Nepal and Disability
2.1 About Nepal
Nepal is a most recent federal republic country located on the southern lap of Himalayas. This country is scattered in the land area of 147,516 square kilometers. Geographically the country is divided in three ecological belts i.e. Himalan region (35 percent), Hilly region (42 percent) and Teria region (23 percent). Recently Nepal has gone to a federal structure with 7 Provinces, 77 districts and 753 Local rural/municipalities. According to the population census 2011 total population of the country stands at 26.5 million of which 51.5 percent were women. The same population census showed 48.6 percent of the population residing in the Terai, 43% in the Hills and 6.7 percent in the Mountain region. Annual population growth was recorded as 1.99 to that of 2.5 in 1990, which makes the total population of 30 million as of today.
Recently, the Constitution 2072 (2015) has restructured the nation seven Provinces, 77 districts, 753 Local Rural/Municipalities. Elections were held for all these structures during 2016 and 2017 including the federal ones resulting into selection of 753 local governments and assemblies, 7 Provincial governments and assemblies and house of representatives, national assembly and the government at federal level. These structures are now under operation as per the new mandates in the Constitution governing their own territories. It may take few more years to come this federal structure under full operation.
The same population census 2011 showed the population of persons with disability as 1.94 percent (514 thousand) of the total population however disability movement is not fully agree with the fact the such population would be more than what is shown in the census report as the census process itself was not disability inclusive resulting into leaving many head counts behind. Using the 10 percent prevalence rate of World Health Population, the population of persons with disability could go upto 3 million. As shown by the Census, the physical disability accords top (36.3%) followed by the Blind and Partially Sighted (18.5%) and Deaf and Hard of Hearing (15.4%). The population of speech related, mental and psychosocial disability is 11.5%, 7.5% and 6.5% respectively. On the other hand, deaf-blind has a lowest population (1.8%) followed by intellectual disability (2.9%). It is estimated that the literacy rate of persons with disabilities is approximately 20% whereas the general literacy rate is 65.9%. The census report also showed the high prevalence of disability in men (55%) compared to women (45%). Geographically, the prevalence is remarkably higher in rural areas (89%) compared to urban areas (11%). Ecologically, the Hill has the highest population (49%) followed by Terai (40%) and the Mountain (11%).
The country is already moving towards enduring peace after the historical struggles waged by Nepalese people. The long waited peace process that is more or less concluded with the promulgation of Nepal's Constitution in 2015 has given hopes in the faces of Nepalese people. So far 14 periodic plans (3-5 years) have been concluded in eight decades of planned development in Nepal while 15th national development plan (2019-2023) is under progress. Surfing the past periods, various development efforts focused on aspects of physical infrastructure, fulfilment of basic needs and poverty alleviation. Through these efforts many social and physical development took place resulting into many changes in mutual relationships between government, civil society and the people. However, economic development efforts and ensuring the rights of the marginalised and excluded people, such as people with disabilities were rarely became the development agenda until the 9th National Development Plan (1998-2002). Though the later NDPs focused persons with disabilities, it was in limited areas i.e. education and employment based on the welfare model. Concrete form of mainstreaming of disability has taken place only after 2009 where Nepal became the State Party upon ratifying the Convention on the Rights of Persons with Disabilities in Dec. 2009, and being effective from June 2010.
According to the National Planning Commission of Nepal, the rate of absolute poverty reduced from 21 (2015) to 18.7 in 2019.[1] The NDP is silent towards the actual headcounts of persons with disabilities Among the disability population, theer are no specific data produced at the government level. The disability experts claim tjat about 80% of people with disabilities fall below the poverty line. In terms of HDI, Nepal stands on 147th position out of 188 countries with HDI value of 0.579[2].
Nepal has made commitments to the Sustainable Development Goals and Agenda 2030. Among the 17 SDG Goals, 4 of them reflect disability agenda more specifically. Disability is referenced in various parts of the SDGs and specifically in the Goal 4: education (4.5: eliminate gender disparities in eduation and ensure equal access to all levels of education and voational training for the vulnerable, including persons with disabilities, indigenous people and children in vulnerable situation, 4.5a: building and upgrading education facilities that are disability sensitive including inclusive and effective learning for all), goal 10: reducing inequalities (10.2: empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or edonomic or other status), Goal 11: Sustainable cities and communities (target 11.2: provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notable by expanding public transport with special attention to the needs of persons with disabilities), (Target 11.7: provide universala ccess to safe, inclusive and accessible gree and public spaces, in particular for ….. persons with disabilities), goal 17: Monitoring and accountability (17.18: disaggregated, timely, reliable and high quality data collection by disability). Despite these provisions, the progress towards SDGs has not been well documented.
The literacy rate (15+ years) of the country is 581 however the literacy rate of the people with disabilities is not accounted separately in the government database. It is that the literacy rate of disability population falls somewhere between 20-22 percent. The HDR 2019 also outlined average per capita income of Nepalese to be $1,047 with double in Kathmandu1. The per capita income of persons with disabilities is lower than the national average.
2.2 Disability movement in Nepal
In Nepal, organised form of disability movement started from early 1990, the year of re-establishment of democracy with the enhancement of new constitution which guaranteed civil liberties and political freedom. Nepal Association of the Blind (NAB); an umbrella of BPS, was established in 1993 however, some of the organisations like Kathmandu Association of the Deaf were in existence since late seventies but without legal recognition. Besides this, there are some organisations; for example, National Deaf Federation-Nepal (NDFN), and Parent Federation of Persons with Intellectual Disabilities (PFPID) are expanding their nationwide network and working through out the country. Today, there are around 400 DPOs working through the country, and there has been gradual increase in the number and their network. According to the National Federation of the Disabled-Nepal (NFDN); an umbrella organisation, there are 330 DPOs affiliated within this umbrella organisation covering all 77 districts of Nepal. National level federations or associations have been formalised in the area of deaf with outreach in 46 districts, blind and partially sighted (44 districts), intellectual disabilities (out reach in 43 districts), hemophilia (outreach 68 districts) however not in the area of physical disability, deafblind, autism, hard of hearing among others. The autism, hard of hearing, psychosocial disability, deafblind, the movement has just started and reached into handful districts while none of the federations except the NFDN has reached to all the districts.
The Government of Nepal (GON) initiated to provide services to persons with disabilities since 1971, the UN International Year of Disabled. In 1982 the government enacted a legislation called Disabled Persons Protection and Welfare Act endowing certain services in the area of education, training, employment, treatment from the welfare perspective. Most recently, this welfare based law has been replaced by Act relating to the rights of person with disability, 2017 that is written in line with the notions of CRPD.
Including CRPD, Nepal has ratified several International Human Right Convention, covenants and declarations[3]. Enactment of Act relating to the Right of Person with Disability, 2017 and issuance of its regulation in 2020, though lately, is the government's commitments towards promotion, protection and utilsiation of rights of persons with disabilities.
According to Social Welfare Council (SWC); a government body to regulate the NGOs and INGOs, the number of NGOs and INGOs affiliated with SWC were over 34,000 and 223 respectively. Besides NGOs there are professional unions, human right activists, pressure groups and public trusts whose number is not accounted. There are very limited number of INGOs that focus fully in disability in partnership with DPOs and on the notion of rights however this seems to be growing in later years mostly with patch work nature of work in the disability field.
2.3 Situation of BPS persons
2.3.1 Educational situation
According to the Ministry of Education, Science and Technology, there are 9548 BPS students undergoing study from grade 1-12 level. Among these, include 4,764 in grade 1-5, 2,987 in grade 6-8, 1,504 in grade 9-10 and 292 in grade 10-11[4]. The data shows that the number of BPS children significantly drop as they advance to the upper grades. According to EDRC, there are 365 Resource Classes running across the country for the education of blind, deaf and hard of hearing and children with intellectual disabilities of which 79 integrated schools related to BPS and 1 special school. Government of Nepal (GoN), through the Local governments, provides four different types of scholarships to the children with disabilities have got opportunities for their education through out the country. In addition, the government also provides free text books and along with the distribution of teaching-learning materials and equipments. The Inclusive education program is running in 411 schools across the country. In area of Braille text book availability, the GoN produces 500-700 sets (approx) of Braille text books yearly however the number of BPS children is high and even increasing day by day. There are complains from the BPS students that the old and already used Braille text books are no longer on use since some of the texts are pressed (not feelable) and also tattered ones. Besides this, the GoN, so far has not produced Braille text books of the voluntary subjects, and also children of grade 11 and 12 do not have text books in braille script.
In one studies carried out by BYAN in the Kathmandu valley in 2015, 65% of total BPS children had usable Braille text books. It is also estimated that approximately ??% of BPS children of school going age are out of school.
Accessibility provisions in the colleges and universities are yet to be considered as BPS persons have to struggle on their own if they wish to persue higher education. Evaluation system for the BPS children is yet to be BPS friendly and full inclusion of the BPS children in the education mainstream still remains as our aspiration.
2.3.2 Economic situation
It appears to be complementary relationship between disability and poverty. Majority of persons with disabilities in Nepal fall below poverty line which is estimated to be mor than 80% however there are no exact head counts or surverys focusing on this aspect. Very least number of persons with disabilities have opportunities for their livelihood. Despite some improvements in the area of education, the GoN, private sectors and other areas are still silent towards the employment issue of persons with disabilities, and therefore for BPS as well. According to the study carried out by NAB, majority of BPS persons are engaged in teaching profession with the exact headcounts to be 618 however the employment in the other areas such as private, non-government and civil service sector is very nominal. In the music sector, 60 BPS persons were employed and are having their independent life. It is worthwhile to mention here that the employment in the music sector was the outcome of the Music Education project implemented by NAB during the period of 2001-2014. Though the project trained many BPS, some of the moved to the teaching professions after the training.
As BYAN is involved in the employment promotion of BPS persons for self-employment and employment in government and non-government sector, it has been possible to create employment opportunities to 103 BPS youth of which 71 are in the government sector, 19 in the non-government sector and 13 as self-employment.
2.3.3 Legal situation
GoN initiated to provide services to persons with disabilities since 1982 through the enactment of Disabled Protection and Welfare Act, 1982 endowing certain welfares schemes to the people with disabilities through proper identification and provision of Disability Identity card, thereby to provide education, training, employment, treatment. The interim Constitution of Nepal (2007) made provision in different 22 areas and also guaranteed rights of persons with disabilities in certain areas such as equality, employment and social security, however in general terms.
As mentioned in above paragraphs, the Constitution 2072 (2015) has ensured generally all the civil rights and political rights of people with disabilities[5], and Nepal's Constitution is considered as among the 10th best constitution in the world from disability perspective. In 2 years time period of the promulgation of the Constitution, the GoN also enacted Act relating to the Rights of Person with Disability, 2017 that is written based on the notions of CRPD and alongside of the Constitutional provisions. In July 2020, the GoN also issued Disability Rights Regulation to back the disability rights act, and to advance the implementation of provisions as outlined in the act. As mentioned in above paragrphs, Nepal ratified CRPD in 2009 and this convention is being effective from 10th May 2010.
In mid 2016, the parliament approved 8th amendments to its Educational Act 1982. This amendment in education act has mostly addressed the educational issues of people with disability by re-defining the special and inclusive education provision to people with all disability categories along side of representation of people with disabilities and their organisations in the different educational structures. In early, 2017, the GoN also issued Inclusive Eduation Policy for the Citizen with Disabilities, and this policy is considered as most advanced policy in order to deal with the issued faced by disability population to ensure access to education. This policy has ensured several educational rights provisions relating to BPS.
Towards the middle of 2017, the Legislative-Parliament of Nepal enacted Act relating to the Right of Person with Disability. From the legal perspective, this is the most progressive law written from the rights perspective and in line with the notion of CRPD. This Act has recognised and categorised disabilities into following 10 different ones as; 1) Physical disability 2) disability related to vision, 3) disability related to hearing, 4) Deafblind, 5) Intellectual disability, 6) Autism Spectrum Disorder, 7) Disability related to voice and speech, 8) Pshychosocial disability, 9) Disablity related to genetic (Hemophilia) and 10) Multiple disability. As a way forward to implement this act, the government has issued Disability Rights Regulation in the middle of 2020.
Besides constitution, various acts and regulations have also made some provision to provide support to people with disabilities. These include income tax act exempts 50% tax than that of other persons, there is 50% discount in travel fares and waiving the custom duty on the items purchased to BPS such as White cane. The civil service act provisions 4% seat allocation for persons with disabilities in government jobs.
When it comes to the health rights of persons with disabilities, the Constitution is much indicative and disability rights act is little explicit one. In the section 28 of the act, it has provisioned free health services to the persons with disability for the diseases as prescribed or for the people having low income as prescribed. Sub-section 3, 4 and 5 of this section has outlined to make health facilities accessible, providing treatment with priority and allocating 2 beds per 25 hospitals. The rehabilitation of persons with disabilities who are weak, with profound disability or intellectual and psychosocial disabilities has been mentioned in section 29 of the act. When it comes to the Sexual and Reproductive Health Rights of persons with disabilities, the act has mentioned to make required provision for the protection of health and reproductive rights of women with disabilities in section 19(2). Apart this provision, this act is totally silent towards SRHR issues and rights of disability population.
Of course, there are a lot of commitments from the government expressed through the acts, regulations and policies and programmes. The closer examination of these provisions reveals that the implementation has been suffered from a rather cumbersome bureaucratic structure and poor budget allocation for the implementation. What is also equally true is that the current transitional structure of the State where full functioning of the Provincial and Local govt. structures shomewhow shadowed the rights and issues of persons with disabilities making them fully accountable towards the rights of persons with disabilities. This is being changed however in much slower pace.
2.3.4 Political situation
The Constitution of Nepal, 2015 has provided political rights to great extent. Despite getting organised into organisations and affiliation into the political parties, the Constitution has ensured proportionate political representation of persons with disability in different state layers for example National Assembly, House of Representatives and Federal Councils. As Nepal accomplished elections for its all layers of the government, there are 4 persons with disabilities in the National Assembly, 2 in the House of Representatives.
The Act relating to the Political Parties ?? has urged political parties to ensure proportionate inclusion of persons with disabilities in their party structures. Eventhough this condition is not fully applied by all political parties, majority of the key political parties have included persons with disabilities in their structures and also formalised separate Departments to look after disability rights issues.
2.3.5 Social situation
Persons with disabilities are generally backwarded in the society. Due to deep rooted traditional beliefs and sub-ordination, people with disabilities are not able to have a respectful and dignified life in the society. Disability is often seen a resultant effect of sin of past generation. Social environment is quite unadjustable due to the society's conclusion that persons with disabilities are physically incapable ones. There is exclusion of persons with disabilities in the social structures and they are rarely regarded as subject in the society. Lack of accessible physical infrastructures coupled with mountanous topography and mindsent of the general people has made it further worse. Despite the several above facts some of the BPS persons have been able to deminstrate their successful work capacity as a result the society's world view is changing in a slow pace.
2.3.6 Health status particularly the SRHR
Nepal has made many international commitments by ratifying the different conventions and declarations. The Constitution of Nepal gives a broader scope to deal with the health, SRHR and FP needs of the people with disabilities. Similarly, the UNCRPD has been found to be progressive in provisioning SRHR and FP needs of the disability population whereas other tools such as SDG, ICPD, CEDAW were found to be little explicit or not explicit at all. Even the specific law enacted to protect and promote the rights of people with disabilities i.e. Act relating to the Rights of Person with Disability, 2017, has restricted provision with respect to the needs and issues faced by the disability population. The Safe Motherhood and Reproductive Health and Rights Act, 2018 also deviates from the SRH rights’ of persons with disabilities. The Disability Inclusive Health Guidelines, 2019 prepared by the Ministry of Health and Population is the most progressive document on the part of government till date. As a guideline, this document lays out strong foundation to address issues faced by the disability population. However, as guidelines may not be legally binding, they may not always be strictly followed, which in itself is a limitation. Surfacing on the program and budget, no policies and guidelines are backed with the reasonable amoutn of budget allocation. After all, accessibility remains as a major bottleneck for people with disabilities. Ensuring accessibility needs more understanding and commitment that goes far beyond than the resources alone.
On the other hand, the disability population itself seems to be less aware of SRHR rights. Inadequare levels of knowledge about human sexuality and inappropriate or poor quality reproductive health information and services, prevalence of high-risk sexual behaviour, discriminatory social practices, negative attitude and powerlessness on the part of women and girls to decide on their sexual and reproductive lives makes the situation worse.[6] Barriers against the persons with disabilities compunds the risk. Traditionally, although premarital and extra marital sex have been discouraged in Nepal and most of the Asian societies[7], studies conducted in different geographical settings have shown that unmarried adolescents in Nepal are becoming more sexually active and are also increasingly vulnerable to STIs and HIV infection due to changing values, norms and independence.[8]
A study carried out by MSI[9] showed that 96.5%of the young people with disabilities are not aware of all modern FP methods, 94% have heard of safe abortion, while 39% are unaware of legal status of abortion. Of those who responded knowing safe abortion methods, 94% and 58% had heard of medical and surgical abortion respectively. Around 80% respondents had one or more myth or misconception associated with FP and abortion. Only 28% ever consulted with the service providers. In addition, 54% considered their service centers were not friendly to their disability because of lack of infrastructure—for example, lack of wheelchair accessibility (57%), service providers’ negative attitude or lack of understanding of their need (29%) and absence of sign language interpreter (12%). Around one-fifth described difficulty communicating with service providers due to shyness, inability to read or write and lack of sign language provider. The study carried out by NDWA[10] among the women with disabilities also illustrated similar findings where 45% of women with disabilities were found to have different reproductive health related problems, 40% of women with disabilities (inclusive of married ones) did not have any information about contraceptives, 53% of the married women had never used any contraceptives. The same study also found that 50% of pregnant women with disabilities did not receive any basic SRH services while 66% pregnant women with disabilities experienced complicated issues such as tumulus period of nausea, soiling feet, abdomen pain and weakness. Among those who delivered child, 55% occurred at home without proper medical supervision, and similar percentage expressed that they did not get care and medication after the delivery.
Another qualitative study carried out by Visible Impact Nepal showed that worldview towards disability is a major barrier to access family planning services. Majority of the participants responded with not being aware of the SRH needs with difficulty in accessing SRH services. Structural and attitudinal barriers serve as major bottleneck with unfriendly health facility structures.[11]
Footnote links ;
[1] 15th National Development Plan 2019. National Planning Commission, Nepal
[2] Human Development Indicators Nepal 2019. UNDP.
[3] The Universal Declaration of Human Rights, 1948; The International Convention on the Elimination of All forms of Racial Discrimination, 1965; The International Convention on Civil and Public Rights, 1966; The International Convention on Economic, Social and Cultural Rights, 1966; The Convention on the Elimination of all forms of Discrimination Against Women, 1979; Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1984; The Convention on the Rights of the Child, 1989; The Convention on the Indigenous and Tribal Peoples, 1989
[4] Nepal Education in Figures, 2017. Ministry of Education, Science and Technology. 2017
[5] 18. Right to equality: (2) There shall be no discrimination in the application of general laws on the grounds of origin, …….disability….. condition, language or geographical region, or ideology or any other such grounds. Provided that nothing shall be deemed to bar the making of special provisions by law for the protection, empowerment or advancement of the women lagging behind socially and culturally, …………………, person with disability, …….. 31. Right to education: (3) Person with disability and person with weak financial capacity shall have the right to free higher education as provided for in law. (4) The blind person shall have the right to free education in brail script, and deaf and people with speech disability shall have right to free education in sign language. 39. Right of children: (9) Children who are helpless, ……., disability, ……….., shall have the right to special protection and facilities from the State. 42. Right to social justice: (1) Socially backward women, ………, person with disability, ………………. shall have the right to employment in state structures on the basis of the principle of inclusion. (3) Person with disability shall have the right to live a dignified life with identity to their diversity, and shall have equal access to public services and facilities. 43. Right to social security: Economically poor, physically incapacitated, ……., person with disability, ………, shall have the right to social security as provided for by law. 51. State Policies (14) Increasing investment in the transportation sector by ensuring simple, easy and equal access of all citizens to transportation facilities, …………….., encouraging public transportation and quality private transportation, while also making the transportation sector safe, well managed and disability friendly. 84. Composition of House of Representatives: (1) The House of Representatives shall consist of two hundred and seventy five members as follows:- (2) Provision shall be made according to Federal law for the representation of political parties to field candidacy for the election of the House of Representatives for proportional representation system through closed list of women, Dalit, Adibasi Janajati, Khas Arya, Madhesi, Tharu, Muslim, and backward regions. Balance in geography and province shall be considered for such candidacy. (3) While fielding candidacy by political parties pursuant to clause (2), provision of representation of person with disability shall also be made. 86. Composition of National Assembly and terms of members: (2) There shall be fifty-nine members in the National Assembly as follows:- (a) Fifty six members elected from an Electoral College comprising members of Provincial Assembly and chairpersons and vice-chairpersons of Village councils and Mayors and Deputy Mayors of Municipal councils, with different weights of votes for each, with eight members from each province, including at least three women, one Dalit, one person with disability or minority community; 176. Formation of the Provincial Assembly: (6) The representation of women, Dalit, indigenous, indigenous nationalities, Khas Arya, Madhesi, Muslim, backward region and minorities community on the basis of geography and population in the nominations filed by the political parties for the election to be held for the Provincial Assembly through the proportional representation (PR) election system shall be made on the basis of closed list in accordance with Federal law. (7) While filing of candidacy by political party pursuant to clause (6), representation of the person with disability shall also be made.
[6] European Society of Contraception and Reproductive Health. Position Paper on Sexual and Reproductive Health and Rights 2019 (The Madrid Declaration). 2019.
[7] UN Economic and Social Council. General comment No. 22 (2016) on the right to sexual and reproductive health (article 12 of the International Covenant on Economic, Social and Cultural Rights). New York: Committee on Economic, Social and Cultural Rights, 2016.
[8] UNFPA. Socio-economic, Demographic and Reproductive Health Profiles of Adolescents in SAARC Countries, Proceedings of the UNFPA South Asia Conference on the Adolescents 1998 July 21-23; New Delhi; 1998.
[9] Ramchandra, Gaihre; Ruchita Rajbhandary; Shilpa Lohani;, Romi Giri and Sabitri Sapkota 2018. Understanding the sexual and reproductive health needs of young persons with disabilities in Nepal. Sunaulo Pariwar Nepal, Blind Youth Association Nepal and Marie Stopes International.
[10] Neeti, Aryal Khanal. 2012. A Study on Status of Social Inclusion, Livelihood and Violence Against Disabled Women of Nepal. Nepal Disabled Women Association and Action Aid Nepal.
[11] Experience of Young People, Sexual and Gender Minorities and People with Disabilities with Family Planning Services in Nepal. Visible Impact Nepal. 2019.