Bhutan

Bhutan is a landlocked country in southern Asia between China and India. Its name is derived from the Sanskrit word for “high land.” Most of the country lies within the Himalaya mountains, with many peaks over 23,000 feet (7,000 meters). Population estimates range from 650,000 to over 800,000 depending on the source. The country is sparsely settled, with most people living as subsistence farmers in small villages scattered throughout the countryside.

This isolated kingdom is one of the most protected countries in the world, with tourism and foreign involvement strictly monitored to assure that the people can stay true to their Buddhist roots. Before 1999, even television was forbidden. Bhutan is the only country to measure what it calls its “gross national happiness,” defining the national quality of life by what is best for the spiritual and cultural good of its citizens.

Beginning in 1961, the kingdom committed itself to building its infrastructure, and has since implemented a well-integrated system of roads, telecommunications, schools, and hospitals. Recent years have also seen tremendous progress in the area of public health. Since the 1990s, life expectancy has risen from around 49 years to 66 years. Infant mortality was nearly cut in half, from 107 deaths per 1,000 live births down to 65 deaths per 1,000.

Despite this rapid rate of progress, significant challenges remain. By 2004, 62 percent of Bhutanese had access to clean drinking water and 70 percent had adequate sanitation facilities—a vast improvement over earlier times, but not enough to end waterborne diseases. The United Nations Children's Fund estimates that six out of every 10 rural children suffer from worms, diarrhea, or skin or eye infections arising from [Page 226]poor sanitation. Acute respiratory infections and malaria are ongoing problems.

Malnutrition is also an issue, especially for the rural poor, although the introduction of iodized salt has reduced the prevalence of goiter from 64.5 percent in the 1980s to 14 percent by 1996 and cretinism (a form of physical and mental stunting) has declined from 10 percent to just 0.4 percent in the same period. Children now routinely receive vitamin A supplements, and pregnant women have better access to iron supplements to control anemia.

Four out of five women still give birth at home, contributing to a high maternal mortality rate of 420 deaths per 100,000 live births. The fertility rate is also high at 4.1 children per mother. About a third of all women have access to contraception; about half receive prenatal care.

Delivery of medical services to the country's many remote communities is a challenge for the kingdom. About 90 percent of the rural population lives outside the small network of roads, making it difficult to reach health centers for either preventative or emergency care. Progress is being made in this sector as well, with hundreds of new health outposts built in recent years.