Despite gains in most reproductive health indicators, many services still do not reach some marginalized communities in Nepal. Physical and social barriers limit access to services. Rates of family planning use are low in Nepal and especially for particular ethnic groups (i.e.; Dalit, Janajati and Muslims) (NDHS, 2011).
To overcome these challenges, the Government of Nepal introduced “Roving” Auxiliary Nurse Midwives (RANMs), a new cadre of community-level health workers with increased capacity to address barriers to family planning use and improve maternal and child health outcomes.
The FACT Project, in partnership with the Family Health Division and the Rupandehi District Public Health Office within the Ministry of Health, piloted RANMs in select communities of Rupandehi District to provide a replicable model for delivering family planning services at the household level.
In communities where RANMs were deployed, family planning use increased, men and family members were engaged in conversations about reproductive health, and they strengthened linkages to the health system.
Many women in the RANM communities experienced improvements in social norms and pressures over time. They were less likely to report pressure to have a son and less likely to report pressure to have a child immediately after marriage than women in non-RANM sites.