Kathmandu, November 17

The example of Nepal shows how information can help programme designers understand some key challenges and opportunities for improving contraceptive choice, says a report released by Washington-based Family Planning 2020.

FP2020 is a global movement that supports the rights of woman and girls to decide — freely and for themselves — whether , when, and how many children they want to have.

According to the report ‘Catalysing Collaboration 2017-2018 published on November 14, data from UNFPA indicate that a basic range of contraceptive methods is generally available to women in Nepal, with nearly 90 per cent of primary-level facilities offering at least three methods of contraception. Performance is slightly lower at secondary and tertiary-level facilities, where 67 per cent had five or more methods available on the day of assessment.

In 2017, Nepal saw relatively low levels of stock-outs across most methods (<  10 per cent of facilities stocked out on the day of assessment). The exception is Long-Acting Reversible Contraceptives: 42 per cent of facilities were stocked out of IUDs and 39 per cent stocked out of implants, meaning that in four out 10 facilities, on the day of assessment, women coming in for family planning would not have access to one or both LARCs.

“While LARCs are only used by about 11 per cent of contraceptive users in Nepal, implant use has grown nearly 400 per cent over the past 10 years. This growth may be hampered if stock-outs persist. Last year approximately 40 per cent of facilities were also without the supplies or staff to provide female sterilisation, the most common method in Nepal, or male sterilisation.

There has been a substantial improvement this year and only eight per cent of facilities were without supplies or staff to provide permanent methods on the day of assessment,” the report states.

Less than half of contraceptive users in Nepal (43 per cent) received all three pieces of information that make up the Method Information Index (information about other methods, side effects, and what to do in case of side effects).

This falls quite close to the average (42 per cent) across FP2020 focus countries. The highest MII values were seen among IUD (65 per cent) and implant (58 per cent) users, while female sterilisation users saw the lowest MII values (27 per cent).

According to the report, since implant and IUD prevalence are relatively low, women may be less familiar with these methods and their side effects, possibly prompting providers to provide more information about these methods. In contrast, female sterilisation has long been the most common method in use in Nepal, so women may be more familiar with the procedure and side effects, and providers may be less likely to counsel on other methods if the norm is uptake of sterilisation after desired fertility has been reached.

In Nepal, only 20 per cent of women report that they were provided with information about FP during recent contact with a healthcare provider. Again, this is close to the average (25 per cent) across FP2020 focus countries with data post-2012, though relatively low.

But these numbers should be interpreted in context: 49 per cent of married women in Nepal are using a modern method, and of those more than one-third are sterilised and so do not necessarily need further information on family planning.

In addition, there is very little sexual activity outside of marriage in Nepal (<  one % of never-married women have ever had sex), so health care providers may be less likely to discuss family planning with unmarried women, it said.

In Nepal, only 20pc women report that they were provided with information about FP