Diminished access to healthcare leads to child mortality in Nepal

27-02-2024

Pauliina Majasaari

Human Rights Researcher 

Global Human Rights Defence

More than 30 percent of children living in Nepal are not registered with the state authorities, which has devastating consequences for the rights of the child.[i] The children are invisible before the eyes of the state and, therefore, lack access to basic rights, such as health care, resulting in more than 45 percent of children dying before the age of five.[ii]

Nepal is one of the most undeveloped countries in the world, leading to the children having very little to no access to their rights, living in extreme poverty and facing difficult issues, such as malnutrition and violence.[iii] Poverty is one of the major causes of unequal access to health services in Nepal.[iv] About 90 percent of the population in Nepal lives in rural areas, consequently, their geographic isolation and low income contribute to limited healthcare access.[v] Furthermore, the healthcare system is not very efficient, as there is a serious lack of medical equipment and materials, as well as a shortage of qualified workers.[vi] However, the Nepalese state is active in bettering its healthcare system. For instance, the Child Health Division under the Ministry of Health provides a wide range of programs to better the access and availability of high quality preventative care and primary healthcare for children.[vii] Additionally, educational programs targeted towards mothers are held to teach them to identify the symptoms of different sicknesses.[viii]

According to Article 6 of the Convention on the Rights of the Child (CRC), every child has the right to life and states should ensure to the maximum extent possible the survival and development of the child.[ix] Additionally, Article 3 of the CRC ensures that the best interest of the child should always be a primary consideration when taking action or deciding about matters on behalf of the child.[x] Lastly, Article 24 of the CRC, provides every child the right to enjoy the highest attainable standard of health as well as the presence and access to facilities for the treatment of illness.[xi] Every state should aim to ensure that children are not deprived of the access to health care services.[xii] Furthermore, the states should take measures to decrease child mortality, develop primary health care, to combat malnutrition by offering access to clean drinking water and nutritious food and to educate parents and children on basics of child health and nutrition.[xiii] The high child mortality rate is an alarming sign of the living conditions of children and the major lack of information about sickness and its treatment for parents. The healthcare system and the practices present in Nepal are not guaranteeing children’s rights under the CRC. 

Firstly, even though the state is not refusing the birth registration of children, by failing to register their children, parents are acting contrary to Article 3 of the CRC, as absence of birth registration has grave consequences for the rights of the child and is not in line with their best interest - the most important principle related to children. Furthermore, the laws on birth registration in Nepal grant the responsibility of registration to the male head of the family. As such, they can contradict the child’s best interest principle, especially in cases where children are born to an absent father, resulting in difficulties for the mother to register her child.[xiv] 

Secondly, high mortality rates and the diminished access to healthcare services are not in line with Article 6 of the CRC, for the child’s right to life is not properly secured. A further complicating factor is the physical inaccessibility of healthcare in rural regions, for families must travel vast distances to reach their closest healthcare centre.[xv] 

Thirdly, Nepal is not abiding by Article 24 of the CRC, insofar as it cannot guarantee sufficient healthcare facilities, access to clean water, nor education for parents about children’s health and treatment of their sicknesses. As a state party to the Convention, Nepal holds commitments to better the current status of healthcare services for its people, especially for children.

The Nepalese government is urged by the international community to educate its peoples, in particular women, on matters relating to children’s health, as well as increase the number of facilities and enhance the quality of services within existing health facilities to ensure that every child, regardless of their socioeconomic status, has access to such services.[xvi] Additionally, as concerns has been raised on the high mortality rates of children, Nepal is urged to work towards changing its policies for bettering the access to healthcare for all children and thereby ensure that every child has the possibility for long life expectancy, in accordance with the right to life and the CRC.[xvii]

[i] Lily Ealey, ‘Around the World: Children's Lack of Access to Fundamental Rights in Nepal and the Effects the Nepalese Legal System Has on Poverty, Health, Education, Child Labor, Child Trafficking, and Child Marriage’ (2020) 39 CHILD. LEGAL RTS. J. 184, 1.

[ii] ibid.

[iii] ibid.

[iv] Shreezal GC and Naveen Adhikari, ‘Decomposing inequality in Maternal and child services in Nepal’ (2023) 23 BMC Public Health 955.

[v]Sonal Singh, Erik Bøhler, Khagendra Dahal et al, ‘The State of Child Health and Human Rights in Nepal’ (2006) 3 PLoS Med. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483907/> accessed February 27th 2024.

[vi] Lily Ealey (n i), 185.

[vii] ibid.

[viii] ibid.

[ix] Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) 1577 UNTS 3 (CRC).

[x] ibid.

[xi] ibid.

[xii] CRC, article 24 (1).

[xiii] CRC, article 24 (2) (a), (b), (c) and (e).

[xiv] Jaap van der Straaten and TEAM Consult Pvt Ltd, ‘Unregistered Children Project. Nepal Report. Plan International: Manila (ESARO)/Kathmandu’ (Plan International South Asia, June 2000) <https://www.researchgate.net/publication/335813864_Unregistered_Children_Project_Nepal_Report_Plan_International_Manila_ESAROKathmandu> accessed March 4th 2024.

[xv] Sonal Singh, Erik Bøhler, Khagendra Dahal et al (n iv).

[xvi] Shreezal GC and Naveen Adhikari (n v).

[xvii] Sonal Singh, Erik Bøhler, Khagendra Dahal et al (n iv).