Family Planning in Asia and the Pacific - International Council on ...

IntroductionNepal’s population is estimated to be 28.6 million <strong>in</strong> 2011.The annual population growth rate was high over <strong>the</strong>last four <strong>in</strong>ter -census periods (1971-2011). The highestannual growth rate occurred between 1971 <strong>and</strong> 2001. Thetotal fertility rate (TFR) decreased from 6.3 children perwoman <strong>in</strong> 1976 to 3.1 <strong>in</strong> 2006 (MoH, 1976; <strong>and</strong> MoHP,2007). In <strong>the</strong> same period, <strong>the</strong> contraceptive prevalence rate(CPR) <strong>in</strong>creased from 2.9 per cent <strong>in</strong> 1976 to 48 per cent<strong>in</strong> 2006 (MoH, 1976; <strong>and</strong> MoHP, 2007). The maternalmortality ratio decl<strong>in</strong>ed from 539 deaths per 100,000live births <strong>in</strong> 1996 to 281 <strong>in</strong> 2006 (NDHS 2006); <strong>and</strong>MoHP, 2006). Much of this decl<strong>in</strong>e can be attributed to<strong>the</strong> <strong>in</strong>creased use of family plann<strong>in</strong>g.The number of females aged 15-49 years also <strong>in</strong>creasedsubstantially over <strong>the</strong> years: from 2.8 million <strong>in</strong> 1971 to3.5 <strong>in</strong> 1981, to 4.4 million <strong>in</strong> 1991 <strong>and</strong> to 5.6 million <strong>in</strong>2001. Thus, <strong>the</strong> share of females aged 15-49 <strong>in</strong> <strong>the</strong> totalpopulation rema<strong>in</strong>ed about 24 per cent over <strong>the</strong> censusyears. At <strong>the</strong> same time, <strong>the</strong> female population aged 15-24 years more than doubled dur<strong>in</strong>g 30 years – from 1.0million <strong>in</strong> 1971 to reach 2.3 million <strong>in</strong> 2011. The share ofyoung females <strong>in</strong> <strong>the</strong> total population was around 9 percent while this figure <strong>in</strong>creased to about 10 per cent <strong>in</strong> <strong>the</strong>census years of 1991 <strong>and</strong> 2001 (see Table 1). The need forfamily plann<strong>in</strong>g <strong>and</strong> reproductive health services cont<strong>in</strong>uesto be important <strong>in</strong> Nepal given its high populationgrowth rate, large number <strong>and</strong> proportion of femalesof reproductive age, <strong>and</strong> o<strong>the</strong>r poor demographic <strong>and</strong>reproductive outcome <strong>in</strong>dicators. In addition, <strong>in</strong>creas<strong>in</strong>gfocus on family plann<strong>in</strong>g will help Nepal achieve Targets5a <strong>and</strong> 5b of <strong>the</strong> Millennium Development Goals byfur<strong>the</strong>r reduc<strong>in</strong>g maternal mortality, <strong>in</strong>creas<strong>in</strong>g CPR <strong>and</strong>reduc<strong>in</strong>g unmet need.Table 2 summarizes some selected demographic <strong>and</strong>reproductive health <strong>in</strong>dicators of Nepal from 1996 to2006, draw<strong>in</strong>g on data from <strong>the</strong> Nepal <strong>Family</strong> HealthSurvey (NFHS) <strong>and</strong> <strong>the</strong> Nepal Demographic <strong>and</strong> HealthTableSurveys (NDHS). Data <strong>in</strong>dicate that <strong>the</strong> median age ofmarriage of females is still low: <strong>in</strong> 2006, <strong>the</strong> median ageof marriage was 17.2 years. Dur<strong>in</strong>g <strong>the</strong> 10-year period,<strong>the</strong> median age at marriage <strong>in</strong>creased only by 5 per cent.The median age at first birth rema<strong>in</strong>ed almost 20 yearsover <strong>the</strong> last decade. Data also show that nearly one-fifthof adolescent girls (15-19 years) became mo<strong>the</strong>rs or gotpregnant while adolescents.Indicators of fertility preference, such as desire for children<strong>and</strong> ideal family size, show <strong>the</strong> potential dem<strong>and</strong> for familyplann<strong>in</strong>g services. The proportion of currently marriedwomen who want no more children <strong>in</strong>creased from 59 percent <strong>in</strong> 1996 to 71 per cent <strong>in</strong> 2006 – an <strong>in</strong>crease of 20 percent dur<strong>in</strong>g <strong>the</strong> period. Similarly, <strong>the</strong>re was a noticeabledecl<strong>in</strong>e <strong>in</strong> <strong>the</strong> average ideal number of children desiredby women – a decl<strong>in</strong>e from 2.9 children <strong>in</strong> 1996 to 2.6<strong>in</strong> 2001 <strong>and</strong> to 2.3 <strong>in</strong> 2006. The ideal number of childrendesired by women <strong>in</strong> 2006 is close to replacement-levelfertility: 2.1 children.Indicators of maternal care, such as antenatal care <strong>and</strong>tetanus toxoid <strong>in</strong>jections, have been improv<strong>in</strong>g verysubstantially <strong>and</strong> <strong>the</strong>ir pace of improvement is also veryhigh. On <strong>the</strong> o<strong>the</strong>r h<strong>and</strong>, <strong>in</strong>dicators of delivery <strong>and</strong> bodymass <strong>in</strong>dex suggest that women are still at greater risk ofdy<strong>in</strong>g before, dur<strong>in</strong>g <strong>and</strong> immediately after delivery. This isbecause only 18 per cent of births were reported to occur <strong>in</strong>health facilities. Conversely, nearly 82 per cent of deliveriesstill occur at home without support of health workers ortra<strong>in</strong>ed birth attendants.Aims of <strong>the</strong> studyGiven this context of <strong>the</strong> position of <strong>the</strong> family plann<strong>in</strong>gprogramme, <strong>the</strong> present paper is aimed at answer<strong>in</strong>g <strong>the</strong>follow<strong>in</strong>g research questions:What are <strong>the</strong> levels <strong>and</strong> trends of contraceptive use <strong>in</strong>Nepal?Table1171