289.5.2Birth Preparedness . 130Postnatal Care . 1309.6.1Timing of First Postnatal Checkup for the Mother . 1319.6.2Provider of First Postnatal Checkup for Mother . 132Newborn Care . 1329.7.1Provider of First Postnatal Checkup for the Newborn . 1349.7.2Newborn Care Practices. 135Abortion . 1369.8.1Knowledge that Abortion is Legal in Nepal . 1379.8.2Knowledge about Places That Provide Safe Abortions . 1389.8.3Pregnancy Outcomes . 1399.8.4Reason for the Most Recent Abortion . 1409.8.5Type of Abortion Procedure . 1419.8.6Place and Provider for Abortion . 1429.8.7Complications during and after Abortion and Contraception . 1439.8.8Abortion and Post-abortion Cost . 143Uterine Prolapse . 143Problems in Accessing Health Care . 1439.10.1 Awareness and Practice of Health Services in the Government Sector . 1449.29.39.49.59.69.79.89.99.10CHAPTER 1010.110.210.310.410.510.610.7CHILD HEALTH . 147Child’s Weight and Size at Birth . 148Vaccination Coverage . 149Vaccination by Background Characteristics . 150Trends in Immunization Coverage . 152Acute Respiratory Infection . 152Fever . 153Diarrhea . 155Contents v

10.810.910.1010.11Diarrhea Treatment . 156Feeding Practices during Diarrhea . 158Knowledge of ORS Packets . 159Disposal of Children’s Stools. 160CHAPTER 1111.1NUTRITION OF CHILDREN AND WOMEN. 163Nutritional Status of Children . 16411.1.1 Measurement of Nutritional Status among Young Children . 16411.1.2 Data Collection . 16511.1.3 Measures of Child Nutrition Status. 16511.1.4 Trends in Children’s Nutritional Status . 168Breastfeeding and Complementary Feeding . 16911.2.1 Initiation of Breastfeeding . 169Breastfeeding Status by Age . 171Duration of Breastfeeding . 173Types of Complementary Foods . 174Infant and Young Child Feeding (IYCF) Practices . 175Prevalence of Anemia in Children . 177Micronutrient Intake among Children . 179Nutritional Status of Women . 182Prevalence of Anemia in Women . 184Micronutrient Intake among Mothers . ER APTER 1313.113.213.313.4vi ContentsHIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 189Introduction . 189HIV and AIDS Knowledge, Transmission, and Prevention Methods . 19012.2.1 Knowledge of AIDS . 19012.2.2 Knowledge of HIV Prevention Methods . 19112.2.3 Comprehensive Knowledge of HIV and AIDS Transmission . 193Knowledge of Prevention of Mother-to-Child Transmission of HIV . 196Accepting Attitudes toward those Living with HIV and AIDS. 197Attitudes toward Negotiating Safer Sex . 199Multiple Sexual Partners . 201Payment for Sex . 202Testing for HIV . 203Self-reporting of Sexually Transmitted Infections . 206Prevalence of Medical Injections . 207HIV and AIDS-related Knowledge and Behavior among Youth . 20812.11.1 Knowledge about HIV and AIDS and of Sources for Condoms. 20912.11.2 Age at First Sexual Intercourse among Youth . 21012.11.3 Premarital Sex. 21112.11.4 Multiple Sexual Partners among Youth . 21212.11.5 Age Mixing in Sexual Relationships among Women Age 15-19 . 21312.11.6 Recent HIV Tests among Youth . 214WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTHOUTCOMES . 215Employment and Form of Earnings . 216Women’s Control over Their Own Earnings and Relative Magnitude of Women’sand Their Husbands’ Earnings . 218Control over Husbands’ Earnings . 219Women’s and Men’s Ownership of Selected Assets. 222

13.513.613.713.813.913.10Women’s Participation in Decision-making . 224Women’s Empowerment Indicators . 227Current Use of Contraception by Women’s Status . 229Ideal Family Size and Unmet Need by Women’s Status . 230Reproductive Health Care and Women’s Empowerment . 231Infant and Child Mortality and Women’s Empowerment . 232CHAPTER 1414.1DOMESTIC VIOLENCE. 233Measurement of Violence . 23414.1.1 Use of Valid Measures of Violence . 23414.1.2 Ethical Considerations in the 2011 NDHS . 23514.1.3 Subsample for the Violence Module. 235Experience of Physical Violence . 236Perpetrators of Physical Violence . 237Experience of Sexual Violence . 237Perpetrators of Sexual Violence . 238Experience of Different Forms of Violence . 239Forced at Sexual Initiation . 239Violence during Pregnancy . 239Marital Control by Husband. 240Forms of Spousal Violence . 241Spousal Violence by Background Characteristics. 243Violence by Spousal Characteristics and Women’s Empowerment Indicators. 244Frequency of Spousal Violence . 245Onset of Spousal Violence . 247Physical Consequences of Spousal Violence . 247Violence by Women against Their Husbands . 248Help-seeking Behavior by Women Who Experience Violence . 14.1314.1414.1514.1614.17REFERENCES . 253APPENDIX AAPPENDIX BAPPENDIX CAPPENDIX DAPPENDIX ESAMPLE DESIGN AND IMPLEMENTATION .

Ministry of Health and Population Government of Nepal Kathmandu, Nepal New ERA Kathmandu, Nepal ICF International Calverton, Maryland, U.S.A. March 2012 New ERA Ministry of Health and Population. The 2011 Nepal Demographic and Health Survey (2011 NDHS) was implemented by New ERA under the aegis . 2.7 Children's Living Arrangements .