Invest In Child Health

Although child health is one of the priority programmes of the government, the results of the Nepal Multiple Indicator Cluster Survey (NMICS) 2024/25 show a disturbing trend. Years of policy commitments, donor support, and health sector reforms have not yielded the desired results. It is evident from the high infant and child mortality rates. Of 1,000 live births, 27 infants die before celebrating their first birthday, whereas the mortality rate of children under five is recorded at 31 per 1,000. Neonatal mortality, where a child dies within a month of birth, stands at an alarming rate of 17 among 1,000 live births. These are no ordinary statistics but a depiction of overall failed maternal care, neonatal services, nutrition, and basic health access. 

The rate of mortality is unevenly shared, which is troublesome. Sudurpashchim Province reports the highest neonatal mortality rate at 26 per 1,000 births, more than double the Bagmati Province's rate of 10. The pattern continues: infant mortality peaks at 38 deaths per 1,000 live births in Sudurpashchim, compared to 17 in Bagmati. Under-five mortality is equally stark: 48 deaths per 1,000 in Sudurpashchim versus just 20 in Gandaki. These are not accidental gaps. They represent deep-seated inequalities in health infrastructure, skilled health workers, nutrition, sanitation, education, and women's empowerment. The economically and geographically lagging provinces continue to pay the price, with a high child mortality rate.

The nutrition data further exposes the depth of the crisis. Almost one in four children under five is underweight for their age, and almost one in three is stunted. Madhes Province has the highest proportion of children with low weight for age at 33.2 per cent, while Bagmati again is the best at 9.6 per cent. Stunting at such levels permanently undermines cognitive development, school performance, and future productivity, thus locking generations into cycles of poverty.

Early childbearing complicates this problem. For every 1,000 adolescents aged 15–19 years, the survey showed 48 live births, and more than one in 10 women aged 20–24 had given birth before the age of 18. Early marriage and adolescent pregnancy continue to endanger the young mothers and their babies, especially in provinces where social norms and weak enforcement of laws persist. 

While the government does deserve credit for partnering with UNICEF and producing comprehensive, credible data, data alone will not save lives. What Nepal suffers from is not a lack of plans but weak implementation and poor provincial targeting, with low accountability. Health budgets are often thinly spread rather than invested where the need is greatest. Nutrition programmes remain fragmented. Provincial governments, empowered under federalism, have yet to demonstrate consistent capacity to address child survival as a top priority.

NMICS 2024-25 should be a wake-up call for Nepal and introduce policies to address this grave public health concern.  The efforts to reduce child mortality from here on will require focused investment in remote provinces, strengthening frontline health services, battling malnutrition at the household level, and confronting early marriage with seriousness. The government needs to increase the budget in the health sector and spend it judiciously to end the structural inequalities. If such disparities are allowed to become the new normal, the country is failing to protect its youngest citizens-and thereby its future.