Family Planning Pilots
Unplanned pregnancies can be avoided by improving awareness, increasing access to family planning (FP) services and expanding service provision to include additional methods of contraception.
The World Health Organisation recommends a two year gap between a birth and the next pregnancy. However in Nepal, studies found that 50% of pregnancies occurred less than two years after the previous birth.
Despite gains in the contraceptive prevalence rate (CPR) and a decline in fertility rate, the unmet need for FP in Nepal remains high and has actually increased in the last 10 years. Levels of unmet need and rates of contraceptive use vary substantially depending on location.
Furthermore, the earthquakes in 2015 caused large scale displacement of families from their homes, and affected the availability and delivery of FP services. Such services urgently needed to be restored and strengthened, in line with the ‘build back better’ objective, particularly for those in hard-to-reach and earthquake affected areas, and for displaced persons living in temporary shelters and settlements.
We worked with the government to design and test three different models of delivering FP services:
Integrating family planning services into immunisation clinics
We worked at district level to support the planning and provision of integrating FP services into immunisation clinics. This meant that when mothers went to get their children vaccinated, they could also receive FP services, rather than having to go to a separate clinic.
We orientated staff and expanded their skills to deliver the services, and increased women’s awareness through group health education. We also reviewed infrastructure requirements in integrated clinics and ensured adequate supplies of contraceptives.
We strengthened reporting and monitoring of FP services and established a referral system for those seeking long term contraceptives that are not available at integrated clinics.
This approach improved the uptake of FP methods and had no negative impact on FP service provision at Primary Health Care Outreach Centres.
Services were provided to 1,539 clients, of whom 58% were new users. More than a quarter of all users of the Enhanced Immunisation Programme were Dalits, suggesting that this underserved group was using the service at a higher rate than its percentage in the population as a whole would predict. The success of the initiative led to the government extending it to further districts.
Increasing access to Long Acting Reversible Contraception (LARC).
Dedicated Visiting Providers, skilled providers of LARC services, were deployed to birthing centres and non-birthing centres. They provide coaching and mentoring to support skilled birth attendants (SBAs) to deliver LARCs or provide LARC services directly when SBAs are not available. We helped design standard operating procedures, provided training and mentoring and supported the government and district level staff to provide quality assurance and oversight. This approach led to a significant increase in the uptake of LARCs - an additional 1,123 users, providing 4,327 couple years of protection (CYP).
Voluntary Surgical Contraception+
We looked at whether the provision of a wider range of family planning services (VSC, LARC, injectable contraceptives, oral contraceptive pills and counselling), delivered through Voluntary Surgical Contraception (VSC) camps, would expand the availability, choice and uptake of FP services to those living in rural Nepal.
We worked with a non-state partner to deliver services in programme districts lacking sufficient skilled in-house staff to carry out the VSC+ camps. Around 90% of interviewed clients in the VSC+ camps reported switching family planning methods on the day of the camp, usually from a short term to a longer term method, or from a reversible to a permanent method.
The VSC+ pilot resulted in the provision of family planning services to 316 users, providing 3,082 CYP.
EIP Services were provided to 1,539 clients, of whom 58% were new users
1,123 additional users of LARC
The VSC+ pilot provided family planning services to 316 users, providing 3,082 CYP