Unmet Need for Family Planning in Nepal

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of methods choice among the women,

• Fear or any experience of contraceptives side effects,

• Religious and cultural barriers related to family planning,

• Low quality of health services available,

• Gender based issues and discrimination and

• Poor accessibility to the available health services.

Local Response:

The Ministry of Health and Population (MoHP) of Nepal has been strengthening its services by providing various family planning services free of cost to the people to increase the accessibility and availability of contraceptives (DoHS, 2011). This has been made possible by mobilizing 48,549 Female Community Health Volunteers (FCHV) throughout the country to serve as a bridge between the government and the community to provide the family planning services to the people (CREHPA, 2010). Distribution of contraceptives free of cost to couples, house visits, women education, mass media campaigns and regular monitoring of the family planning services through outreach programs are some of the major activities being carried out by the family planning programme in Nepal (RHDP, 2007).

Along with the government sector, involvement of Non Government Organizations (NGOs) like Family Planning Association of Nepal (FPAN) has contributed to the improvement in service utilization in the country (CREHPA, 2010). Started in the year 1959, it was through FPAN that Nepal adopted its first family planning program in the country. Development and implementation of policies targeted to decrease fertility rate, community-based distribution programs, information, communication and education campaigns to reach a wide number of people and free mobile sterilization camps are among the many successful steps taken by one of the largest and oldest NGOs in the country (FPAN, 2006). Besides FPAN, there are numerous other national (Jagriti International, ADRA Nepal, etc) and international (John Snow Inc., UNFPA, etc) non-governmental organizations working in family planning sector in Nepal (DoHS, 2011).

Achievements:

As a result of the effort of the government and NGOs, there has been a 16-fold increase in the trend of contraceptive prevalence rate (table 1) in Nepal in the last 35 years (MoHP, 2011). This indicator signifies the success of family planning program in the country.

Table no. 1: Trend (%) in the current use of contraceptive methods (1976-2011)

Methods 1976 1981 1986 1991 1996 2001 2006 2011

Any method 3 7.8 15.1 NA 26 39.3 48 49.7

Modern method 2.9 7.6 15 24.1 26 35.4 44.2 43.2

Source: NDHS, 2011 and MoHP, 2007

Another success story shared in family planning sector, by Nepal Demographic and Health Survey (NDHS), is the increasing trend of male sterilization seen in the country in a period of 15 years from 5.4 in 1996 to 7.8 in 2011 (table 2). Involvement of male in family planning has proven to reduce opposition to any decision made by partners in family planning (Chaudhury, 2001).

Table no. 2: Trend (%) in sterilization among male and female (1996-2011)

Sterilisation 1996 2001 2006 2011

Female 12.1 15 18 15.2

Male 5.4 6.3 6.3 7.8

Source: MoHP, 2011

With the increase in use of the family planning methods in the country the total fertility rate (TFR) has also been decreasing in the past 15 years from 1993 to 2010 as shown in the bar diagram below.

Fig. no. 1: Trends in Total Fertility Rate (1993-2010)

Source: MoHP, 2011, pg 10

Along with this decrease in the TFR, there has also been a significant decrease in the maternal mortality ratio from 539 per 1000 live births in 1996 to 281 in 2006 (CREHPA, 2010). This decrease has been attributed to the increasing use of family planning services in the country (CREHPA, 2010). All these reproductive health indicators are in line with directly meeting the MDGs goal 5 and indirectly affecting other goals (Cates, 2010).

Fig no. 2: Trends in Unmet Needs (1996-2006)

* National Family Health Survey

Source: Aryal et al., 2008, pg. 6

The above figure shows a decline in the unmet needs of family planning among the women from 31% in 1996 to about 25% in 2006 (Aryal et al., 2008).

Challenges for Nepal:

In defiance of the attainment of the family planning goals, there exists the challenge to further decrease the current unmet needs, where still 25% of the married women have reported having unmet need of family planning (CREHPA, 2010). Out of the 25% unmet family planning needs, 15.2% is for limiting pregnancy and 9.6% for spacing, suggesting that women’s’ contraceptives need for limiting births are less likely to be fulfilled as compared to the women with the spacing needs (DoHS, 2011). Delivery of various family planning methods targeting the limiting needs should be increased in order to address both the needs equally.

Along with unmet needs, another challenge of increasing demand of family planning services among married women exists in the country. Among the total MWRA in Nepal, 27% of them have not expressed any demand for the contraceptive use (DoHS, 2011). In order to design any policy, it is necessary to determine the service demand of people as without the demand of the people; services provided are of no use (Aryal et al., 2008). Thus, strategies that help to increase the demand of women on family planning services is needed. Nepal’s family planning programme has been directed towards these groups in order to decrease unmet needs and increase contraceptive demands among those women (DoHS, 2011). Although targeting them will help to address the problem of unmet needs to some extent, it can only be achieved through contemporary approaches and evidence based strategies.

Ways forward:

Need assessment of the couples should be done to ensure the right family planning method is available to the right couple according to their demand, which will help to appropriately