Author: Guanying Peng, Nawshin Nawar, Sarah Paden, Yi Chiew

Section 1: Country Introduction (Nawshin)

Bhutan is a very small landlocked country situated in the Himalayas between India and China. It is a mysterious land of natural beauty with steep mountain ranges and deep valleys. Breathtaking views and unadulterated natural sights have made Bhutan one of the most famous tourist spots in South Asia. Due to having mountainous ranges and deep valleys all over the country, population settlement patterns in Bhutan are very scattered.

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The five most populous areas in Bhutan are - Thimpu, Punakha, Tsirang, Phuntsholing, and Pemagatshel.

The capital city of Bhutan is Thimphu, which is located on the central western part of Bhutan. Initially, the original capital was Punakha but it was officially changed to Thimphu in 1961. Spread out rather well in the valley (and Dochula pass) that houses it, Thimphu is the 3rd highest capital of the world and the air here is very thin.

Thimphu is nestled in a range of mountains — as such, it is very picturesque but difficult to get to when compared to many other cities in the world. The climate here, though, is consistently mild, the coldest being about 27.3 degrees Fahrenheit in the winter to about 77 degrees Fahrenheit in the summer. There are several rivers surrounding or crossing the city of Thimphu, which is probably why the land here is so well-given to agriculture and thus become one of the most important cities in Bhutan.

Section 2: Demography (Guanying)

No. It’s qutie normal

Section 3: Cultural-Linguistic Information (Sarah)

Geographic Distribution of Lanugages The top three languages spoken in Bhutan are Dzongkha (210,000), Nepali (187,000), Tshangla (182,000). As depicted in the map above, we can see that Nepali is most spoken on the southwestern coast - represented in the black and white stripes - while Dzongkha is Western, as depicted by the hot pink. Lastly, Tshangla is southeastern, depicted by the light pink.

Section 4: Economic Information (Yi)

Income of Bhutan Population The median adult income of Bhutan in 2021 is USD 2446.

Vegetable is the most important exports (USD 127,500).

Section 5: Education (Sarah)

As of 2019, the Bhutan population education data suggests an expected 13 years of schooling; however, the average years of schooling only falls around 4.1 years. Although since 2005, the average rate of schooling has increased at a rate of 1.8%. Additionally, about 27.6% of the population who are ages 25 and over have at least some kind of secondary education - which has grown at a rate of 2.9% since 2012.

Bhutan has one overarching public university - the Royal University of Bhutan - which is composed of eight colleges: Sherubtse College, Jigme Namgyel Engineering College, Samtse College, Gaeedu College of Business Studies, Paro College of Education, College of Natural Resources, College of Sciences and Technology, and College of Language and Culture Studies. Bhutan also has three private institutions: Royal Thumphu college, Royal Institute of Management, and Royal Institute for Tourism and Hospitality. Additionally, there are two medical schools: Royal Institute of Health Sciences and National Institute of Traditional Medicine.

The Royal University of Bhutan tuition is Nu.69,710 for arts and humanities programs, or Nu.86,360 for science and engineering programs. The Royal Thumphu College tuition is Nu.68,200, while the Royal Institute of Management tuition is Nu.60,500. The Royal Institute for Tourism and Hospitality does not have tuition payments, but instead a security deposit of Nu.2,500 and any additional travel fees that may arise. The Royal Institute of Health Science tuition falls around Nu.93,000 and the National Institute of Traditional Medicine tuition can range from Nu.138,324 to Nu.163,324 annually.

Since Bhutan only has a few colleges - Fig. 4 represents the average cost at each institution. Fig. 5 represents the cost of tuition as a percent of median annual household income - which is Nu.182,103.48. Since the Royal Institute for Tourism and Hospitality skews the tuition data, the percent for each institution is provided, instead of a median for all of them.

Section 7: Annotated Bibliography

Trend - Fertility

Thinley (2017) focused on the adolescent fertility rate (AFR). Bhutan’s AFR in 2015 was 20.1 births per 1000 adolescent women (15–19 years old), while national reports reflect an AFR of 28 births in 2012 per 1000 adolescent women. Despite a slight discrepancy, the above rates are far better than the average AFR of the world at 46.7. The rapid reduction of the AFR from 120 in 1994 to the above levels could be attributed to increasing literacy, poverty alleviation, urbanization, and availability of contraceptives. In addition, in a logistic regression analysis of the socioeconomic and demographic factors affecting young women’s pregnancy, variables such as a rural location, a poor background of the household, low education of a woman, the marital status of the young woman, a significant age difference between the age of a woman and her male partner, and a woman having less power in decisions on her sexual and reproductive health, correlated positively with an early age pregnancy.

Dorjee and Spoorenberg (2016) found that the total fertility rate in Bhutan has declined from a high of 6.4 children per woman in 1982 to 1.9 in 2017, which is below the replacement level of 2.1 births per woman. Furthermore, it indicated that Bhutan had undergone classical demographic transitions. The crude birth rate of 39 births per thousand populations in 1984 started declining after 2000. It came down to a level of 15.5 births per thousand populations in 2017. Bhutan’s Prime Minister Lotay Tshering said the country suffered from a declining fertility rate due to the population control measures implemented two decades ago. He said the measures implemented in the 1970s were based on flawed data. In order to help improve the birth rate, the government of Lotay Tshering is planning to initiate a mother and child health allowance in a few months. The interventions to improve the fertility rate includes strengthening social security, developing regional hubs, improving wellbeing measures in the eastern part of Bhutan, and improving women’s participation rate in the labor force.

On the other hand, according to Gubhaju (2007), there was a remarkable decline in the fertility rate in Asia from the period 1995-2000. For Bhutan, the fertility rate was dropped by 21 % from 1990-95 to 2000-05. The article also compared Bhutan and the rest of the Asia countries and found that Bhutan had one of the steepest declines in fertility rates among Asian countries. The result from these studies had highlighted that the fertility trend in Bhutan is indeed worrying.

Trend - Ways that climate change is impacting your country

Climate change has affected agriculture the most in Bhutan. Bhutan is an agrarian country, with about half of the people depending on agriculture. For example, Chhogyel and Kumar (2008) found that rice farmers in high-altitude areas were devastated with 80–90% crop loss to blast disease. In addition, turcicum leaf blight of maize in 2007 damaged more than 50% of the farmers’ harvest. Also, in 2008, a severe windstorm flattened all maize crops belonging to hundreds of households. Furthermore, the study also showed that farming had been constrained by the mountainous topography and rapid changes in environmental variabilities. With climate change, agricultural production and food security are likely to face one of the biggest challenges of the twenty-first century. For example, the country has already been experiencing some impacts of climate change, such as crop loss to unusual outbreaks of diseases and pests, erratic rainfalls, windstorms, hailstorms, droughts, flash floods, and landslides annually.

Another study Vilà-Vilardell, Keeton, Thom, Gyeltshen, Tshering, and Gratzer (2020) looked at the impact of wildfire activity in the Himalayan Mountains due to climate change in Bhutan. Due to the geographical and socioeconomic characteristics of Bhutan, the region is susceptible to climate change. For example, the capital city of Bhutan has more significant fire hazards than its neighboring country. The study contributes to understanding and ability to predict forest fire hazards in Himalayan blue pine ecosystems. The findings will help allocate fire management resources in Bhutan more precisely, plan suburban development to minimize fire risk to livelihoods and adapt forest management in the face of climate change.

In a similar vein, Bajracharya, Mool, and Shrestha in 2007 discussed the climate projections of countries surrounding the Himalayas in the next couple of decades due to climate change. Mainly, Glaciers in the Bhutan Himalaya are less well studied than those in other countries. Nonetheless, there is some indication of glacier retreat in the Bhutan Himalaya. Karma et al. (2003) examined terminus variation for 103 debris-free glaciers in the Bhutan Himalaya over 30 years (from 1963 to 1993). Retreat rates (on the horizontal projection) as high as 26.6 m/year were reported for these glaciers, which cause terrible floods and hazards to the surrounding neighborhood. This study argued that climate change would continue to be a global concern for the foreseeable future, particularly in those countries surrounding the Himalayas. This could pose a threat to the public health of Bhutan citizens in the future.

Population Decline

The population in Bhutan was expected to have risen over the years; however, several factors have actually contributed to the population’s decline occuring over the last few decades. In the 1930’s, a prominent group of Bhutanese descendants - known as the Lhotshampa made up about 20% of the total Bhutan population and inhabiting areas across the five most populated areas of the country (Sinha, 2008). In 1958, the Lhotshampa were granted citizenship (Sinha, 2008). Despite this, the Lhotshampa faced harsh discrimination from the other Bhutanese people and were exiled from Bhutan in the 1990s (Sinha, 2008). It is not presently clear how many Lhotshampa still reside in Bhutan, although those that do are unfortunately at the risk of eviction and cultural extinction. While a direct connection has yet to be made between the exile of the Lhotshampa and population decline in Bhutan, the population trends and timing of declines suggest a connection between the two. Despite being speculative, in the line graph above, we can see a spot between 1990 and 1995 where population did not rise according to the past and future trends, and seems to have remained stagnant for some reason. This tentatively coincides with the theory of the exile of the Lhotshampa as contributing to this period’s population decline.

Another contributor to Bhutan’s overall population decline is the country’s fertility trends and governing stance on population control. Bhutan’s total fertility was previously at 1.6 children per woman, although as of 2016, fertility has only reached replacement level (Dorjee & Spoorenberg, 2016). The reason for this low fertility rate can likely be attributed to the Bhutanese’s stance on population control. In 1980, Bhutan imposed compulsory birth control (Giri, 2004). If a couple produces more than two children, it is required that one of them receive a vasectomy or laparotomy (Giri, 2004). If a couple doesn’t abide by this and produces a third child, the government is informed and they are at liberty to schedule surgery for either the mother or the father (Giri, 2004.)

Bhutan Fertility over the Years

The above graph - from Dorjee and Spoorenberg’s 2016 article - provides some visual insight as to the timeline of the country’s emphasis on population control and fertility rates. Fertility rates in Bhutan have not been consistently reported, and therefore, an advantage of the above graph is that is provides numerous reported fertility rates over time from different studies. Regardless of which study the fertility rates are derived from, there is a clear population decline after the country’s interference on birth and population control.

Public Health Trend: Dengue and COVID-19

In 2019, Bhutan experienced a dengue epidemic among their population (Tshten et al., 2020). Dengue is caused by an infected mosquito bite and causes symptoms including fever, muscle and joint pain, rash, nausea, and more. Given that Bhutan had just dealt with the worst of the dengue endemic, it’s arguable that they were in a better position to anticipate and deal with COVID spread. The biggest obstacle in Bhutan’s way was the realization that COVID and dengue present with very similar initial symptoms. Hospitals were obligated to test incoming patients for both COVID and dengue to quickly identify and prevent the spread of both. While co-infection and detection of dengue vs. COVID was an obstacle for Bhutan, it could also be argued that this put them in a better position to combat both dengue and COVID (Tshten et al. 2020). The first COVID case in Bhutan was detected in an elderly American tourist, and Bhutan was fortunate to act quickly at the first notice of the COVID pandemic and contain it. They immediately enacted a 31-day quarantine of all citizens, and zoning of “high risk” areas aided in the mitigation of restless citizens, and well as differentiated which areas of Bhutan were in need of mandatory testing (Tamang & Dorji, 2021). The country also required in-patient, 21-day long quarantines for travelers entering the country (Tshten et al., 2020). When the second outbreak hit, Bhutan enforced a 40-day quarantine to ensure zero spread - even longer than the first outbreak’s quarantine length (Tamang & Dorji, 2021). A particularly interesting aspect of Bhutan and their handle on the dengue endemic and COVID pandemic is their prioritization of their citizen’s well-being. Their decisions to extend family quarantines, make testing free, target the testing by need and population, as well as their diligence to contact tracing, travel restrictions, physical distancing, and hygiene measures benefited their population and lessened the negative economic impact that typically occurs post-endemic and pandemic (Dorji, 2021).

Total COVID-19 Cases in Bhutan As seen in the above graph - data sourced from John Hopkins University - Bhutan has experienced a total of 2,640 cases of COVID since the first case in March 2020. They have experienced only three deaths as of December 1st, 2021. Unfortunately, this is not a completely accurate picture however, due to limited testing availability. Despite this, Bhutan has handled the pandemic from an honorable stance, placing its citizens and their well-being first.

Trend : Age structures

For the past 20 years, the population goes a relatively steady growth in Bhutan, which results in a normal age structure by now. For Bhutan, the population at present is still predominantly young and the working-age population dominates the whole structure (nearly 60% by 2020), the steady decrease in the infant mortality and increase in life expectancy, all of these factors contribute to a youthful, sturdy age structure at present in Bhutan. However, the serious problem is coming, according to the prediction and the demographic transition will occur at a much faster rate in Bhutan in the near future.

By 2050, the proportion of population 60 years and above will have increased significantly , while the old-age security system still lags behind the population development. Due to Bhutan’s religion conventions and traditional family structure, the responsibility of caring the old age people mostly belongs to an extended family network with part of old-age security based on the Buddhist monasteries, which means the country-sized old-age provision is absent. While the fast-increasing size of older people raises the unbridgeable demands for several special social services including medical facilities, financial support, family care and sound aging support system, the network-based security is far from enough.

While the working age keeps increasing, the economic development still goes in the future, only a pension scheme which provides regular monetary income in old age will help to relieve the aging burden on the working young and sustain the aging population structure in Bhutan. The income in old age could be increased and costs could be reduced by transforming the existing provident fund totally or partly into a pension scheme. Meanwhile, the religion aging support may be a helpful solution to building the national aging-caring system, relieving part of the state financial burden.

Trend : Changing family structures, sex ratios or gender roles

There are eye-catching and interesting contradictions in the gender structure of Bhutan. Bhutan is one of the most gender-equal countries in Southeast Asia. In terms of national policies and laws, Bhutan’s macro measures are gender neutral. Especially according the Bhutan’s Gross National Happiness Index, the gender equality is one of the important goals. However, the gender-based disparities still exist from the socio-cultural notion.

For the family structure, Bhutan’s traditional society has been defined as patriarchal. Although there are more dynamics happening in the Bhutan’s traditional-dominated society, the disintegrating structure from two parents into single parent families, the increase of blended families and divorce, still lead to unstable influence factors in family-related social problems.

For gender roles, the roles and position of men and women in the Bhutanese society is one such traditional value system, male to public sphere and female to private sphere.In 2010, 84.6% of women of reproductive age (15-49 years) had their need for family planning satisfied with modern methods[1].In division of labour, female also play the domestic role of women as mothers and caregivers. The gender gap in proportion of time spent on unpaid demoestic chores and care work is huge. [1]https://data.unwomen.org/country/bhutan

Also, the inequality in the higher education results in the lack of importance on the education and skills enhancement, entrepreneurship development, micro-financing for women, leadership capacity development and awareness and advocacy.

In terms of the gender gap in political participation, women comprised 36.43% of the total civil servant in Bhutan in 2017(Lhamu,2019).

Women’s representation in the Parliament has not been encouraging, the percentages have declined from 13.8% in 2008 to 8.3% in 2013 and 15.3% in 2018, but it is still quite a long way for reaching a critical mass of 33%(Lhamu,2019).

The regional development imbalance continues to put threat on the gender equality in Bhutan. In southern Bhutan, men tend to have more control and influence over decision-making than women do. And arrange marriage had been prevalent mostly in rural areas which leads to a more traditional family structure.

The most fundamental reason of Bhutan’s inequality in gender is the traditional value system, and the deeply-rooted regional development imbalance worsens this phenomenon. Besides the improvement of national policy and laws on the higher education and career support for Bhutan’s women, the gap between the southern and northern regional economic imbalance is still the main concern.