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10 Dec 2021 | Gender

The gendered impacts of indoor air pollution in Nepal’s Koshi basin

Sijal Pokharel

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Energy poverty and gender

Energy is essential for survival – and for progress and prosperity. It is a prerequisite for human development and wellbeing, and a critical input to most economic activities (from household production to farming and industry) and provisional and social services (such as education and health). The type and extent of access to energy determines people’s welfare, so it is important to lend energy poverty – which is the state of insufficient choice in accessing affordable, reliable, high-quality, safe, and environmentally benign energy services to support economic and human development[1] – the same weight as other manifestations of poverty. And as with other types of poverty, energy poverty impacts women differently.[2] Energy needs at the household level are directly related to women’s workload and time,[3] and energy poverty has significant impacts on poor women and girls (predominantly living in rural areas).

This article focuses on the gendered impacts of one specific dimension of energy services[4]: household access to clean cooking facilities (i.e. fuels and stoves that do not cause air pollution in houses[5]). Close to two-third of Nepal’s population uses solid fuels such as firewood (64%) – a major contributor to indoor air pollution[6] – as a primary source of energy. As women play a significant role in the management and use of energy sources for household cooking, they are disproportionately affected by indoor air pollution[7]. In Nepal, around 8,700 people, mainly women and children, die prematurely each year due to illnesses related to indoor air pollution from solid biomass fuel burning[8].

This article explores the connection between indoor air pollution and its disproportionate impacts on women in the Koshi basin in Nepal; the fixed roles and limited autonomy of women in households, which perpetuates the gendered impacts of this particular dimension of energy poverty; and the need for gender-sensitive energy policies and programmes.


Sources of household fuel

Nepal’s general household energy source profile across geographies is quite similar, with massive dependency on wood/firewood, followed by LPG, and dry dung. Urban areas buck this trend, with large dependence on LPG (68%), followed by wood/firewood (26%). Geographically speaking, mountain households across Nepal depend almost entirely on firewood (95%) and Terai households depend largely on firewood (57%) and dry dung (22%).[9] In general, households in the Koshi basin rely heavily on wood/firewood (71%), followed by LPG (14%) and dry dung (12%) (see Figure 1). Within the Koshi basin, almost all rural mountain/hill districts[10] depend heavily on wood/firewood, while districts in urban centres such as Kathmandu, Lalitpur, and Bhaktapur depend on LPG (see Figure 2). Districts in rural areas and the Terai in general also depend on dry dung after wood/firewood.

energy sources
Figure 1. Energy source use by percentage of population across geographies (Source: CBS, 2011)
Note: National figures have been provided for urban, rural, mountain, hill, and Terai usage.


energy sources across Koshi basin
Figure 2. Energy source use by percentage of population across the Koshi basin (Source: CBS, 2011)


According to WHO, one of the crucial parameters determining the choice of fuel sources is economic status.[11],[12] Households with high income have the capacity and willingness to pay for quality fuel.[13] The major source of fuel in poor areas is usually firewood and dung cakes because of their easy availability and comparatively cheaper cost,[14] but these also emit high concentrations of harmful gases.[15] As Figure 2 shows, Rautahat, Mahottari, and Sarlahi (which lie in the Koshi basin and are the poorest districts of Province 2 in Nepal[16]) primarily depend on firewood and dry dung. Women and children who are exposed to high levels of indoor particulate matter from these sources have a higher risk of acute respiratory infections, and women who cook over biomass for long periods of time have a higher risk of chronic obstructive pulmonary disease (COPD) and lung cancer.[17]


Gendered impacts of indoor air pollution and related policies in Nepal

Indoor air pollution ranks as eighth-most factor contributing to 2.7% of the global burden of disease.[18] Because they spend more time indoors, women and children are especially exposed to high levels of indoor air pollution released by biomass fuels.[19] The WHO has recognized indoor air pollution as a gender issue[20] since women and children accounted for more than 60% of all premature deaths worldwide from indoor air pollution in 2012. It is the single leading environmental health risk for women in low- and middle-income countries. Indoor air pollution is a major cause of non-communicable diseases like strokes and COPD, including pulmonary and cardiac diseases. Women who are exposed to high amounts of indoor smoke are more than twice as likely as women who use cleaner fuels and technology to develop COPD.[21] Different interventions in the source and sink level of indoor pollution have resulted in a decrease in the overall mortality rate due to COPD, but the decline is much greater among men (102.6 per 100,000) when compared with women (119.7 per 100,000)[22] Households in Nepal’s Province 2, which consists of most Terai-based districts of the Koshi basin, are particularly prone to indoor pollution due to unclean fuel use, the lack of a separate and ventilated kitchen to cook in, and smoking indoors.[23]

Indoor air pollution is a threat that can be mitigated on several levels. The Government of Nepal has implemented policies and actions such as the National Indoor Air Quality Standard and Implementation Guidelines 2009, the promotion of non-grid/grid electrification (National Rural Electrification Programme), and the push for cleaner cooking fuels and clean cook stoves (led by the Alternative Energy Promotion Center).[24]

A shift in individual consumer choice on fuel type in rural areas can also help reduce indoor pollution. Women in the Koshi basin (mostly from rural areas and the Terai) spend longer hours in the kitchen and are responsible for managing and extracting household fuel sources, but they have limited autonomy in household decision making, which extends to fuel choices,[25] and this disproportionately impacts women’s health.

Women require policies and programmes that expand their options for the sort and extent of energy they have access to, as this influences their wellbeing and growth. Gender concerns were mainstreamed in national planning under the Tenth Plan (2002–2007), but gender-transformative ideas to address deep-rooted and wide-ranging gender inequality were not presented. The 2013 Subsidy Policy for Renewable Energy provided tangible methods to address concerns of income- and location-based exclusion, but gender equality was not addressed in the policy framework. The 2006 Rural Energy Policy was forward-thinking in that it recognized that “rural energy is strongly tied to traditional activities carried by women in rural areas.” Despite this, it has failed to acknowledge and solve the challenges that women confront when it comes to rural energy technology projects, such as difficulties in accessing project benefits, gaining employment, or influencing decisions made by users’ committees and construction companies. This gender-neutral strategy exacerbates existing gender disparities in energy poverty and its consequences. The Center for Rural Technology/Nepal (CRT/N) and Practical Action’s analysis of national energy policies recommends unambiguous articulation of gender concerns by identifying women as a discrete target group in the objectives, rather than a general mention of social justice in the policy. The evaluation also emphasizes the distinction between men and women’s energy demands in order to address concerns of physical accessibility, energy cost, and the need for knowledge to understand how men and women use energy technologies.[26]


Conclusion and way forward

Energy sector policies and practices in Nepal have received limited attention from the gender equality and social inclusion lens. The overall improvement of the political, economic, social, and health status of women is highly governed and driven by the related policies of the country. However, most governmental energy interventions are envisioned to improve services rather than reducing human drudgery or opening up new development opportunities for women and men. Energy development programmes are not tailored to address the gender roles in energy use.[27] The majority of Terai districts are economically underdeveloped, so national policies need to consider the accessibility, affordability, and gendered impacts of energy-related technologies. The Koshi basin – being a socioeconomically and geographically heterogeneous area – should be understood as a special context to ensure gendered differential energy needs. Together with sensitization on the impacts of indoor air pollution and its very real impacts on health and wellbeing, gender-specific empowerment programmes are needed to enable more autonomous and informed decision making on energy sources.

1 Reddy A K N and B S Reddy (1994), Substitution of Energy Carriers for Cooking in Bangalore. Energy, 19(5): 561-71.

2 Clancy, J. S., Skutsch, M., & Batchelor, S. (2003). The Gender-Energy-Poverty Nexus: Finding the energy to address gender concerns in development. DFID project CNTR998521.

3 Mahat, I. (2016). Gender roles in household energy management: Issues and implications.

4 Nussbaumer, P., Bazilian, M., & Modi, V. (2012). Measuring energy poverty: Focusing on what matters. Renewable and Sustainable Energy Reviews, 16(1), 231-243.
Nussbaumer et al. (2012) identified five dimensions representing basic energy services: cooking, lighting, services provided by means of household appliances, entertainment/education, and communication.

5 Winkler, H. (2011). Cleaner energy cooler climate: developing sustainable energy solutions for South Africa. University of Cape Town.

6 Smith, K. R., Mehta, S., & Maeusezahl-Feuz, M. (2004). Indoor air pollution from household use of solid fuels. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors2, 1435-1493.

Bloomfield, E. (2015). Gender and Livelihoods Impacts of Clean Cookstoves in South Asia-Full Report.

8 WHO. 2009. Country profiles of Environmental Burden of Disease, Public Health and the Environment, World Health Organization.

9 Paudel, D., Jeuland, M., & Lohani, S. P. (2021). Cooking-energy transition in Nepal: trend review. Clean Energy5(1), 1-9

10 Khotang, Bhojpur, Okhaldunga, Solukhumbu, Taplejung, Ramechhap, Dolakha, Terathum, Sindhupalchowk, Panchthar, Udayapur, Sindhuli, Dhankuta and Kavrepalanchok

11 Baiyegunhi, L. J. S., & Hassan, M. B. (2014). Rural household fuel energy transition: evidence from Giwa LGA Kaduna State, Nigeria. Energy for sustainable development20, 30-35.

12 Ghimire, S., Mishra, S. R., Sharma, A., Siweya, A., Shrestha, N., & Adhikari, B. (2019). Geographic and socio-economic variation in markers of indoor air pollution in Nepal: evidence from nationally-representative data. BMC public health19(1), 1-15.

13 Ali, A., Mottaleb, K. A., & Aryal, J. P. (2019). Wealth, education and cooking-fuel choices among rural households in Pakistan. Energy Strategy Reviews24, 236-243.

14 Das, S., De Groote, H., & Behera, B. (2014). Determinants of household energy use in Bhutan. Energy69, 661-672.

15 Raiyani, C. V., Jani, J. P., Desai, N. M., Shah, S. H., Shah, P. G., & Kashyap, S. K. (1993). Assessment of indoor exposure to polycyclic aromatic hydrocarbons for urban poor using various types of cooking fuels. Bulletin of Environmental Contamination and Toxicology;(United States)50(5).

16 Government of Nepal, Oxford Poverty and Human Development Initiative. (2018). Multidimensional Poverty Index. Analysis towards Action.

17 Sood, A. (2012). Indoor fuel exposure and the lung in both developing and developed countries: an Clinics in chest medicine33(4), 649-665. update. Clinics in chest medicine33(4), 649-665.

18 Bonjour, S., Prüss-Üstün, A., & Rehfuess, E. (2007). Indoor Air Pollution: National Burden of Disease Estimates. World Health Organization.

19 Mohapatra, I., Das, S. C., & Samantaray, S. (2018). Health impact on women using solid cooking fuels in rural area of Cuttack district, Odisha. Journal of family medicine and primary care7(1), 11.

20Bustreo, F., 2016. Household air pollution is a gender issue. Retrieved from:

21 World Health Organization (WHO), 2018., Household air pollution and health. Retrieved from:,use%20cleaner%20fuels%20and%20technologies

22 Adhikari, T. B., Neupane, D., & Kallestrup, P. (2018). Burden of COPD in Nepal. International journal of chronic obstructive pulmonary disease13, 583.

23 Ghimire, S., Mishra, S. R., Sharma, A., Siweya, A., Shrestha, N., & Adhikari, B. (2019). Geographic and socio-economic variation in markers of indoor air pollution in Nepal: evidence from nationally-representative data. BMC public health19(1), 195.


25 Acharya, D. R., Bell, J. S., Simkhada, P., Van Teijlingen, E. R., & Regmi, P. R. (2010). Women’s autonomy in household decision-making: a demographic study in Nepal. Reproductive health7(1), 15.

26 CRT/N and Practical Action Nepal, 2010. Policy Brief on Strategy for Mainstreaming Gender in Rural Energy Policies in Nepal, Gender, Energy and Water Network (GEWNet), Centre for Rural Technology, Nepal and Indoor Air Pollution and Health Forum, Practical Action Nepal, December 2010.

27Mahat, I. (2004). Rural energy planning and policies in Nepal: gender perspectives. Journal of Resources, Energy and Development1(1), 19-41.

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