Reproductive Health and Family Planning
Early marriage is common in Nepal and often leads to unplanned or adolescent pregnancies and exposure to sexually transmitted infections (STIs). Many women are unable to access contraceptive services and therefore have little control over family planning (FP). As a result, around half of all repeat pregnancies occur within 23 months of the previous birth.
Nepal has made significant progress with its family planning programme over the last 30 years. The fertility rate fell from 5.1 children per woman in 1984 to 2.3 in 2014 as a result of increased family planning investments and a strong policy framework. Despite these gains, the unmet need for contraceptives remains very high with more than 1 in 4 women reporting that while they do not want to become pregnant, they are not using contraception. The contraceptive prevalence rate is low partly because women are unlikely to receive family planning counselling during post-partum check-ups. Large disparities exist in contraceptive use and unmet needs across different population groups, with access to services in remote areas a particular concern.
Sexual and reproductive health (SRH) services save lives yet many women in Nepal still lack access to contraceptives, abortion, STI/HIV prevention and treatment, and other related services. Nepal’s terrain and the damage caused to health facilities during the 2015 earthquake add to the challenge of ensuring that women receive the SRH and family planning services they need. Bringing new contraceptive technologies to local markets will increase coverage and mean women can choose when and how many children they have. Moreover, expanding coverage of effective prevention, treatment and care services for STIs will reduce their spread and impact on the lives of the most vulnerable.
We support better SRH and FP services through:
- Research to understand people’s experiences of SRH and FP, particularly those who are hard reach due to their caste, ethnicity, culture or behaviours
- Evidence-based solutions to improve service use among those who find accessing services difficult or shameful
- Advocacy and behaviour change communications
- Strengthening and expanding delivery and coverage of services including designing and piloting evidence-based approaches
- Accountability of service providers, health and government leaders for the delivery of high quality services for all.
We have worked with Nepal’s Ministry of Health to design, monitor and evaluate evidence-based, innovative pilot interventions to expand access to FP services to underserved populations, including those worst affected by the earthquake. These approaches have included the integration of FP into the national expanded programme of immunisation (EPI); expanding the range of contraceptive methods available at voluntary surgical contraception camps and establishing a visiting provider system to increase service provision. It also builds skills of staff to deliver services through onsite coaching and mentoring.
Key results and achievements
- Pilot evaluations of EPI/FP integration in two districts found that the number of women receiving family planning increased with more than half being new users.
- In Kalikot district of mid-western Nepal, these new clients will increase the contraceptive prevalence rate (CPR) by 3.3% should they continue with their FP use.
- In Ramechhap district of central Nepal, visiting providers increased the uptake of long acting reversible contraceptives (LARCs) and couple years of protection (CYP). The visiting provider intervention is a cost-effective way to increase the uptake of LARC in areas of low CPR and high unmet demand.
- Comprehensive voluntary surgical contraceptive event (VSC+) pilot intervention implemented in Baitadi and Darchula districts of far-west Nepal proved to be a cost-effective approach to provide a range of FP methods (sterilization, implant, IUCD, short-term methods, information and counselling) to individuals and couples in remote areas.