Challenges of Family Planning in Nepal
This October the world's population was projected to reach 7 billion. WRA called on our members to submit stories and photographs that illustrate the progress made on the topic of family planning - a topic of increasing concern in a world of 7 billion people. This posting comes from Yuba Raj Baral, a PhD student at London Metropolitan University. He is researching maternal and newborn health issues in Nepal. Research is necessary in order to hold governments accountable in their commitments to Every Woman, Every Child because it provides evidence of the on-going problems, where a government’s commitments have fallen short of expectations and where more assistance is necessary to reduce maternal mortality. Read an abstract of Yuba Raj Baral’s work below:
The use of contraception is one of the key determinants of fertility. Fertility is directly related to maternal morbidity and mortality. It is documented that if the existing demand for family planning services were met then maternal deaths in developing countries could be reduced by 20% or more. Over the past decade in Nepal, the use of modern family planning methods has been increasing steadily and fertility has dropped from 4.6 children per woman in 1996 to 3.1 in 2006. According to different research findings the unmet demand of modern family planning methods still high in Nepal. The Nepal Demographic Health Survey (NDHS 2006) reports that there is high unmet demand, as 25% of married women could not access modern contraceptive services.
Family planning is given a high priority in maternal health policies with the aim of providing and sustaining adequate family planning services through community level health facilities in Nepal. However, not all women are not able to receive those services easily. According to NDHS 2006, knowledge of at least one modern contraceptive method of family planning is universal among married women but there are substantial differences in the use of contraceptive methods among subgroups of married women. Women in urban areas are more likely to use modern contraceptive methods than rural. Similarly, married women in the Terai (the plain area in the south of Nepal) have higher use than hill and mountain women. This perhaps reflects the easier access and wider availability of these methods in the Terai and urban areas. The impact of education on contraceptive use is mixed. Wealth is positively correlated with contraceptive use. The use of modern contraceptive methods between the highest and lowest quintile women are vast differences. Married women who have three to four living children are more likely to use modern contraceptive methods than married women who have no living children, presumably because they latter may wish to have children and do not want to prevent pregnancy.
Experience from many developing countries of Asia and Africa (e.g. Malaysia, Sri Lanka, Thailand, Tunisia) and also Jamaica, suggest that some countries are able to reduce maternal mortality through providing universal access to family planning and skilled birth attendance with back-up emergency support. Many of these countries have reduced their maternal mortality rates by more than half within a ten-year period. Evidence from Nepal suggests that over the past decade, Nepal has achieved significant improvement in levels of maternal morbidity and mortality but is still higher than most other developing countries.
In Nepal, the available research findings have shown that utilisation of family planning services vary according to the socio-economic and demographic status of women. Poor rural road links and lack of access to health services are some factors that hinder the utilisation of services. Higher status women (e.g. measured by education level, wealth and urban dwelling) make better use of family planning services including for maternity care. In order to increase family planning services utilization priority should be given to poor and rural women with least access to facilities by providing sufficient support (e.g. finance, free education, health insurance, free health service and other health incentives) together with increasing reproductive health education. The government should also prioritise the establishment of new health facilities in remote and less developed areas together with developing road links to major urban areas of Nepal where main health facilities are located.