In Nepal, a woman’s lifetime risk of dying due to pregnancy and childbirth is 258 deaths per 100,000 live births, nearly 12 times higher than the risk in developed countries. With an estimated 220 million women worldwide not using any family planning method despite wanting to avoid pregnancy, increasing use of modern family planning methods is critical. This is especially true in Nepal, where women have approximately one more child than their ideal number.
Over the last 15 years, modern method use in Nepal has risen dramatically—especially the use of female sterilization, injectables, pills, and male condoms. And knowledge of at least one family planning method is almost universal. However, rates of discontinuation within a year are also high for the pill (71% discontinuation), male condoms (63% discontinuation) and injectables (55% discontinuation).
We know that 24% of Nepali family planning users discontinue modern hormonal methods because of side-effects and health concerns, similar to the global average. High rates of discontinuation for pills and injectables, for example, may be fueled by a lack of counseling around how to manage side effects for women who choose these methods. Compounding this issue are gaps in information about which side-effects are typical—and potentially manageable—and which may reflect other medical concerns. The social context around the gaps and misinformation is equally important, as discussion and sharing of inaccurate information can falsely substantiate fear and non-use among peers and across communities.
What we’re doing about it
Under the USAID-funded FACT Project, recent formative research in five Nepali districts led by Georgetown University’s Institute for Reproductive Health and Save the Children confirmed that lack of fertility knowledge and fears of family planning methods (and their side effects) are critical barriers to uptake.
With focus groups, participatory group discussions, and in-depth interviews with young married women, men, and family planning service providers, this qualitative study investigated family planning beliefs, behaviors, and gender-related factors influencing the use of family planning.
What we’ve learned so far
Men and women reflected mixed attitudes toward use of hormonal methods, and a fear of side-effects and an inability to manage them.
Participants reported discontinuation and frequent method switching resulting from both severe and common health issues like backache, headache, stomachache, and myths such as accumulation of blood clots in stomach, and perceived wounds in uterus. Some women perceived use of injectables as causes of bleeding, weakness, loss of appetite, and irregular menstruation.
“If a person takes medicine for long, it will cause weakness… If a Copper T is inserted, we need to remove it every year… That is why I think all are useless except condom. (Focus Group Discussion, Male)
Women expressed fears that an IUD could become dislodged and fall out while working or while urinating. Some women noted fears that persistent or regular use of hormonal family planning would result in impure blood and long-term harm to the body.
“If we use Depo-Provera [injectable] or insert Copper-T, we don’t have menstruation for 1-1.5 years. All the dirty blood gets collected inside [the uterus] and causes diseases. There will be tumor and one needs to undergo operation. So we find condoms appropriate.” (In-depth Interview, Female)
Myths & Misconceptions: How to move past them?
Fear of side-effects remains a significant barrier to uptake of modern family planning methods in Nepal. Disseminating accurate and easily-understood messages about side-effect management at the community level is a key step toward mitigating individual concerns. This can be achieved by supporting existing health service providers in integrating educational counseling materials that ensure the sharing of accurate information.
The FACT Project—which aims to foster an environment in which women and men can take actions to protect their reproductive health throughout the life-course—is working with service providers, community stakeholders, and within existing social networks in Nepal. Through engaging activities like games, role-plays and group discussions, FACT is contributing to the spread of correct information about fertility and family planning supported by close monitoring and counseling services for both individuals and groups to help assuage fears and myths.
Stay tuned for outcomes from FACT’s work in Nepal!
Learn more about one of FACT’s interventions in Nepal, PRAGATI.