Nepali Times: What are the main demographic trends that will affect Nepal in the next 30 years? Won Young Hong: There are two major demographic trends we see on the horizon in Nepal in the next 30 years. The first of these is the age of the population. We expect fertility rates to continue to decline, as in many other countries in the region. It dropped from 4.6 children per woman in 1996 to 2.1 in 2022. This indicates a shift towards smaller family sizes in Nepal.&nbsp; The working-age population between 15-64 years is 64.6%, and this will peak in 2051 at 69.4% before starting to decline to 66.7% in 2061. At the same time, the proportion of people aged 60 and above increased from 7.6% in 2011 to 9.0% in 2021.&nbsp; The UN projections estimate that the share of the elderly population will continue to grow in the next few decades until one in five people (22.4%) are elderly in 2061. The second major demographic trend relates to migration, both within Nepal and overseas. According to the 2021 census, around 2.2 million Nepalis were living abroad in 2021. This trend is likely to continue as most young people seek opportunities abroad. Internal migration is also a major trend.&nbsp; Between 2011 and 2021, the population share in the Tarai increased from 50.3% to 53.6%, while in the hills, it decreased from 43% to 40.3%, and in the mountain region, it declined from 6.7% to 6.1%.&nbsp; There is significant internal migration from rural to urban areas in search of better job opportunities and improved living conditions, leading to rapid urbanisation. By 2021, about 27.1% of the population resided in urban areas, up from 22.3% in 2011, while the share of the population living in peri-urban areas remained similar at around 39%.&nbsp; The share of the rural population declined from 38.5% to 33.2% during the same period. Urban areas, especially the Kathmandu Valley, have seen significant population growth, while over half of rural municipalities have seen negative growth. Provincial capitals like Biratnagar and Janakpur have seen population surges. Current trends indicate a rising share of the urban population and a shrinking rural population in the future. How can Nepal avoid the mistakes of some other Asian countries in responding to low fertility? It is an important question, and there are no fixed answers because each country is unique in many ways. Low fertility levels are a global trend, and no single country has managed to reverse this through policies despite a variety of initiatives being introduced. There are many lessons to be learned.&nbsp; It is clear that policies with an exclusive focus on the reproductive function of women with cost-based financial support without addressing structural issues affecting reproductive decisions made by men and women are largely unsuccessful.&nbsp; It is important for Nepal to analyse the issues and develop a context-driven and evidence-based approach to responding to the needs of people. Generally, policy is most effective in supporting people's choices when it responds to the diverse needs of individuals.&nbsp; For example, it is crucial to recognise the impact of the disparities between paid employment and raising children and close that gap with financial support for families with limited incomes. At the same time, employment needs to support women and men with children so they can balance family life and activities with work. Less rigid 9–5 working hours and accessible and high-quality childcare support are just a few of the measures that can help.&nbsp; Employers need to be encouraged to recognise that people with children in the workplace have needs and that there are systemic barriers for parents that have wider social impacts. These can be broken down with greater accommodation of the diversity of preferences of adults as to their choices of when and how many children they want to have.&nbsp; Policies need to create family and child-friendly societies focused on the health, education, and well-being of children and families at large to be successful. Public spending is another such tool, with levels of public funding for families closely linked with period fertility rates as well as cohort family size. There also needs to be individual choices available including in relation to sexual and reproductive health and rights and family planning.&nbsp; There is no one-size-fits-all solution. UNFPA is encouraging this kind of learning and knowledge sharing across countries because there is a huge increase in countries with declining populations, and we believe there are important lessons to be shared across the region and the wider globe. And it is imperative that policies be developed now rather than in a reactive manner.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240714020756_22823ab3f792d6bcc5169b6912021be51006b65c1dda95771fbed1293fccdf6f.jpg" data-media-id="editor_0" data-image-id="20240714020756_22823ab3f792d6bcc5169b6912021be51006b65c1dda95771fbed1293fccdf6f" data-rendition-name="original" width="1060" height="1500" loading="lazy" alt="Won Young Hong UNFPA"> <figcaption>Photo: UNFPA ASIA</figcaption> </figure>  How serious is the anomaly in male: female ratio in Nepal? I would say any population anomaly has serious impacts. Nepal exhibits a skewed sex ratio at birth, with 112 boys born for every 100 girls, according to the 2021 census. This is higher than the biologically normal range of 102 to 107 males per 100 females, indicating potential sex selection practices. The disparity is particularly pronounced in Madhes province, where the sex ratio at birth is 118, compared to the lowest ratio of 106 in Kosi province.&nbsp; This imbalance is concerning as it mirrors trends seen in countries like China (112) and India (108), where cultural preferences for male children have led to significant gender imbalances. The preference for male children can have long-term social impacts, including an imbalance in the population structure related to gender disparity and discrimination.&nbsp; This might include a decline in marriages and partnerships, which can further increase the risks of human trafficking, gender-based violence, and other forms of harm. Nepal needs to identify the underlying drivers and address them with appropriate policy measures. In countries where over the long term there was this kind of imbalance, we see challenges, including a shortage of domestic labour in the workforce, a rapid reduction of fertility levels, and very few tools to reverse these trends. How are population dynamics, gender relations, migration and dropping fertility rate impacting Nepal’s population? The large proportion of the population that is young can potentially bring an enormous demographic dividend with investments in education, healthcare, and infrastructure. There is, however, a limited time window to seize this opportunity of about 30 years, when the population dynamic momentum will reverse as the lower rates of fertility start to impact working age groups and the percentage of the elderly will continue to increase.&nbsp; As the population ages and the proportion of young to old reverses, profound policy-level challenges arise. To take advantage of the window of a demographic dividend, targeted investments that directly benefit young people, including girls, need to be made now while fully implementing a wider range of socio-economic initiatives at all levels in line with the national development vision. We are seeing some really key results in Nepal’s legal framework and policies, including special measures to promote women in public life. At the same time, gender inequality remains a significant challenge, with persistent disparities in public and private spaces.&nbsp; Such persistent gaps, combined with social and economic factors like rising living costs, education costs for children, and childcare costs, will continue to discourage young women and men from having children.&nbsp; For that to happen, there needs to be a family-friendly environment for young people, women and men, to pursue a family life that includes raising children at home and being balanced with the workplace.&nbsp; This brings me on to the second part of your question on migration. The impact is, of course, profound. As people move abroad or to cities, the population landscape changes. If the large numbers of people overseas decide not to return, it will definitely contribute to the low fertility trends in the medium to long term. Equally, as people move to cities from rural or remote areas, there is a huge risk of leaving these areas barren and depopulated, leaving only an ageing population.&nbsp; These population flows require careful policy intervention and incentives to encourage people to invest in Nepal. It is welcome that the government is discussing ways to allow migrants to vote so their preferences can be reflected in the legislature and policymaking and future opportunities that encourage them to return to the country. UNFPA has been involved in helping the Nepal government plan for the demographic window? What have some of your main suggestions been? We do support the Government of Nepal in the area of the demographic window, and the first part of this relates to generating data and evidence that take into account demographic shifts and other megatrends in development policies and plans, as we recognise that without disaggregated, high-quality data and evidence, it will not be possible to achieve inclusive and sustainable development, including economic growth.&nbsp; Evidence is key to good decision-making, and the decisions made today can profoundly impact population dynamics in the future. As such, we support timely, high-quality, and disaggregated data generation that is essential for identifying those furthest behind. A second and related part supports the strategic use of evidence, including data, to improve understanding of the population and demographic structure of Nepal in actual policy decisions. We work with government decision-makers at all levels and civil society to translate data and evidence into pragmatic policies, such as the population policy, that respond to existing and future needs, including the sexual and reproductive health and rights of women and men.&nbsp; Population policy is very important to Nepal, and our experience across the globe shows that to future-proof population policy, it needs to respond in a holistic manner to the socio-economic changes we are witnessing and respond to the diverse needs of young people.&nbsp; To do this, it needs to examine a wide range of issues, including budgetary ones, affecting family decisions, and gender inequality. It is critical for Nepal to expand its understanding of population issues and build an integrated planning framework to respond to the new population trends.

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Future-proofing Nepal’s population strategy

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101148/63720f509c7e80680e0b796ajpeg.jpg" alt="" width="3000" height="2000"/><figcaption>Photo: NISSI THAPA</figcaption></figure>Over 600,000 <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/" target="_blank" rel="noopener noreferrer">pregnancies in Nepal in 2017 were unintended</a>, close to two-third of which ended in abortion, reveals a new report released this week by the UNFPA, the United Nations sexual and reproductive health agency aimed at shedding light on the often neglected health crisis affecting women of reproductive age worldwide.The State of World Population 2022 report titled Seeing the Unseen also estimated that nearly half of all global pregnancies, totalling 121 million each year, are unintended and that 'for the women and girls affected, the most life-altering reproductive choice — whether or not to become pregnant — is no choice at all.'“This report is a wakeup call. The staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights,” says UNFPA Executive Director Natalia Kanem. “Our report reveals that rates of unintended pregnancy strongly correlate with gender inequality, with lower socioeconomic development, and with more restrictions on sexual and reproductive rights.”The report further states that over 60% of unintended pregnancies end in abortion and an estimated 45% of all <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener noreferrer">abortions are unsafe</a>, responsible for 5-13% of all maternal deaths. After taking dramatic strides to reduce maternal mortality rate from 539 per 100,000 live births to 239 between 1996 to 2016, Nepal’s progress has since stagnated, further affected by the pandemic in the last two years.Some 44% of Nepali women of reproductive age who want to avoid pregnancy do not use any contraceptive methods. Similarly, use of modern methods of birth control among married women of reproductive age stands at 43%, leading to high rates of unintended pregnancy and unsafe abortion, while 50% of those who do use contraceptives discontinue within a year. Prevalent gender norms that <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener noreferrer">prevent women and girls from accessing reproductive health care</a> including contraceptives have been identified as a key factor.In addition, half of all pregnancies among adolescents are estimated to be unintended, as only 23% in the group are reported to use contraceptives -- much lower compared to the national average of 43%.Read also: <a href="https://www.nepalitimes.com/banner/lets-talk-about-it/" target="_blank" rel="noopener noreferrer">Let’s talk about it</a>, Duksangh SherpaThe report further states that for every additional dollar spent on <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener noreferrer">expanding modern contraceptive use</a>, Nepal would save $2 on maternal and newborn care as a result of fewer unintended births, induced abortions and maternal deaths."The perception among some policy makers that investing in family planning is no longer necessary due to the decline is fertility in Nepal is very concerning," says Lubna Baqi, UNFPA Country Representative, "as it does not take into account the high levels of unmet need for family planning, which currently stands at 24%, and the high rates of unintended pregnancies, and unsafe abortions that take place because of the gaps in services.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101148/63720f549c7e80680e0b796bjpeg.jpg" alt="" width="960" height="1216">Women and girls from minority groups face further challenges and discrimination in accessing services and information. Given that <a href="https://www.nepalitimes.com/nepali-times-search/?q=child+marriage" target="_blank" rel="noopener noreferrer">child marriage is still prevalent</a> in Nepal with nearly 41% of adolescents married before 18, adolescent girls are at a higher risk.Abortion services on the other hand are largely unsafe. Despite being legalised in 2002, majority of abortions continue to be conducted by untrained personnel or induced by pregnant women themselves. On top of this, most women and girls face structural and informal hindrances barring them from safe services.The report urges decision-makers and health systems to improve accessibility, acceptability, quality and variety of contraception methods to reduce unwanted pregnancies by expanding <a href="https://www.nepalitimes.com/latest/sisterhoods-empowering-education-in-nepal/" target="_blank" rel="noopener noreferrer">sexual and reproductive health care </a>and public awareness. Equally crucial is to empower women and girls to make their own decisions in the matters of sex, contraception and motherhood.Says Baqui: “Contraceptives save lives and it is high time the Nepal government allocated the necessary financing to fulfil this fundamental human right."Read also: <a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener noreferrer">Born in Nepal</a>, Sewa Bhattarai<a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener noreferrer"> </a>

1 in 2 pregnancies in Nepal unintended

https://youtu.be/FmieAvLuWBoFederalism was supposed to bring the government closer to the people, decentralise medical care and improve <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">public health</a> at the grassroots. But the new three-tier government structure threatens to undo Nepal’s gains in improving health services.The government’s ‘adjustment policy’ in the medical sector, which lets staff to pick their preferred tier of work, has led many to choose the federal level, leaving provinces and municipalities underserved. The biggest losers are the areas already lacking in services: Province 6 (Karnali) and the Far Western Province.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37757&amp;preview=true" target="_blank" rel="noopener">Poor health makes Nepalis poorer</a>, Editorial At the Kolti Primary Health Care Centre in Bajura, there is no doctor, after the one serving here chose to be transferred to Kathmandu. Bajura District Hospital has five doctors but the contracts of three of them will soon expire.“I have not been informed of my new hospital yet, but I am about to be transferred. In two months, there will be a shortage of doctors here,” predicts Chief Medical Officer Rup Chandra BK, adding that all technicians, including a paramedic, a radiographer and health assistants, have been transferred or will be soon.Read also: <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66a79c7e80680e059998jpeg.jpg" alt="" width="640" height="427"/>With a population of 135,000 people, Bajura has no private hospitals and only one government hospital, a primary health care centre, and 26 health posts. WHO recommends a doctor-patient ratio of 1:1,000, but here it is 1:150,000, while Kathmandu has a ratio of 1:850.This is nothing new: Far Western Province has long faced medical staff shortages. According to the Department of Health Services Report 2018, only 80% of positions in health facilities were filled, and only 56 of the 142 sanctioned doctor positions were staffed. That number will decrease further after adjustment.According to a list of adjustments of 8th level general practitioners (GPs) by the ministry of health, 36 doctors were serving in Far Western Province, but only 9 of them have chosen to remain. Of the 631 doctors at this level, as many as 326 chose the federal level, which means they are concentrated in Province 3. It is the same story in all other provinces. There are only 14 doctors in Province 6.“Far Western Province has always faced a shortage of doctors. We have a lot of nurses, assistants, and technicians, and even if they are transferred there are others to replace them. But specialist doctors earn a lot in the cities and a government hospital cannot offer them as much. No wonder they do not want to stay here if they have a choice,” says Ramesh Kunwar at the ministry of social welfare in the province.Read also:<a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, Editorial<a href="https://www.nepalitimes.com/here-now/henry-marsh-returns-to-the-institute-created-by-his-neurosurgeon-colleague-upendra-devkota/" target="_blank" rel="noopener">Henry Marsh returns to the institute created by his neurosurgeon colleague Upendra Devkota</a><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66a99c7e80680e059999jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>The Government Doctors’ Association of Nepal (GODAN) is also unhappy. “From the beginning we have said that the medical sector is different from others and adjustment would result in neglect of underserved regions and migration of doctors to the cities, and we were right,” says Dipendra Pandey, president of GODAN. “We proposed that a federal bridge should be created, so that medical professionals working at the federal level can be sent back to their previous working area.”Ironically<a href="https://www.nepalitimes.com/banner/risking-his-life-to-save-lives/" target="_blank" rel="noopener">, physician Govinda KC</a> had to call off his 17th fast unto death in Dadeldhura because the district hospital did not have proper facilities in case his health deteriorated. KC has been protesting the commercialisation of medical education, which forces doctors to work in the cities to recoup their investments.“If the government does not replace those who are leaving the province, there is going to be a great crisis in healthcare in the Far West,” says Gunaraj Awasthi, chief of the Far West Regional Health Directorate in Dipayal. “It should immediately reinstitute those medical professionals on contract service.”<h2>Neglect kills mothers</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66ad9c7e80680e05999ajpeg.jpg" alt="" width="640" height="427"><figcaption> </figcaption></figure>Lalita Bohora, 27, was ten months pregnant when her husband helped her walk for three days from Kolti to Bajura District Hospital to deliver her baby earlier this year. The staff told her it was a complicated pregnancy and there were no doctors to perform a caesariean section.Bohora was lucky — many other mothers are in no position to walk to the district hospital. Although Nepal’s maternal mortality rate (MMR) has come down drastically from 600 per 100,000 live births two decades ago to 239 today, many mothers in remote districts like Bajura continue to <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">lose their lives</a> just because maternity wards are not staffed, or properly equipped.Read also: <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">People, Politics, and Placentas</a>, Bikrash Gauchan<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66b09c7e80680e05999bjpeg.jpg" alt="" width="643" height="376">Since it started in 1997, the government’s safe motherhood program has provided cash to mothers if they do all four antenatal checkups, and mothers, and medical staff, are given cash incentives for institutional delivery. The number of birthing centres staffed by at least one skilled birth attendant has reached 1,755 nationwide.Despite the progress, Nepal is unlikely to bring MMR down to 125 by next year as planned, or meet the Sustainable Development Goal (SDG) target of 70 by 2030. Nepal’s topography and lack of roads are not the only reasons progress in MMR has stalled. According to a recent survey, half of public health facilities in Nepal lack running water and electricity at all times.Bajura District Hospital is constructing a new building, but it still operates out of an old, partly demolished building, where the operation theatre is a tin shed and there is irregular water supply and  electricity.“We hook up machines to the power supply during complicated operations, and the electricity suddenly goes off — we have to improvise a lot here,” says surgeon Durga Maharjan.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66b19c7e80680e05999cjpeg.jpg" alt="" width="640" height="427"></figure>Ward at Bajura District HospitalHaemorrhage during birth used to be the biggest cause of maternal mortality in the 1990s, now it is hospital-borne infections like sepsis. Many older women still think babies should be born at home, and dissuade their daughters-in-law from giving birth at a health facility.“There is still the idea that childbirth is a normal, natural thing, and not something you need to visit a hospital for,” says Latika Maskey at the UN Population Fund (UNFPA).Only 30% of women in Bajura go for all four of the antenatal checkups, while the average for the Far West region is 55%, and nationally it is still a high 44%. Because settlements are scattered in roadless remote Nepal, the government has focused on basic health facilities and birthing centres instead of large well-equipped hospitals, explains Punya Poudel at the safe motherhood program in the ministry of health.“We have a roadmap to reduce MMR to 70 by 2030 by focusing on postnatal checkups, midwives will be trained for delivery and community nurses will visit women at home during ante and postnatal periods,” says Poudel.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151124/636a66b49c7e80680e05999djpeg.jpg" alt="" width="640" height="427"><figcaption> </figcaption></figure>However, many of the new birthing centres are near bigger health facilities, which makes them less useful. There is a concern among health professionals that populist agendas have fuelled construction sprees, and that the birthing centres are not always staffed and ready to provide service.“Simply building birthing centres is not the solution. They should be properly mapped and located where they will be most effective. They should be functional so that at least one person is available 24 hours a day to provide simple delivery services,” says Pavan Agarwal at Bayalpata Hospital in nearby Achham district.Neetu Shrestha of UNFPA says reproductive health should not be limited to treatment of birth as an event. She says: “To improve maternal health, we need to focus on sex education, invest in <a href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener">family planning</a> knowledge and methods, ante and post-natal care, and address cultural barriers.”

Federalism leaves Nepal’s medical sector ailing

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f1049c7e80680e035a06jpeg.jpg" alt="" width="800" height="1199"/><figcaption>Pics: NSI</figcaption></figure>Avinashi Poudel, 30, is a mother of two, including a 10-week baby boy. She only breastfeeds her baby, and has supportive in-laws and a mother friendly environment at her workplace. But seven years ago when she was a first time mother, she was not aware of the benefits of exclusive breastfeeding and her first baby did not get enough of her milk.Rama Thapa, 23, moved to Kathmandu from Tanahu after she got married. She now has a six-month baby boy, and feeds him food supplements because she says her own milk is not enough. Her family and friends told her the baby needs the formula to grow up strong and healthy.Nearly seven out of every ten Nepali mothers still exclusively breastfeed their babies, but some families are turning to supplements because of inroads by baby food manufacturers. Ironically, mothers in western countries where those baby food alternatives were first introduced, have returned to exclusive breastfeeding.Nepal is among the countries that are already above the World Health Organisation (WHO) target to increase the rate of exclusive breastfeeding in babies' first six months to at least 50%, by 2025. However, because of aggressive marketing by baby formula brands, Nepal has set its own national target to increase exclusive breastfeeding to 80%.“Nepal has set a good standard in breastfeeding but we need to sustain it and make further progress, this requires policy implementation and monitoring,” says Pradiumna Dahal, nutrition expert at UNICEF Nepal, who is worried that not all health workers are aware of the benefits of breastfeeding.The use of breast milk substitutes is so widespread that health professionals in the Far-West are prescribing bottled milk in hospitals. Baby food is a burgeoning industry, and salesmen often target hospitals, doctors and nurses with inducements to prescribe babies substitutes for breast milk.After a huge international outcry against Nestle and other baby food supplement manufacturers, the WHO adopted the <a href="http://www.who.int/nutrition/publications/code_english.pdf" target="_blank" rel="noopener noreferrer">International Code of Marketing of Breast-milk Substitutes</a> to promote breastfeeding. Nepal passed the <a href="http://www.nnfsp.gov.np/PublicationFiles/2574d2af-7992-469b-befa-ad939ac96497.pdf" target="_blank" rel="noopener noreferrer">Substitute of Breast Milk Act</a> in 1992 to control the sale and distribution of breast milk substitutes. It penalises health professionals pushing and manufacturers promoting baby food formulas.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f1079c7e80680e035a07jpeg.jpg" alt="" width="500" height="234">But while the $70 billion global baby food industry has seen sales plummet in Western countries, as more mothers embrace breastfeeding, modern lifestyles and higher purchasing power has pushed families in developing countries to use infant formulas.Recently, the <a href="https://www.theguardian.com/us-news/2018/jul/08/trump-administration-opposes-breastfeeding-resolution-report" target="_blank" rel="noopener noreferrer">Trump administration exerted pressure to dilute</a> the clause in a resolution to promote and support breastfeeding at the World Health Assembly in Geneva in order to promote the interests of infant formula manufacturers. The US delegation even threatened Ecuador that it would terminate military aid if it voted for the resolution. Washington could also cut funding for WHO, the UN Population Fund and other agencies involved in promoting breastfeeding, reproductive health, contraceptives, abortion and even vaccination programs in developing countries, including Nepal.Allowing infant formula manufacturers unrestricted access to the domestic market threatens to undo decades of effort in Nepal to reduce the infant mortality rate and promote <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener noreferrer">maternal health</a>.“We have been working to promote breast milk and convinced a large proportion of mothers in Nepal to exclusively breastfeed. However, we have not been able to regulate the activities of the manufacturers of breast milk substitutes,” says Bikash Lamichhane at the Department of Health Services.Nutritionist Aruna Uprety says that despite the government’s claim that the rate of exclusive <a href="https://katherinerosman.com/extended-breastfeeding/" target="_blank" rel="noopener noreferrer">breastfeeding</a> has increased, breast milk substitutes are used widely, even in government hospitals. Manufacturers are known to reward clinics and doctors promoting and prescribing their infant formulas.“Breastfeeding is engrained in our culture, we don’t need foreign experts to teach us its significance. We just need to create awareness and provide an enabling environment for women to be able to breastfeed,” Uprety told Nepali Times.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f1089c7e80680e035a08jpeg.jpg" alt="" width="800" height="1199">Indeed, health officials say any future cuts in American funding for maternal and child health should not make a big dent on efforts to promote exclusive breastfeeding in Nepal.In 2016, the government set up a system to monitor the use of breast milk substitutes in each district. But with new federal and provincial structures in place, and confusion about the role of district health offices, experts are worried that the monitoring system will not be effective.A <a href="http://www.nphss.org.np/archive_2012/52-54.pdf" target="_blank" rel="noopener noreferrer">survey in 2011 by the Institute of Medicine</a> showed that despite the Baby Friendly Hospital Initiative, there had been no action to control and regulate breast milk substitutes and producers and the distributors were found to be violating the Breast Milk Substitute Act. The study also noted that the promotion of breastfeeding was not prioritised and awareness was limited to token functions during World Breastfeeding Week.Studies have shown that counselling, awareness and legislating paid maternity leave increased the rate of exclusive breastfeeding, and had an immediate impact on maternal and infant health as well as the overall economy.Says UNICEF’s Dahal: “We need to encourage more women to breastfeed. That means adding breastfeeding corners in our work places and providing maternal security in the form of sufficient leave.”The Department of Health Services is planning to inaugurate a breastfeeding corner at its own office in Teku to mark World Breastfeeding Week (1-7 August). UNICEF is supporting the government to set up 30 baby friendly hospitals, and train counsellors and other personnel. The Ministry of Health is also preparing to extend the duration of paid maternity leave from two months to six, to improve maternal and child health.<h4>The Trump tremor</h4><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f10b9c7e80680e035a09jpeg.jpg" alt="" width="640" height="354">Nepal has scored dramatic success in reducing maternal and infant mortality rates over the few decades, and USAID has been one of the biggest bilateral backers for family planning, reproductive health, maternal and child health projects.However, funding for these programs has often been affected by successive Republican administrations because of a strong conservative lobby for the <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener noreferrer">Global Gag Rule</a>, which seeks to end American aid for contraceptive promotion and abortion.The <a href="https://pai.org/wp-content/uploads/2016/12/Access-Denied-The-Impact-of-the-Global-Gag-Rule-in-Nepal.pdf" target="_blank" rel="noopener noreferrer">last time it was in effect, during the Bush Administration</a>, mobile clinics providing reproductive services to rural Nepal were discontinued. The Family Planning Association of Nepal (FPAN) lost $400,000 in USAID-funded contraceptives, which represented two-thirds of its total stock, and a further loss of $100,000 per year that supported reproductive health clinics.President Donald Trump has renamed the Gag Rule as ‘Protecting Life in Global Health Assistance’ after restoring it in March 2017. Despite its new name, it is actually stricter, even targeting breastfeeding and vaccines.“The Global Gag Rule is not new, what is new is that it has come back with added force under Trump and can have devastating consequences on Nepal,” explains public health expert Aruna Uprety. “By pulling money out of abortion, they are going to increase unsafe abortions and end up killing more women. It is against human rights.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107121148/6368f10d9c7e80680e035a0ajpeg.jpg" alt="" width="600" height="558">Just a month before the 2015 earthquake, the Nepal Government made a commitment to increase the family planning budget allocation by 7% annually. It partnered with international and private organisations to meet the target, but most of these partners are likely to lose a chunk of their funding.“Our government already lacks resource to meet the commitment. With the US pulling out, the gap is only going to widen,” says an official working in family planning.A US Embassy spokesperson said the United States remained committed to helping the welfare of women and children in developing countries: “The Protecting Life in Global Assistance policy has not reduced funding for women and children’s health by one dollar. USAID works together with the Government of Nepal and other external development partners, including multilateral partners, to coordinate interventions, synergise, and reduce gaps. USAID has strong working relationships with both UNFPA and WHO in Nepal.”Although <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener noreferrer">family planning</a> is a small component of the aid budget for maternal health, the cuts are biting. The EU and Nordic countries have stepped in, but their contribution does not meet the shortfall.At the recent World Health Assembly in Geneva, the United States wanted to dilute a routine agreement on breastfeeding, amidst a global outcry.The United States delegation wanted to water down the resolution by removing a call on governments to ‘protect, promote and support breast-feeding’ and another clause calling for restrictions on the promotion of baby foods.“What happened was tantamount to blackmail, with the US holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health,” Patti Rundall of the British advocacy group Baby Milk Action was <a href="https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html" target="_blank" rel="noopener noreferrer">quoted by the New York Times </a>as saying.The uproar set off alarm bells in Nepal, where donor support has been critical in trying to meet the target of getting 80% of mothers to breastfeed by 2022.The US Embassy clarified that improving nutrition among mothers, infants, and young children was still an important public health priority for the United States, and it remained committed to working with WHO and other stakeholders to improve health and nutrition through “cost-effective and evidence-based” measures.But, the spokesperson added: “While the United States recognises that breastfeeding and provision of breast milk is best for all babies, we recognise not all women are able to breastfeed for a variety of reasons. These women should have access to full and accurate information about breastfeeding, the benefits of breastfeeding, and safe alternatives when breastfeeding is not possible.”Some experts contend that cuts in funding would not affect the breastfeeding campaign, and Nepal did not need to be dependent on donors anymore.“Even if the US cuts funding, Nepal is capable of going ahead on its own. Awareness here about breast milk far exceeds any opposition from outside, it’s just that the government has to own it,” says former WHO public health expert Rita Thapa.Aruna Uprety agrees, but adds that the Americans have played cleverly on a woman’s choice not to breastfeed: “This distracts from the fact that mother’s milk is the healthiest for babies.”The conclusion is that Nepal is perfectly capable of maintaining its momentum not just on breastfeeding, but also on protecting maternal and infant health with or without outside help.<h4>Breast is best</h4>Awareness and education can double exclusive breast-feeding rates in societies. Paid maternity leave can increase breastfeeding rates by 50%. This directly helps the national economy, and the health of mothers and babies. Breastfeeding:<ul><li>Prevents breast cancer deaths</li> <li>Reduces infant diarrhoea by half and respiratory infections by one-third</li> <li>Decreases hospital admissions by 57-72%</li> <li>Children's IQ increases by average of 3 points</li> <li>Investing $1 to promote breastfeeding yields $35 in economic returns</li></ul>https://www.youtube.com/watch?v=-PSs2cPsciw

Sonia Awale

Back to the nipple in Nepal

Architecture can be a powerful agent of change, shaping not just spaces but the way people live, connect, and experience the world.&nbsp; For Nepal, which is <a href="https://nepalitimes.com/banner/natures-fragile-gift-to-nepal">gifted by nature</a> and rich in <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/ambassador-fund-cultural-preservation-nepal,2092">cultural heritage</a>, &nbsp;reviving rural architecture with modern amenities could hold the key to more <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">sustainable tourism </a>that benefits local people more. “<a href="https://nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award">Design and architecture</a> are amazing tools to create a unique experience for visitors,” says Spanish architect Tomeu Esteva of Esteva i Esteva Architecture Studio. “Difficult destinations have beautiful hotels with design and comfort.” Esteva was in Kathmandu with his colleagues at an event organised by the Spanish Honorary Consulate at Dwarika’s Hotel last week to showcase buildings which Nepali architects can adapt with local material and design inputs.&nbsp; Rural architecture holds a unique significance: it is more than a shelter and must reflect <a href="https://nepalitimes.com/here-now/inking-an-idenity">local identity, culture</a> and <a href="https://nepalitimes.com/here-now/saving-humla-from-heritage-loss">heritage</a>. An area’s natural and cultural harmony can be upset by <a href="https://nepalitimes.com/here-now/protecting-protected-areas-from-infrastructure?fbclid=IwAR1wK0MDFlFST_2EYb3f54LS4-fPt6rYfLG1DJ1JaQsU3w8-ezyXIxGOqzk">poorly planned development</a>, speakers at the event said, but the environment can be improved and revitalised by well-integrated structures.&nbsp; Another Spanish architect, Belen Moneo, has designed hotels at elevations of 3,700m in her home country Spain that supply natural spring water spas. “<a href="https://nepalitimes.com/banner/lost-in-reconstruction">Creativity in construction</a> must be encouraged. Rural architecture always shows possibilities of what we can do better,” Moneo explains, adding that designs must enhance <a href="https://nepalitimes.com/opinion/the-healing-power-of-nature">the beauty of nature</a> and give a natural feel at a time when steel, glass and cement dominate <a href="https://nepalitimes.com/here-now/rebuilding-kathmandu-after-the-1934-quake">urban design</a>.&nbsp; This is why the <a href="https://nepalitimes.com/here-now/weaving-nature-into-craft">use of natural products</a> such as bamboo, local timber, straw and rammed earth are in demand from customers who want a fresh eco-friendly look encouraged in construction of rural architectural structures. The demand for boutique hotels has increased world over, with &nbsp;more and more tourists favouring aesthetics, experience and comfort over price. While creativity is an important part of <a href="https://nepalitimes.com/here-now/architecture-for-mountains">construction and architecture</a>, incentives to build and use <a href="https://archive.nepalitimes.com/article/nation/Building,370">rural construction materials</a> still remain minimal, and Moneo emphasises the significance of design and execution.&nbsp; Esteva helped design the Vana Retreat in Dehradun that kept the natural environment in focus, with the structure giving an elaborate aesthetic experience to visitors. Another example is Hotel Las Mercedes in the Dominican Republic which was designed and constructed by Moneo and the company she co-founded Moneo Brock, respecting and revaluing the traditional architecture of the area. Hotels providing such experience could attract tourists and revenue. The Spanish ambassador to Nepal Juan Antonio March Pujol said, “The role of architecture and architects in developing tourism is crucial, not only in urban areas but rural settings as well.”&nbsp; The concept of rural boutique hotels gained traction in Spain during the 1990s, particularly in regions like Majorca with economic and environmental sustainability as the main focus. In Nepal <a href="https://nepalitimes.com/opinion/12-full-opinion/guiding-nepal-s-tourism-industry">the tourism industry</a> directly employs about 1 million people, and makes up about 8% of the country’s GDP. In Nepal, the stone homes of <a href="https://nepalitimes.com/news/reviving-himalayan-vulture-and-culture">Mustang and Manang</a>, bamboo and mud structures of <a href="https://nepalitimes.com/here-now/the-tarai-s-shrinking-forests">the Tarai</a>, and the Kathmandu Valley’s terra cotta tile skylines, graceful temples, and tranquil bahal courtyards are all examples of <a href="https://nepalitimes.com/here-now/nepal-s-traditional-seismic-resistant-designs">Nepal’s traditional architecture</a>.&nbsp; Nepali architect Sarosh Pradhan has been working for the past eight years on the Brakka Village project in Manang Valley north of <a href="https://nepalitimes.com/banner/municipalities-want-to-manage-annapurna">the Annapurnas</a>. Other examples of this kind of rural architecture for high-end tourism are the Shinta Mani Hotel in Mustang and Khumbu Lodge below <a href="https://nepalitimes.com/news/mt-everest-pvt-ltd">Mt Everest</a>. Says Pradhan, “There are places in Nepal that radiate purity and embrace simplicity. Creating projects in such settings require deep reflection and thoughtful planning.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421030444_a07a23f6b60fa89c0f35b9dc1aaf19937da4881e6bfb2e1858f3c27dff91729f.jpg" data-media-id="editor_19" data-image-id="20250421030444_a07a23f6b60fa89c0f35b9dc1aaf19937da4881e6bfb2e1858f3c27dff91729f" data-rendition-name="original" width="4608" height="2184" loading="lazy" alt="A new architecture for Nepal's tourism"> </figure>  Rural architecture is not easy, and sometimes more expensive. Inflation, energy efficiency, <a href="https://nepalitimes.com/here-now/those-who-stay">the climate crisis</a>, and <a href="https://nepalitimes.com/banner/cost-of-living-in-a-big-city">increased costs of living</a> pose obstacles to sustainable rural architecture. Read also: <a href="https://nepalitimes.com/here-now/forgotten-international-starchitects-in-nepal">Forgotten international starchitects in Nepal</a>, Anne Feenstra and Varun S Bapu Esteva says faith and trust between client and architect is necessary for any project to be successful. He adds that architects must practice being humble, the process of designing always involves learning and not imposing their ideas on clients. Nepal is uniquely positioned for the growth of <a href="https://nepalitimes.com/banner/hiking-up-the-benefits-of-tourism">rural tourism</a> because of its stunning countryside as well as its internationally renowned traditions in holistic wellness. Creating infrastructure that is small, thoughtfully planned and that respects both tradition and contemporary hospitality standards is crucial. “Projects in Nepal can be made cost effective by using materials from houses that have been brought down,” says Esteva. “Pilot projects involving <a href="https://nepalitimes.com/banner/local-government-by-the-people-for-the-people-of-the-people">local people </a>and simple designing also helps the process.” <a href="https://nepalitimes.com/banner/vacant-homes-become-homestays-in-nepal">The growth of homestays in Nepal</a> is a step in the right direction, but they are still a bit too rustic for the international traveller who also wants comfort and is willing to pay extra for it. Upgrading the facilities in homestays and ensuring that the <a href="https://nepalitimes.com/here-now/an-archive-of-nepali-heritage">architectural heritage</a> of the locality is preserved using locally sourced building material could allow owners to charge more. Says Sangita Shrestha of Dwarika’s Hotel, “Our effort is to build upon rural architecture by empowering local communities and using what is available locally. We can fine tune and encourage indigenous design and training.” The vision goes beyond just boosting the economy, it is about building a future where tourism helps villages grow in a healthy and lasting way. Instead of using up resources, it gives back to the land and the people. It supports local communities by<a href="https://nepalitimes.com/opinion/staying-in-nepal-to-create-jobs"> creating jobs</a>, improving infrastructure, and protecting natural beauty. When done right, tourism can be a tool for <a href="https://nepalitimes.com/editorial/progress-and-or-preservation">preserving culture and nature</a>, not harming them. Architects must therefore see their work as more than just designing buildings, they also need to care deeply about people and places, especially in rural areas that can benefit the most.&nbsp; With global interest in sustainable and off-the-beaten-path travel increasing, Nepal stands at the cusp of a <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">tourism transformation</a> that values community-driven, eco-conscious hospitality. A mix of modern ideas and traditional knowledge could transform rural tourism in Nepal. Says Shrestha, “Young architects should spend time with <a href="https://nepalitimes.com/latest/the-unsung-heroes-of-conservation">local and indigenous communities</a>, listen to their stories, and learn from their <a href="https://nepalitimes.com/banner/life-and-livelihood-in-remote-nepal">ways of living</a>. These communities have deep knowledge about the land, materials, and climate. If this wisdom is used in new designs, it can help create tourism spaces that truly benefit everyone.” &nbsp;

A new architecture for Nepal's tourism

Extract from an addendum to Nepal's Two Wars, Chapter 2 in the updated edition of Essays on Nepal: Past and Present by Sam Cowan, a retired British Army general with a long association with the Gurkhas. The book was first published in 2018, and republished earlier this month by FinePrint exclusively on Amazon. The addendum details a one-to-one conversation the author had in the <a href="https://archive.nepalitimes.com/news.php?id=8884">Royal Palace </a>with the <a href="https://archive.nepalitimes.com/news.php?id=8371">King Gyanendra</a> in November 2002 just after he had taken his initial steps on the road that ultimately led to <a href="https://archive.nepalitimes.com/news.php?id=14681">the abolition of the monarchy</a> in Nepal in 2008. In the early evening of September 16, 2002, in my role as Colonel Commandant of the Brigade of Gurkhas, I had my second and last official audience with King Gyanendra to give him an update on the Brigade’s activities over the previous 12 months. I had some 6 or 7 such audiences with <a href="https://nepalitimes.com/here-now/preserving-king-birendra-s-family-home">King Birendra</a>.&nbsp; These were official affairs with the British ambassador of the day present, along with key <a href="https://archive.nepalitimes.com/news.php?id=12233">palace officials</a> and a representative from Nepal's Foreign Ministry. The two monarchs were very different in character and temperament, but both treated me with the utmost civility and made the audiences as relaxed and easy for me as possible.&nbsp; It is, however, worth recording that when the official business had been covered, King Birendra, with a twinkle in his eye, often ended by asking, “Now General, what’s the gossip in London?” The second audience with <a href="https://archive.nepalitimes.com/news.php?id=8026">King Gyanendra </a>was my last official act in uniform. We came back to Kathmandu in the first week of November (after treks) to stay for a few nights with our Defence Attaché before heading back to the UK. Waiting for me was a message from the Palace saying that King Gyanendra would like to meet me informally: <a href="https://archive.nepalitimes.com/news.php?id=6933">no uniform</a> and no ambassador.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080420_f9046f9882d4481781d14f2b64f18c7fbbea62562e1d74e3465de6d01fb43750.jpg" data-media-id="editor_7" data-image-id="20250421080420_f9046f9882d4481781d14f2b64f18c7fbbea62562e1d74e3465de6d01fb43750" data-rendition-name="original" width="1750" height="2406" loading="lazy" alt="Gyanendra crowned page 1"> <figcaption>Nepali Times Special Edition of 6-14 June 2001 with enthronement of Gyanendra. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_21333d6ae21828eb47fe3f849438d215fe2804460d47bb2896ef4aee4e895ad2.jpg" data-media-id="editor_8" data-image-id="20250421080424_21333d6ae21828eb47fe3f849438d215fe2804460d47bb2896ef4aee4e895ad2" data-rendition-name="original" width="1500" height="1857" loading="lazy" alt="Royal massacre"> <figcaption>Nepali Times 22-29 June 2001 covering the royal massacre after which Gyanendra became king. </figcaption> </figure>  Although I had no idea what the purpose of the meeting might be, events in Kathmandu since I last saw the king put me on edge. On October 4, 2002, Gyanendra had dismissed Prime Minister Sher Bahadur Deuba, allegedly for failing to hold <a href="https://nepalitimes.com/news/what-goes-on-in-nepal-s-elections">elections</a>. He had put in place a new prime minister and a cabinet personally selected by him. When I heard the news on my travels, the people I met were generally supportive of the king’s actions. There was a general view that something had to be done, the country was going nowhere, and the king deserved his chance, not least to solve<a href="https://nepalitimes.com/latest/14-years-after-conflict-no-closure-in-nepal"> the Maoist </a>problem. Back in Kathmandu, views were not so sanguine. The chosen prime minister, Lokendra Bahadur Chand, was a relic from <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">the Panchayat period</a> whose party had failed to win a single seat in the last elections held in 1999. Some of the chosen cabinet ministers had, to put it mildly, dubious reputations, and others had no record of proven competence in any field. There was a fear that the king’s real motive in dismissing <a href="https://nepalitimes.com/editorial/deubas-denouement">Deuba</a> was to start to reverse the democratic gains made since 1990. I informed <a href="https://nepalitimes.com/news/nepal-britain-mark-centenary-of-1923-treaty">the British ambassador</a> about the invitation. He was strongly against accepting it, which was probably the clinching reason for my decision to do the polite thing and accept it. On the evening of November 7, 2002, I presented myself at the royal palace, alone and in civilian attire.&nbsp; As in the past, the Military Secretary, Major General Vivek Shah, met and escorted me into the presence of the monarch. This time, however, he was politely asked to leave the room and shut the door behind him. King Gyanendra greeted me warmly and invited me to sit down.&nbsp; Read also:<a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal"> The ghost of monarchy returns to haunt Nepal</a>, Shristi Karki  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_e382af945d0ad2a04ae41fabe5393f793dd10f54cb1220f111c7c9e7423eb558.jpg" data-media-id="editor_15" data-image-id="20250421080424_e382af945d0ad2a04ae41fabe5393f793dd10f54cb1220f111c7c9e7423eb558" data-rendition-name="original" width="1000" height="993" loading="lazy" alt="Gyanendra coup"> <figcaption>Nepali Times 4-10 February 2005 after king Gyanendra's coup imposed media censorship. anendra became king. </figcaption> </figure>  I had wondered, and to be truthful, had worried, not just about the purpose of the meeting, but about how the conversation might start and develop. I reduced my resolve to two points: be polite but speak candidly. The latter resolve was quickly put to the test with the king’s opening words: “Sam, [in previous meetings it had been ‘General’, you walk the highways and byways of this land more than most, tell me what the common man is thinking?” &nbsp;“Your Majesty, I have no idea what they are thinking, but they are waiting.” “Waiting?” “Yes, Your Majesty, they are waiting to see whether what you did some weeks ago in appointing your own prime minister and cabinet ministers is going to make any difference to their lives or whether it is just going to be more Kathmandu hot air.” “Everything is going to be difficult and is going to take time, a lot of time.” “Your Majesty, time is the one thing you don’t have. You must act quickly and decisively to take advantage of the opportunity you have created. Everyone knows that you have appointed these new ministers. Why don’t you get them in here one by one and tell them that they have three months to deliver a programme in their area of responsibility that is going to make a difference to people’s lives? Most will fail to do so. Sack them! It will be a powerful signal of your strong intent to deliver real change.” I can express the opening of our conversation in this way because just about every word is still etched in my mind. The king’s response to my last quoted words was to challenge me to give an example of something that could be delivered quickly. I can give a verbatim record of what I said in response to this unexpected challenge: “Health posts, Your Majesty, there is no shortage of them throughout the country as building them has been one of the sources of local corruption, but very few have any medicine to issue at present or have skilled people to assess and meet medical needs. Your Majesty, children are dying for lack of a few pills. Given the right priority, over a period, say of six months, every health post could be fully stocked with medicine and manned with trained people. This is something I could help to lead for you as I know it would have strong international backing. At last, people would know that you mean business.” As I warmed to the theme, I could see no sign of the king having any enthusiasm for the idea, and I quickly disengaged as it dawned on me, as it had clearly dawned on the king, that the reason for the deficiencies in health posts was to prevent any Maoist combatant from gaining access to any <a href="https://nepalitimes.com/opinion/tech-away/nepal-s-health-tech-industry-is-here-to-stay">medical support</a>, and if this meant people suffering, so be it. The subject of the Maoist insurgency inevitably came up, and I took the opportunity to elaborate on what is written in the final four paragraphs of the article above. I advised King Gyanendra that, self-evidently, since there were three parties in the conflict—him, the Maoists, and the political parties—it was imperative that he form an alliance with one of them, preferably the political parties; otherwise, he would find himself isolated, as the other two parties would inevitably, at some stage, form their own alliance. However, it quickly became apparent that the king’s mind was on a totally different track. On the Maoists, he told me that he had channels open to them, but he was scathing about the political party leaders. He made it clear that they would be waiting for a very long time before he gave any power back to them, and that is a polite way of expressing the actual words he used, but “crawling through the door” is a phrase which has stuck in my mind.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080424_5403455ff6168f0d202a96cb53edea69136d74d59b989cfcc7cc4a1d57672cb5.jpg" data-media-id="editor_17" data-image-id="20250421080424_5403455ff6168f0d202a96cb53edea69136d74d59b989cfcc7cc4a1d57672cb5" data-rendition-name="original" width="2000" height="1317" loading="lazy" alt="fall of monarchy"> <figcaption>Nepali Times 28 April-3 May 2005 with cover image by Ajay Joshi of jubilant protesters after street demonstrations sidelined king Gyanendra, paving the way for a ceasfire and restoration of democracy. </figcaption> </figure>  As the conversation developed, it became ever clearer that King Gyanendra had decided to go in alone, relying on the misleading assurances he was constantly receiving from <a href="https://archive.nepalitimes.com/news.php?id=14954">the army</a>, and no doubt his close advisers, that the Maoists could and would be quickly defeated militarily, and taken out of the equation. This would obviate the need for him to do any deal with the political parties.&nbsp; Thus, the way would be clear for him to establish a version of his father’s Panchayat system, under a constitution that would be granted to the people by him, their sovereign, as his father and brother had done in 1962 and 1990. As in those constitutions, ultimate power would have remained in the sovereign’s hands. This proposed direction of travel was very clear from what the king said to me. In sum, King Gyanendra was motivated by a desire to emulate his immediate predecessors by granting his people a constitution that would restore his father’s Panchayat system in a modern form and give him a central role in decision-making. What was particularly dispiriting was that beyond this single objective he had no plan worthy of the name, nor demonstrably did he have the people with the skills to implement an appropriate plan even if one had existed. Crucially and depressingly, there was little or no indication from the king that he realised that such a course of action could put Nepal’s monarchy into serious jeopardy, as indeed proved to be the case. <h2>King Twice</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250420110436_315d519fe3d68d2406ebe1480fed54720fbf21b8907a4da5cde751fdc623d445.jpg" data-media-id="editor_19" data-image-id="20250420110436_315d519fe3d68d2406ebe1480fed54720fbf21b8907a4da5cde751fdc623d445" data-rendition-name="original" width="1302" height="632" loading="lazy" alt="“Tell me what the common man is thinking!”"> </figure>  <a href="https://archive.nepalitimes.com/news.php?id=8371">Gyanendra Bir Bikram Shah has been king twice</a>. In 1950 he was enthroned briefly as a child king (left, above) by the Rana Prime Minister Mohan Shumsher when his grandfather, King Tribhuvan, fled to exile in India. In 2001 he was crowned king again after the massacre in the royal palace in which his brother King Birendra and nine other members of his family were killed by Crown Prince Dipendra.&nbsp; During his second reign, Gyanendra gradually asserted power by sacking Prime Minister Sher Bahadur Deuba in 2002, and then taking full control after the 1 February 2005 coup. He was sidelined after the ceasefire in April 2006, and became a commoner after the Constituent Assembly finally <a href="https://archive.nepalitimes.com/article/from-nepali-press/Ftnp-abolishing,624">abolished the monarchy in 2008</a>. In the past year, Gyanendra has tried to exploit public dissatisfaction with the political parties to restore the monarchy.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250421080432_26ef4a4b0e3cee9fdc6794446702efe16550d293904b4f6dd46fe35d4d10c788.jpg" data-media-id="editor_22" data-image-id="20250421080432_26ef4a4b0e3cee9fdc6794446702efe16550d293904b4f6dd46fe35d4d10c788" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="Essays on Nepal by Sam Cowen"> </figure>

“Tell me what the common man is thinking!”

He had just sat down for lunch after tending the garden at his house in Lagan Tole on 25 April 2015 when the ground began to shake violently. &nbsp; Gautam Nepal, 56 at the time, realised it was an earthquake. He panicked at the thought of his neighbours' multi-storied buildings toppling on top of his modest one-storey house. He rushed out as the high-rises swayed and groaned. “We were used to earthquakes, moderate ones are a regular occurrence in Kathmandu, but I had never felt fear like I felt on that day,” recalls Gautam. “My house proved strong, it did not collapse.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_82a74881218223df70e30eb1759cd3a7c9edbb7728acef83c3f8b397d6e6dfe9.jpg" data-media-id="editor_0" data-image-id="20250419040440_82a74881218223df70e30eb1759cd3a7c9edbb7728acef83c3f8b397d6e6dfe9" data-rendition-name="original" width="1737" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>LAGAN TOLE'S TOLL: Lagan Tole photographed by tour guide Neil S Rawlins during his travel to Kathmandu in February 1970.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040448_90914720a75b7d31a12bc27f0c0af9484a5e5efc7dd797dc6bcd190fc28ecdcb.jpg" data-media-id="editor_1" data-image-id="20250419040448_90914720a75b7d31a12bc27f0c0af9484a5e5efc7dd797dc6bcd190fc28ecdcb" data-rendition-name="original" width="1500" height="1004" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan Tole photographed by Neils Gutschow in 1992.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_9a4dd35b070949949bfe275eff8216dd29f88f74a30b063dc614845226f68f03.jpg" data-media-id="editor_2" data-image-id="20250419040440_9a4dd35b070949949bfe275eff8216dd29f88f74a30b063dc614845226f68f03" data-rendition-name="original" width="1501" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan Tole in 2025.</figcaption> </figure>  Other residents of Lagan who also live in traditional low rise houses had the same fear. Tara Nepali, then 48, was doing the washing that Saturday.&nbsp; She recalls, “When my house began to shake, I could only think about the bigger buildings falling on top of me. I was sure my house would collapse, but to my surprise, it survived, and so did we.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_2b4b1ec427d9aec5980021b97b25ca3164d5f79337f113ba02b1d802f71b7cad.jpg" data-media-id="editor_3" data-image-id="20250419040440_2b4b1ec427d9aec5980021b97b25ca3164d5f79337f113ba02b1d802f71b7cad" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Gautam Nepali in front of his one-storey Lagan home, where he had been having lunch just before the earthquake struck 10 years ago.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040436_6f8a7057bbd269214712076e13117b665165e03a0351db0e3666aee05e91f63c.jpg" data-media-id="editor_4" data-image-id="20250419040436_6f8a7057bbd269214712076e13117b665165e03a0351db0e3666aee05e91f63c" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Tara Nepali in front of her house in Lagan. She was doing the washing during the earthquake in 2015.</figcaption> </figure>  But Buddha Khadgi, 68, was not so lucky. His was one of the few houses in the neighbourhood to be reduced to rubble. His lifelong collection of photographic prints were buried, and so were the traditional Newari musical instruments passed down through generations of his family that he used to give music lessons.&nbsp; “I lost the things that connected me to my roots and my heritage. That was infinitely more heartbreaking than the fact that my house was gone,” says Khadgi, now living in a new cement structure.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040436_58f4a8ee4eb740536c69096a4d8c0cd2007fdbcc4ef56551ff460d2ef0ef6f2b.jpg" data-media-id="editor_5" data-image-id="20250419040436_58f4a8ee4eb740536c69096a4d8c0cd2007fdbcc4ef56551ff460d2ef0ef6f2b" data-rendition-name="original" width="2496" height="1671" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan's Maka Galli some decades ago. Photo: SHREE RAM NEPALI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_6b2bacaf0a1e93b441aff8093b343836d6de0b44d7b29f9b758209845f675bff.jpg" data-media-id="editor_6" data-image-id="20250419040440_6b2bacaf0a1e93b441aff8093b343836d6de0b44d7b29f9b758209845f675bff" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Lagan's Maka Galli in 2025. The neighbourhood's old Newari houses have been replaced by concrete structures, although the falcha has been rebuilt in traditional style.</figcaption> </figure>  Lagan Tole in Kathmandu's historic heart emerged relatively unscathed from the earthquake in large part because, like in nearby Asan, the buildings are densely packed and lean on each other. But in the years after the earthquake, urban pressure and fear of future quakes have made families tear down their traditional houses with sloping tile roofs and replace them with concrete structures.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_25983e79dc88388cb370b16f7f631e4c276cfc997ffa1f9ce3701e40c876b355.jpg" data-media-id="editor_7" data-image-id="20250419040440_25983e79dc88388cb370b16f7f631e4c276cfc997ffa1f9ce3701e40c876b355" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>Glimpses of present-day Lagan.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_9a6a88df8815352a452895c43840a898d4b6c080b79562383306c0cfe8bcd952.jpg" data-media-id="editor_8" data-image-id="20250419040440_9a6a88df8815352a452895c43840a898d4b6c080b79562383306c0cfe8bcd952" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Loss of soul and soil NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_a348b974bd3a5e76d0bf9b309f98813556d43dd6c361856c67e79c03d4283e69.jpg" data-media-id="editor_9" data-image-id="20250419040440_a348b974bd3a5e76d0bf9b309f98813556d43dd6c361856c67e79c03d4283e69" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> </figure>  Lagan’s longtime residents, especially the elderly whose families have lived here for generations, say that the neighbourhood with its characterless new tall cement boxes is no longer familiar to them. “We used to say that our houses are not supposed to be taller than temples, the houses of our gods,” says Gautam. “Now, the houses here dwarf the temples and even the chariot of Seto Machindranath.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_88d18ce580abaf9e62fd807403f2e3c9a5bd8972d3b32bdacb97d8991c7fec35.jpg" data-media-id="editor_10" data-image-id="20250419040440_88d18ce580abaf9e62fd807403f2e3c9a5bd8972d3b32bdacb97d8991c7fec35" data-rendition-name="original" width="1041" height="1441" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>The Seto Machindranath procession at Lagan on 10 April 1998, during which the chariot caught fire. Photo: SOCIAL MEDIA</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250419040440_c403f91f9a48c14eaaeed2d38a2cb97714416765730b6d12f29487f9b0f47e83.jpg" data-media-id="editor_11" data-image-id="20250419040440_c403f91f9a48c14eaaeed2d38a2cb97714416765730b6d12f29487f9b0f47e83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Loss of soul and soil NT"> <figcaption>The Seto Machindranath procession at Lagan earlier this month.</figcaption> </figure>  &nbsp;The old baha courtyards, falcha resting places, and open spaces where Lagan’s residents used to grow vegetables and gather as a community are nearly all gone. And the taller the houses get, residents say they feel less anchored to the soil. Lagan has also lost its soul -- the community spirit is eroding as elderly neighbours rarely venture down to meet each other in the evenings. &nbsp; “This no longer feels like the tole I grew up in,” says a resident. “We are beginning to lose the relationships we had with each other as a community, and with it, the spirit of Lagan.”&nbsp;

Loss of soul and soil

Dealer Cimex has extended warranties on BYD EVs sold in Nepal for 10yrs/200,000km, up from 8yrs/160,000km. Lights, tyre pressure monitors, suspension and ball joints now have 5yr/125,000km warranties, and all other parts now have 7.5yr/187,500km warranties.&nbsp;

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