I love to travel. I have traveled all over the United States and to some countries outside of the United States. This summer I took my oldest to the United Kingdom for a graduation present — their first trip abroad. I am getting the travel itch again. This time I want to go to Nepal.
When I say this to family and friends I get a mix of reactions from concern to horror to curiosity. Many assume I want to travel to Kathmandu and that I want to go trekking or to see the temples and Mount Everest. While those are attractive reasons to go to Nepal, I want to go for completely different reasons.
Comparing Nepal to the United States
The World Health Organization (WHO) has a feature on their website that allows you to easily compare countries. I am from the United States, so I will use the US as my comparison point. All of the information provided in the comparisons below was obtained from the Landscape Information System: Nutrition Landscape Information System (NLIS) Country Profiles available through WHO.
According to the WHO, the US had a total population of 322,180,000 in 2016 while Nepal’s total population was 28,983,000. The gross national income per capita in 2013 (PPP International $) for the United States was 53,960 compared to 2,260 for Nepal. In other words, Nepal is a poor country when compared to the United States. I suspect that this is not a surprise for most.
The life expectancy at birth for men in the United States is 76 and 81 for women. In Nepal, the life expectancy is 69 for men and 72 for women. The probability of dying under the age of 5 in the United States is 7 per 100,000 live births while in Nepal it is 34 per 100,000 live births.
Nutrition and Malnutrition
The United States and Nepal have opposite challenges when it comes to child malnutrition. In 2016 the United States had 41.8 percent of school-age children and adolescents aged 5–19 who were classified as overweight compared to 7.5 percent in Nepal. However, looking at children under age 5 in 2011, 29.1 percent of Nepalese children were underweight and 40.5 percent were stunting while in the United States 0.5 percent of children were underweight and 2.1 percent were stunting. The US has a problem with child obesity. Nepal has challenges with malnutrition. In the United States, 6 percent of children under 5 years old are anemic compared to 51 percent of children in Nepal.
Examining the health of women, in the United States in 2016 2 percent of women had a BMI less than 18.5 compared to 17 percent of women in Nepal. Examining vitamin and mineral deficiencies, 13.2 percent of non-pregnant women and 16.2 percent of pregnant women in the US were classified as anemic compared to 34.9 percent of non-pregnant women and 40.0 percent of pregnant women in Nepal. Women of reproductive age in the United States were less likely to be anemic in general with 13.3 percent of US women of reproductive age having anemia compared to 35.1 percent of Nepalese women.
Access to Health Services
There are differences with respect to access to health services when comparing the United States to Nepal. In the United States, 98.5 percent of births are attended by skilled health personnel compared to 55.6 percent of births in Nepal. In the US, 99.2 percent of the population uses improved drinking-water sources and 100.0 percent of the population uses improved sanitation facilities. In comparison, in Nepal 91.6 percent of the population uses improved drinking-water sources and 45.8 percent of the population uses improved sanitation facilities. In the United States 92.0 percent of children aged 1 year are immunized against measles compared to 83.0 percent of children in Nepal. There are significant differences in access between the two countries.
There are also differences with respect to access to healthy foods when comparing the two countries. Of course, with all of these it should be noted that there are often significant disparities within the countries themselves (there are areas that are food deserts in the United States and there are pockets of food insecurity in the nation as well). In the United States 8.0 percent of households are consuming adequately iodized salt compared to 94.2 percent of Nepalese households. Less than 5 percent of the population in the United States is undernourished compared to 7.8 percent of the Nepalese population. In Nepal, 15.0 percent of the population is below the international poverty line, but comparable data is not available for the United States.
In Nepal, the total expenditure on health per capita (International $, 2014) was 137 compared to 9,403 in the United States. The total expenditure on health as a percent of the GDP in Nepal was 5.8 percent in 2014 compared to 17.1 percent in the United States. The percent of total government expenditure that is spent on health in 2014 in Nepal was 11.2 percent compared to 21.3 percent in the United States. In Nepal, the nursing and midwifery personnel density per 1,000 population is 0.5 while in the United States it is 9.9. Nepal is designated as a Low-Income Food-Deficit Country (LIFDC) while the United States is not.
Comparing conditions for females in the two countries is also informative. The Gender Inequality Index (GII) for Nepal is 0.497 compared to 0.203 for the United States. The Gender Parity Index in primary level enrollment (the ratio of girls to boys) is 1.09 in Nepal and 0.99 in the United States. The percent of seats held in the national parliament in Nepal was 29.5 percent in 2015 while in the United States it was 19.4 percent. Comparing female education levels is not possible as there is no data for the United States. In Nepal, 39.8 percent of females had no education, 17.4 percent had a primary education, 35.0 percent had a secondary education, and 7.8 percent had higher education. The maternal mortality ratio (per 100,000 live births) in Nepal was 258 in 2015 compared to 14 in the United States.
Poverty and Access to Health Care — Why I Want to Go to Nepal
The preceding sections were designed to bring attention to the overall health disparities between residents in Nepal and residents in the United States. I have been reading quite a bit lately about the work of the Bill and Melinda Gates Foundation and others who are working to bring attention to and address health challenges around the world. As a part of exploring this work and reading materials on the websites, I recently came across a book by Rose George entitled Nine Pints. This book was all about blood. Two of the chapters addressed the disparities that men and women face with respect to health and hygiene and focused specifically on women’s access to feminine hygiene products and cultural myths and taboos about women who are menstruating. George highlighted the experiences of women in Nepal who are menstruating and the practice of chhaupadi. In essence women are not allowed to have contact with others in the family or some animals during their periods and are not allowed to sleep in the family home. They are banned to menstruation huts. Women have died from exposure, been assaulted, and had other negative outcomes as a result of this practice of menstrual shaming.
As I read this book, I started wondering more and more about the customs and practices around the country. I have been thinking a lot about access to quality and affordable health care in general across the country of Nepal, but more specifically access to affordable health care for women. What are the infant and maternal mortality rates in Nepal? What are the conditions for prenatal care, labor and delivery care, and postpartum care in this country?
In short, I have been wondering what I can do to help women in countries like Nepal. I want to learn more about their cultures and their lives. In essence, I want to understand this country that is so different from my own. I would like to learn as much as I can to better understand what we can do to help women around the world who struggle with access to affordable health care, access to feminine hygiene products, and access to education.
I am trying to plan a trip to Nepal (and possibly India, but I will talk about my interest in India in another article). I want to explore the different cultures and lives. I want to better understand those who have different cultures and dynamics than what I have had in my relatively privileged existence as a white woman in the United States. I also want to find a way to channel my life, my privilege, and my experience to help others. I hope I can save enough to travel to Nepal and learn about the beautiful cultures there while also seeking to understand the challenges that people who are different from me face.