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

Impact of family plann<strong>in</strong>g <strong>and</strong> futureprojectionsTFR <strong>in</strong> Nepal decl<strong>in</strong>ed from 6.3 <strong>in</strong> 1976 to 3.1 <strong>in</strong> <strong>the</strong>period 2003-2005. The average annual l<strong>in</strong>ear decl<strong>in</strong>e frommid-1999 to mid-2004 was 0.2 children per woman, while<strong>the</strong> comparable figures <strong>in</strong> <strong>the</strong> earlier years were more orless 0.1 children per woman. This reveals that <strong>the</strong> pace offertility decl<strong>in</strong>e after 2000 was faster than <strong>in</strong> <strong>the</strong> decades of<strong>the</strong> 1980s <strong>and</strong> 1990s.Impact of contraception on fertilityreductionResearch conducted by Ross <strong>and</strong> Frankenberg (1993),tak<strong>in</strong>g data from 100 develop<strong>in</strong>g countries, revealed thata 15 per cent <strong>in</strong>crease <strong>in</strong> CPR is generally associated witha one-child decl<strong>in</strong>e <strong>in</strong> TFR. In Nepal, Karki <strong>and</strong> Krishna(2008) found a strong correlation between TFR <strong>and</strong> CPR(coefficient = –0.955), which was significant at <strong>the</strong> 0.01level. They also ran a l<strong>in</strong>ear regression (Y = a + b X ) ofTFRs <strong>and</strong> CPRs <strong>and</strong> found <strong>the</strong> follow<strong>in</strong>g equation:TFR = 6.648 + (– 0.068) * CPR (r2 = 0.955)Us<strong>in</strong>g this equation with Nepalese data, we have predictedTFR for each year from 1976 to 2006 (see Table 19).The predicted TFR for 2006 was 3.4 while <strong>the</strong> observedTFR was 3.1. The predicted TFR for Nepal <strong>in</strong> 2006would be 6.648 assum<strong>in</strong>g no contraceptive use (<strong>the</strong> valueof constant). Thus, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> contraceptive useexpla<strong>in</strong>s roughly 96.5 per cent of <strong>the</strong> decl<strong>in</strong>e <strong>in</strong> fertility.This implies that o<strong>the</strong>r proximate determ<strong>in</strong>ants of fertility,such as post-partum amenorrhoea, abortion <strong>and</strong> marriage,have had very little effect <strong>in</strong> reduc<strong>in</strong>g fertility. Thus, us<strong>in</strong>gNepalese data, a 14.1 per cent <strong>in</strong>crease <strong>in</strong> contraceptive useis associated with a one-child decl<strong>in</strong>e <strong>in</strong> TFR. Assum<strong>in</strong>gthat o<strong>the</strong>r proximate determ<strong>in</strong>ants of fertility rema<strong>in</strong> stableat <strong>the</strong> current level, Nepal, <strong>the</strong>refore, needs to achieve 63-65 per cent CPR to reach replacement-level fertility (2.1births per woman).Future projection of contraceptiveprevalence rateCPR must <strong>in</strong>crease <strong>in</strong> <strong>the</strong> future <strong>in</strong> Nepal, but <strong>the</strong> paceof <strong>in</strong>crease will depend upon several factors, <strong>in</strong>clud<strong>in</strong>gwomen’s education, employment <strong>and</strong> <strong>the</strong> national familyplann<strong>in</strong>g programme. A fur<strong>the</strong>r expansion of dem<strong>and</strong> forfamily plann<strong>in</strong>g is likely for two reasons. First, <strong>the</strong> onsetof <strong>the</strong> fertility transition <strong>in</strong> rural areas, especially among<strong>the</strong> most vulnerable, poorest, Muslims <strong>and</strong> Dalits, has notbeen actually <strong>in</strong>itiated, while for o<strong>the</strong>r social groups <strong>the</strong>transition has not yet been completed. Second, Nepal’shigh population growth rate <strong>in</strong> <strong>the</strong> past means that <strong>the</strong>number of women enter<strong>in</strong>g <strong>the</strong> reproductive age groupwill rise for a few decades.Methodology:Global, regional <strong>and</strong> country projections <strong>and</strong> figures forCPR <strong>and</strong> <strong>the</strong> proportion of women <strong>in</strong> union are availablefrom robust sources, such as <strong>the</strong> United Nations (1999)<strong>and</strong> <strong>the</strong> Futures Group (Morel<strong>and</strong> et al., 2010). TheFutures Group projection was carried out by employ<strong>in</strong>gSPECTRUM software, i.e., DEMPROJ for populationprojections, <strong>and</strong> FAMPLN for projection of familyplann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g o<strong>the</strong>r proximate determ<strong>in</strong>ants offertility. The authors used <strong>the</strong> basel<strong>in</strong>e <strong>in</strong>formation from<strong>the</strong> recent Demographic <strong>and</strong> Health Survey of <strong>the</strong> country<strong>in</strong> question. In <strong>the</strong> case of Nepal, <strong>the</strong> authors used datafrom NDHS 2001. CPR was estimated for all women ofreproductive age us<strong>in</strong>g any methods, <strong>in</strong>clud<strong>in</strong>g traditionalmethods, not only for married women or women <strong>in</strong> union.For projection of <strong>the</strong> percentage of women <strong>in</strong> union, <strong>the</strong>authors assumed that marriage <strong>and</strong> union patterns wouldbe <strong>in</strong>fluenced by level of education <strong>and</strong> be taken <strong>in</strong>toaccount.The projection of CPR shows that CPR of Nepal would be54 per cent by 2015, 70 per cent by 2025 <strong>and</strong> 80 per centby 2035. It is projected that CPR will rema<strong>in</strong> at 80 percent from 2035 to 2050. It should be noted that <strong>the</strong> annuall<strong>in</strong>ear <strong>in</strong>crease <strong>in</strong> CPR is 0.60 per cent between 2001 <strong>and</strong>2005; 1.7 per cent between 2005 <strong>and</strong> 2010; <strong>and</strong> that it willbe 1.64 per cent from 2010 to 2030. Therefore, accord<strong>in</strong>gto <strong>the</strong>se projections, Nepal will not reach its target of 67per cent CPR by 2015, which is needed to achieve Target5b of <strong>the</strong> Millennium Development Goals.On <strong>the</strong> o<strong>the</strong>r h<strong>and</strong>, <strong>the</strong> proportion of women <strong>in</strong> union isprojected to decl<strong>in</strong>e l<strong>in</strong>early <strong>in</strong> each of <strong>the</strong> successive years.The proportion of women <strong>in</strong> union was projected to be 77per cent <strong>in</strong> 2005, which would decl<strong>in</strong>e to 71 per cent by2020, to 66 per cent by 2035 <strong>and</strong> to 63 per cent by 2050.RecommendationsThe follow<strong>in</strong>g recommendations have emerged from <strong>the</strong>present assessment:1. Improve <strong>the</strong> quality of familyplann<strong>in</strong>g services:Improve <strong>the</strong> quality of family plann<strong>in</strong>g counsell<strong>in</strong>g bytra<strong>in</strong><strong>in</strong>g health-care providers <strong>and</strong> volunteers to addressmisconceptions <strong>and</strong> mis<strong>in</strong>formation of providers <strong>and</strong>clients. Monitor counsell<strong>in</strong>g practices periodically.2. Increase access to family plann<strong>in</strong>gservices:194