Feb 22, 2016 - sources of statistical information on children and women. .... Advise mothers and caretakers to feed chil
©Government of Nepal, Central Bureau of Statistics and UNICEF Nepal, December 2015 This booklet can be reproduced with due acknowledgement Illustrations by Krishna Gopal Shrestha Cover illustration by Bhupendra Tamatta
Published by: Government of Nepal
Central Bureau of Statistics Thapathali, Kathmandu, Nepal Tel. 977-1-14245947/ 4229406 United Nations Children's Fund (UNICEF) United Nations House Pulchowk, Lalitpur, Nepal Tel. 977-1-5523200 PO Box 1187, Kathmandu, Nepal
This booklet can be downloaded from http://www.cbs.gov.np and http://www.unicef.org.np
Foreword Multiple Indicator Cluster Surveys (MICS) have gradually evolved to collect statistically sound, internationally comparable estimates of key indicators that are used to assess the situation of children and women. For many countries around the world, MICS are becoming the primary data source on children, a tool for developing new policies and strategies and identifying vulnerable groups, as well as influencing public opinion about issues involving children and women. These findings can be presented in a child-friendly manner to provide children access to important data and information on matters that affect them. I am very pleased to introduce the child-friendly version of the 2014 MICS. This booklet presents the situation of women, children and adolescents in the areas of nutrition, health, sanitation, and behavioural practices of Nepal. This booklet has been developed to promote understanding of various facts about children and women and also to inform children what can be done to improve the situation. This booklet entitled ‘Lives of Children, Adolescents and Women in Nepal, 2014’ covers topics such as Water for Health, Caring of Newborn baby, Health Seeking Behaviour, Foods for Growth and Development, Drinking Water, Hygiene and Sanitation, Early Childhood Development, Child Protection, Harmful Practices among Adolescents, and Protecting Ourselves from HIV. These are immensely important areas for our children which equips them with knowledge and skills. As the booklet encourages teachers to provide support in these matters to the children, MICS would thus even help to improve learning environment in schools. The Central Bureau of Statistics is grateful to UNICEF for communicating MICS results through this child-friendly booklet. I would like to take this opportunity to acknowledge the teams involved in preparing this informative, entertaining, and educational booklet.
Suman Raj Aryal Director General Central Bureau of Statistics
To Young Readers Dear Children, It is my pleasure to share with you this child-friendly version of Nepal Multiple Indicator Cluster Survey (MICS) 2014 report. Along with illustrations, the booklet also contains simple key messages that highlight the situation of children in Nepal, especially those who live in rather difficult circumstances. It is designed to inform children and adolescents aged 10 to 19 years living across the 75 districts of Nepal. MICS is conducted by the Government every three years with the support of UNICEF. The recent and fifth round was concluded in Nepal in 2014. Data generated from this survey allow the Government of Nepal to check if the country is progressing towards meeting its important goals regarding children, including the Millennium Development Goals (MDGs) and other international commitments like the Convention on the Rights of the Child (CRC). I hope that the two important sections, “Survey Findings” and “What should we do,” in each chapter will not only help you to be aware of the situation of children in Nepal but also enable you to understand the need and ways to promote equity and a childfriendly attitude in your community. I also hope that this booklet will guide you on ways to ensure the protection of the rights of children as described in the CRC. UNICEF is grateful to the Central Bureau of Statistics for their leadership in conducting the MICS survey in Nepal. The survey has provided a strong base for this child-friendly version of the MICS report. Special thanks to child club members of the Dasharathchand Municipality, Baitadi for participating in an artwork event and drawing meaningful illustrations for the cover of this booklet. We are also thankful to the teachers and students of Tangal Higher Secondary School, Naxal for their active participation and contribution during the pretesting process of the report. Happy reading!
Tomoo Hozumi Representative UNICEF Nepal
Table of Content About the Booklet
6
Whom Is This Booklet For
7
Chapter 1
Healthy Beginning
8
Chapter 2
Newborn Care
10
Chapter 3
Healthy Habits
12
Chapter 4
Food for Growth and Development
14
Chapter 5
Water for Life and Health
16
Chapter 6
Hygiene and Sanitation
18
Chapter 7
Child Development and Early Learning
20
Chapter 8
Building a Better Future
22
Chapter 9
Protecting Children from Violence, Neglect and Abuse
24
Chapter 10
Harmful Practices
26
Chapter 11
Protecting Ourselves from HIV
28
About the Booklet Lives of Children, Adolescents and Women in Nepal, 2014 a pictorial booklet, is created with the technical and financial assistance from UNICEF Nepal. It is based on a survey carried out by Central Bureau of Statistics in the year 2014. The booklet describes the overall situation of people in Nepal and focuses on the activities they could carry out in order to improve their living standard. The booklet covers a wide variety of topics ranging from Healthy Beginning, Newborn Care, Healthy Habits, Food for Growth and Development, Water for Life and Health, Hygiene and Sanitation, Child Development and Early Learning, Building a Better Future, Protecting Children from Violence, Neglect and Abuse, Harmful Practices among Children and Adolescents and Protecting Ourselves from HIV.
Multiple Indicator Cluster Survey (MICS) is an internationally agreed household survey programme developed by UNICEF and constitutes of one of the world's largest sources of statistical information on children and women. It assists countries in filling data gaps to monitor human development in general and the situation of children and women in particular. It provides data for developing evidence-based policies and also seeks to monitor progress towards national goals and global commitments aimed at promoting the welfare of children, including the Millennium Development Goals. MICS is conducted every three years in Nepal. The previous round of Nepal Multiple Indicator Cluster Survey (NMICS) which was implemented in 2010 covered only the Mid and Far Western Region (24 districts) of Nepal. This time NMICS-5 covered all the 75 districts with a sample size of 12,405 households (in 519 clusters). It has provided disaggregated data of 15 sub-regional levels and also urban and rural areas. The data was compiled by 15 teams of interviewers conducting survey by covering households, women aged 15-49 and children under five years.
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Whom Is This Booklet For ? The booklet has been developed to simplify the findings of the survey carried out. Although this booklet is mainly for children and adolescents aged 10 to 19 years and for their teachers at school, anyone can benefit from the knowledge in this booklet.
Nepal Multiple Indicator Cluster Survey (NMICS), 2014
Note : The boundaries and the names shown on this map do not imply official endorsement or acceptance
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Chapter 1
Healthy Beginning The birth of every child is a special and a critical moment. To ensure that a baby grows and develops well before and after birth, along with institutional delivery, pregnant women should receive proper nutrition, complete antenatal check-ups, adequate rest, good care and affection from their husband and family members. The Government of Nepal provides free child delivery services at health facilities including a transportation allowance of NRs 1,500 for people residing in the Mountain region, NRs 1,000 for those living in the Hilly region and NRs 500 for those in the Terai. Along with this incentive, they also get NRs 400 for a complete antenatal check-up.
Survey Findings •
6 out of 10 pregnant women receive a complete i.e. 4 antenatal check-ups
•
6 out of 10 women deliver their babies at a health facility
•
6 out of 10 mother and child receive postnatal health check-ups
8
What should we do? • Advise pregnant women to have at
least four antenatal check-ups during pregnancy and three postnatal checkups after delivery.
• Encourage every pregnant woman to deliver only at a health centre.
• Suggest pregnant women and recent mothers to take rest, not to carry heavy loads, not to consume tobacco and alcohol and to be careful about personal hygiene.
• Advise pregnant women and those who have recently delivered to eat one additional nutritious meal in addition to regular meals. A mother’s daily food intake should include yellow-coloured fruits, vegetables, lentil soup, meat, fish, poultry products, liver, ghee, green vegetables and a glass of milk.
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Chapter 2
Newborn Care
The first 28 days of life - the newborn time period - is critical as babies are more sensitive and require extra care. A healthy mother, delivery at health facility, proper child care, loving family and a clean home environment contributes greatly to a newborn’s health. Inability to suckle breast milk, fever along with cold hands and feet, difficulty in breathing, rapid breathing, birth weight below 2,500 grams, bluish marks around the mouth, infection in and around the umbilical stump/navel, allergies around the body and hypothermia are some of the signs of danger for newborns and should be immediately checked by health workers.
Survey Findings • 5 out of 10 newborn are breastfed within one hour of birth
• 2 out of 10 newborn’s weigh less than 2,500 grams at the time of birth
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What should we do? • Advise mothers and family members to wash their hands carefully with soap and water before touching the baby.
• Tell families about the importance of dressing the baby in dry, clean and soft clothes and suggest them to keep the baby warm.
• Suggest that the baby should be bathed only 24 hours after birth.
• Communicate the importance of breast feeding within one hour of the child’s birth. Colostrum (first yellowish breast milk) keeps the child safe from a number of diseases.
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Chapter 3
Healthy Habits Common child illnesses like diarrhoea, pneumonia, acute respiratory infection, measles, malaria and malnourishment are preventable. Children under the age of one should receive all the required vaccinations. It is the most effective way to protect children from diseases. Diarrhoea is often caused due to poor hygiene practice, lack of clean drinking water, and when infants are not breastfed. Children who have been exposed to smoke from cooking fires or tobacco are at risk of pneumonia and other breathing problems.
Survey Findings •
7 out of 10 children aged 12-23 months are fully immunized by their first birthday
• 2 out of 10 children aged under 5 suffer from diarrhoea receive oral rehydration solution and zinc tablets
• 8 out of 10 household members use solid fuels which emit smoke for the purpose of cooking
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What should we do? • Ensure that all the children under the age of one are fully immunized.
• Encourage parents to give oral
rehydration solution, regular food and plenty of extra fluids during diarrhoea.
• Zinc tablet along with oral re-hydration
solution for children under five reduces the episodes of diarrhoea.
• Advise families to contact the nearest health facility to treat diarrhoea and pneumonia.
• Advise families to use improved
cooking stove for a better home environment.
• Suggest sleeping inside insecticide-
treated beds nets to prevent mosquito bites and diseases spread through mosquitoes.
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Chapter 4
Food for Growth and Development
The period from pregnancy through the first two years of a child’s life shapes their future. Eighty per cent (80%) of a child's brain develops within this time frame. Right nutrition and care received in these 1,000 days have a profound impact on a child's ability to grow, learn and rise out of poverty. If children are malnourished during the first two years of life, physical and mental growth and development will be slowed for the rest of their lifetime. This will be very difficult or impossible to improve later on.
Survey Findings • 4 out of 10 children aged under 5 are stunted or are shorter in height
• 3 out of 10 children aged under 5 are underweight as per their age
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What should we do? • Encourage mothers to exclusively
breastfeed their babies for the first six months.
• A six to eight month old child needs to have solid food at least 2-3 times a day in addition to being breast fed. Likewise, a child of eight months or older needs to have solid food 4-5 times a day along with being breast fed. Also, advise mothers to breastfeed the children as per the children's demands.
• Children should be fed a wide variety of nutritional foods like rice, jaulo (made
of rice, lentils, garlic and ginger), green vegetables, yellow fruits, lentils and peas/ beans, dairy products, butter and ghee, meat, eggs and fish.
• Advise mothers and caretakers to feed children with patience, love and care and to ensure that their hands and utensils are clean before feeding them.
• Advise mothers and caretakers to feed children as frequently as required.
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Chapter 5
Water for Life and Health Using water from sources that are treated can prevent most diseases and prevent children from malnutrition. Water for consumption should come from a safe source or should be purified. Containers carrying and storing water need to be kept clean inside out. They should also be covered to ensure that the water remains clean and safe for drinking.
Survey Findings • 9 out of 10 household members use drinking water from improved sources
• 1 out of 10 household members treat water for drinking purpose
• 8 out of 10 household members drinking water contain faecal coliform that are found in human faeces
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What should we do? • Use treatment methods like boiling, filtration, SODIS (solar disinfection method), chlorination to purify water at home and school. In situations of emergency, chlorinated water can be used. Filtration
Piyush )Chlorination(
Boiling
SODIS
• Use water from wells that are covered. Make sure to purify it before drinking.
• Always keep drinking water safe by storing it in clean and covered containers.
• Always keep the areas around springs and wells clean.
• Plant trees to help prevent springs and wells from drying up.
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Chapter 6
Hygiene and Sanitation
Young children are more vulnerable to the ill-effects of poor hygiene. Washing hands with soap and water reduces the incidence of illnesses like diarrhoea. It also diminishes the risk of respiratory infections such as pneumonia, and lowers the frequency of eye infections like trachoma. The use of latrines combined with good hygiene practices like washing hands with soap and water protects children from diseases and helps in achieving their right to good health and nutrition.
Survey Findings • 6 out of 10 household members use toilets that are clean and not shared
• Faeces of 5 out of 10 children, who are under the age 2, are disposed off safely
• 7 out of 10 households have water and soap available at a fixed place for washing hands
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What should we do? • Encourage family and community to build toilets and always use it for defecation and urination.
• Encourage school teachers and the
school management committee to build separate toilets for boys and girls at school.
• Wash hands properly with soap and
water after defecation, before touching and eating food and before feeding children. Follow this habit in both normal and emergency situations.
• Ensure availability of soap and water in
school and at home for washing hands.
• Advise all the family members to always wash their hands with soap and water before eating and feeding children.
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Chapter 7
Child Development and Early Learning Children start learning from the time of their birth. The first five years of a child's life shapes their future health, happiness, growth, development and learning capability. They develop faster when they get love and affection, attention, encouragement and mental stimulation along with nutritious meals and good healthcare. This helps children to develop a sense of trust and security that helps them to be confident as they grow.
Survey Findings • 5 out of 10 children aged 3 to 5 years are attending early childhood
education
• 1 out of 10 fathers of children aged 3 to 5 years has engaged in four or more activities to promote learning and school readiness
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What should we do? • Explain to parents that the first two years of a child’s life is very important for the growth of their brain.
• Encourage young children to play and
explore. This helps them to learn and develop socially, emotionally, physically and intellectually.
• Advise parents that early childhood development education helps children be ready for school and builds a strong foundation for lifelong learning.
• Explain the fact that, fathers, like mothers also have an important role to play in nurturing a child.
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Chapter 8
Building a Better Future Education plays a key role in an overall development of a child. Entering primary school at the right time is critical to the continuity of a child's development. The new Constitution has provision for free education up to the secondary level (currently up to Grade 10) in community schools. Scholarships are also provided up to grade 10 for Dalits, girls and children with disabilities.
Survey Findings • 8 out of 10 children of primary school age, are attending primary or secondary school
• 6 out of 10 children of secondary school age are attending secondary or higher education
22
What should we do? • Encourage all children who do not attend school to become enrolled in one.
It is also equally important to advise children already enrolled in schools to not drop out.
• Spread awareness about the importance of education and the incentives provided by the government for different groups of people.
• Ask children not to participate in bullying at school and to always report any
form of sexual or psychological abuse and harassment to a teacher, parent or to a person they trust.
23
Chapter 9 Protecting Children from Violence, Neglect and Abuse All children have the right to be protected against violence, abuse and exploitation. Child protection refers to the protection of children from actions and behaviors causing negative impact on children's physical, mental, cognitive, social, moral and intellectual development. In other words, child protection means protection from abuse, neglect, exploitation and violence against children. Children need protection from discrimination, abuse, torture or violence, sexual exploitation, trafficking and transportation, traditional harmful practices, neglect, abduction and economic/child labor exploitation. A family is the first line of protection for children. Parents and family members are primarily responsible for building a protective and loving environment. Children should be safe with family and at school and community. A safe environment provides them an opportunity to live, grow and be confident. Violence, abuse, neglect, exploitation, exclusion and/or discrimination can limit a child’s potential of living, developing and pursuing their dreams.
Survey Findings • 8 out of 10 children aged 1-14 years are punished by their caretakers and others
• 6 out of 10 children aged below 5 years have their birth registered
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What should we do? • Report any incidence of violence at home or
outside to the people you trust. These people could be your friends, brothers, sisters or others. Speak about the violence you experience. Do not keep quiet. • In case of any kind of misbehaviour or illtreatment report the incidence of violence to your teacher, adults, child club members, police or community based groups such as gender based violence watch groups, women's group, village/municipality child protection committees. • Familiarize yourself with the institutions established for child protection and keep handy their contact number and information.
• Make people aware that any person committing violence against children is subject to punishment according to the law.
• Ask your parents if your birth is
registered. Request them to register yours and your siblings’ birth at the Village Development Committee or Municipality Ward office.
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Chapter 10 Harmful Practices Formal or informal union between boys and girls below the age of 18 years is a child marriage. In Nepal, the minimum legal age of marriage is 20 years for both male and female. Before the age of 18, girls are neither physically nor emotionally ready to become wives or mothers. Child marriage not only denies girls an education, but it often makes them vulnerable to a cycle of discrimination, domestic violence and abuse.
Survey Findings • 2 out of 10 women age 15-49 years were first married before the age of 15
• 5 out of 10 women aged 20–49 years were first married before the age of 18
26
What should we do? • Make parents aware that a couple needs to be at least 20 years of age to get married.
• Do not marry before the age of 20 years and also encourage others not to get married before 20.
• Encourage every boy and girl in your community to at least complete secondary education.
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Chapter 11
Protecting Ourselves from HIV
HIV can be prevented and managed. If HIV positive infants and children are diagnosed early, receive effective treatment and take antiretroviral drugs as prescribed, they have a better chance of growing, learning, and developing. Antiretroviral drugs restore the immune system and delay progression to AIDS. To find out if a pregnant women is HIV positive, a blood test can be done during the first pregnancy test. This facility is available at health centres or hospitals with HIV test services.
Survey Findings • 4 out of 10 women aged 15–24 years have comprehensive knowledge on HIV
• 4 out of 10 women aged 15–49 years can correctly identify all three means of mother-to-child transmission of HIV
• 5 out of 10 women aged 15–49 years have positive attitudes towards people living with HIV
28
What should we do?
• Learn how to protect yourself from HIV infection. For example:
1. Practice safe sexual behaviours, for example: • Practice abstinence until you are physically and mentally matured. • Be faithful towards your partner. • Use the condom correctly during every sexual intercourse. 2. Use only new or properly sterlized needles and disposable syringes. 3. Ensure that the blood has passed the HIV test before transfusing it.
• Explain that HIV is not transmitted through casual contact.
• Do not stigmatize and discriminate
against people who are HIV-positive or have been affected by HIV and AIDS.
Health post
• Make people aware that HIV treatment services are provided free of cost at government health facilities.
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About artwork of the coverpage: An artwork event was organized by UNICEF with participation from the municial level child club network of Dasharathchand Municipality, Baitadi districts on 06 January 2015. Fifteen adolescent children: five girls and ten boys aged between 12 – 17 years from various child clubs of the municipality participated in the event. Painting materials such as crayons, color pencils, paint brushes, water colors and art paper were made available to participants. Furthermore, they were given four themes: me & my home, me & my village, me & my district and me & my country to focus their imagination while creating meaningful artworks. Participants were allowed to choose a theme of their interest and involve in artwork depicting their visions. Altogether, 17 meaningful illustrations were sketched of which one of them sketched by Bhupendra Tamatta was selectd and published on the cover of this booklet. Participants of the event were Nisha Bhatta, Mamata Kumari Bhool, Jayanti Kumari Lohar, Roshan Gurung, Kaushal Bhatt, Deni B.K., Mayank Chand, Jagadish Pant, Tilak Bhatta, Abishekh Chand, Deepa Rawal, Anushka Bohora, Bhupendra Tamatta, Ashok Luhar, Raju Chunara. The event coordinated by Binod Kumar Chand (Social Development Officer) and Jagadish Lohar (Social Mobiliser) of Dasharathchand Municipality, and was facilitated by Shankar Paudyal and Sarina K.C. of UNICEF.
