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

is provider bias that such methods take more time toprovide than short-term methods, such as <strong>in</strong>jectables <strong>and</strong>pills. In addition, <strong>the</strong> report stated that <strong>the</strong> availabilityof female service providers, husb<strong>and</strong>'s support <strong>and</strong> goodcounsell<strong>in</strong>g with complete <strong>in</strong>formation on <strong>the</strong> advantages<strong>and</strong> disadvantages of LARC methods are o<strong>the</strong>r potentialbarriers to <strong>the</strong> use of such methods. Ano<strong>the</strong>r barrier to<strong>the</strong> use of LARC methods is that Female CommunityHealth Volunteers promote male <strong>and</strong> female sterilizationover short- <strong>and</strong> long-term methods used for spac<strong>in</strong>g birthsbecause <strong>the</strong>y get <strong>in</strong>centives from <strong>the</strong> mobile camps to doso. Insertion of LARC methods are restricted to tra<strong>in</strong>edphysicians, nurses <strong>and</strong> health assistants. Many of <strong>the</strong>sereasons were also stated by key stakeholders.Preferred method of contraception <strong>in</strong><strong>the</strong> futureTable 6 presents <strong>the</strong> preferred method of contraceptionamong Nepali women who were not us<strong>in</strong>g a contraceptivemethod but <strong>in</strong>tend to use one <strong>in</strong> <strong>the</strong> future, from recentDHS data. This is <strong>the</strong> key <strong>in</strong>dicator to underst<strong>and</strong> <strong>the</strong>future dem<strong>and</strong> for specific methods of family plann<strong>in</strong>g.Data suggest two key clues for <strong>the</strong> Nepali family plann<strong>in</strong>gprogramme. First, <strong>in</strong>jectables <strong>and</strong> female sterilization haverema<strong>in</strong>ed important preferred methods over <strong>the</strong> years <strong>in</strong>Nepal <strong>and</strong> would rema<strong>in</strong> so <strong>in</strong>to <strong>the</strong> future as well. Thisholds true for younger (< 30 years) as well as older (30-49years) women. Second, from <strong>the</strong> po<strong>in</strong>t of view of women,condoms have not ga<strong>in</strong>ed popularity as only 3 per cent ofnon-users preferred it <strong>in</strong> 2006.Levels <strong>and</strong> trends <strong>in</strong> unmet needfor family plann<strong>in</strong>gAt 25 per cent <strong>in</strong> 2006, unmet need for family plann<strong>in</strong>g<strong>in</strong> Nepal cont<strong>in</strong>ues to be high1 (see Figure 2). However,unmet need decl<strong>in</strong>ed from 31.4 per cent <strong>in</strong> 1996 to 27.8per cent <strong>in</strong> 2001 to 25 per cent <strong>in</strong> 2006 (DHS). As ofTable2006, unmet need for limit<strong>in</strong>g births was 15 per cent <strong>and</strong>for spac<strong>in</strong>g births, 9 per cent. Therefore, <strong>the</strong> contraceptiveneeds of women for limit<strong>in</strong>g births are less likely to befulfilled compared with <strong>the</strong> need of women for spac<strong>in</strong>gmethods. At <strong>the</strong> same time, <strong>the</strong> decl<strong>in</strong><strong>in</strong>g trends of unmetneed for family plann<strong>in</strong>g for both limit<strong>in</strong>g <strong>and</strong> spac<strong>in</strong>gpurposes mean that <strong>the</strong> family plann<strong>in</strong>g programme is<strong>in</strong>creas<strong>in</strong>gly reach<strong>in</strong>g women who do not want any morechildren. It should be noted that <strong>the</strong> pace of decl<strong>in</strong>e <strong>in</strong>unmet need for spac<strong>in</strong>g was three times as high as <strong>the</strong>limit<strong>in</strong>g method between 1996 <strong>and</strong> 2006. This suggeststhat ei<strong>the</strong>r <strong>the</strong> family plann<strong>in</strong>g programme is <strong>in</strong>creas<strong>in</strong>glyprovid<strong>in</strong>g spac<strong>in</strong>g methods, or couples do not wantpermanent sterilization despite hav<strong>in</strong>g <strong>the</strong> desired numberof children <strong>and</strong> <strong>the</strong>refore choose spac<strong>in</strong>g methods.Unmet need for family plann<strong>in</strong>g varies largely by place ofresidence. Rural women have relatively higher unmet needcompared with urban women. Interest<strong>in</strong>gly, unmet need<strong>in</strong> urban areas actually <strong>in</strong>creased between 2001 <strong>and</strong> 2006.This may reflect two th<strong>in</strong>gs. First, many women who haverecently migrated may be out of reach of family plann<strong>in</strong>gservices <strong>in</strong> urban areas. Second, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> unmet needmay also reflect <strong>in</strong>creas<strong>in</strong>g awareness among women liv<strong>in</strong>g<strong>in</strong> urban areas of limit<strong>in</strong>g or spac<strong>in</strong>g births.Accord<strong>in</strong>g to key stakeholder <strong>in</strong>terviews, reasons for <strong>the</strong>cont<strong>in</strong>ued level of unmet need for family plann<strong>in</strong>g <strong>in</strong> Nepal<strong>in</strong>clude <strong>the</strong> follow<strong>in</strong>g factors: government programmes arenot effectively reach<strong>in</strong>g youth <strong>and</strong> marg<strong>in</strong>alized groups;<strong>the</strong> government is promot<strong>in</strong>g <strong>and</strong> prioritiz<strong>in</strong>g sterilizationra<strong>the</strong>r than long-term or spac<strong>in</strong>g methods; <strong>the</strong>re is a lackof skilled providers <strong>in</strong> rural areas to furnish long-termmethods; <strong>the</strong>re is a lack of high-quality accurate familyplann<strong>in</strong>g counsel<strong>in</strong>g; IEC campaigns have limited reach<strong>in</strong> very remote areas where people do not have access tomedia; <strong>and</strong> <strong>the</strong>re is a lack of knowledge about where toobta<strong>in</strong> certa<strong>in</strong> methods. Ano<strong>the</strong>r reason mentioned is <strong>the</strong>fact that many organizations are work<strong>in</strong>g on <strong>in</strong>creas<strong>in</strong>gTable6178