Kathmandu: Aaradhya*, who is in a managerial position in a corporate organization in Kathmandu, ‘accidentally’ got pregnant recently. Aaradhya, who is in her mid 30’s, did not want to have another child as she and her husband were content with raising a single child. She discovered her pregnancy during the seventh week.
“I missed my periods, and when I used a pregnancy kit, I realized I was pregnant,” she shared. Aaradhya and her husband had been using withdrawal as a method of contraception. “This method was working perfectly fine for me and my husband for the last year as we learned it from the internet. Now, I am just not ready for a child as I want to prioritize my career at the moment,” she said.
Despite adequate knowledge about family planning methods, couples in Nepal, like this one, have seen a recent decline in the use of modern contraceptive methods, opting instead to rely solely on traditional methods–like withdrawal. The government data proves it.
The 2022 Nepal Demographic and Health Survey shows the number of individuals opting for modern contraceptive techniques has been consistent, while there has been a five percent increase in the utilization of traditional methods compared to 2016. The study shows Nepal’s modern contraceptive prevalence rate currently stands at 42.7 percent. In 2016, it was 42.8 percent, 43.2 percent in 2011, 44.2 percent in 2006.
This trend, according to experts, is worrying as Nepal has aimed to reach a modern contraceptive prevalence rate (mCPR) of 70 percent by 2030. The target now seems less likely to be achieved, they say.
Factors such as limited availability of contraceptive devices and awareness in rural regions, coupled with negligence and carelessness in urban areas, have limited the widespread adoption of contraceptives.
“There is a misconception that using a condom, the simplest contraception method, hampers the fulfillment of sexual desire. Another reason is that people still feel shy to buy condoms. Not just condoms, people, even couples, are shy to discuss openly about the method of safe sexual intercourse,” said Drishti Bhandari, health teacher at School of Medical Sciences, adding that this is the major reason behind the adoption of traditional practices.
In Nepal, 14.6 percent of the reproductive age group use such traditional methods. It was 9.8 percent in 2016, seven percent in 2011, and four percent in 2006.
The exodus of youths to foreign countries has also hindered the target of contraceptive prevalence. “When husbands travel abroad, wives often refrain from using birth control methods, and upon their husbands’ short-term return, they tend to rely on traditional methods, leading to unintended pregnancies,” said Bhandari.
According to a report by the UN Population Fund (UNFPA) on sexual and reproductive health, complications arising from pregnancy and childbirth constitute the leading cause of death among girls aged 15-19 in low-income countries such as Nepal. The National Population and Housing Census 2021: A Report on Maternal Mortality shows that out of 100 pregnancy-related deaths, 10.3 occur among individuals aged 15 to 19.
Unmarried youth, especially teenagers, only discuss family planning exclusively with their sexual partners, with most preferring condoms over other methods, typically provided and kept by the male partner.
Underage pregnancies in Nepal remain at 14 percent overall, but it is significantly higher in Karnali and Madhesh provinces. In Karnali, 21 percent of girls under 20 are pregnant, while in Madhesh, the figure is 20 percent. In Gandaki and Koshi provinces, 13 percent of underage girls become pregnant, while in Lumbini, it is 10 percent, and in Bagmati, it is 8 percent.
Early marriages and unwanted teenage pregnancy have hampered girls’ education, their economic freedom, and their social life. “I thought that I could never be a mother at a young age, but my mother-in-law didn’t agree. She told me, ‘I had a baby when I was 16, so what will happen to you?’ I wanted to have a child after reaching the appropriate age but she didn’t agree. The neighbors used to tell my mother-in-law, ‘She doesn’t have a baby. Why would you let her stay there? You should kick her out’ So to maintain prestige in the society, I had to have a baby,” a 16-year-old married girl from Achham of Sudurpaschim Province was quoted in a report titled ‘Behavioural Determinant of Child Marriage and Adolescent Pregnancy’ recently published by UNICEF.
Among women aged 15–19, 14 percent have experienced pregnancy, 10 percent have had live births, and two percent have experienced pregnancy loss. Two percent of both women and men aged 15–19 reported having sexual intercourse before the age of 15. Three percent of women aged 15–19 were married by the age of 15, with one percent having been pregnant by that age.
Although condoms are easily available, they are the least used modern contraceptive in urban areas compared to rural areas. Among currently married women, the utilization of modern contraceptives is higher in rural areas, accounting for 47 percent, compared to urban areas where it stands at 41 percent. Surprisingly, women residing in urban areas are relying on traditional contraceptive methods, with 16 percent opting for them, in contrast to 11 percent in rural regions.
“People face challenges in getting hold of modern contraceptives due to things like limited availability, high costs, and lack of awareness. As a result, they may resort to traditional methods instead. Cultural beliefs and societal norms play a big role in contraceptive choices. In certain communities, traditional methods may be more widely accepted or familiar, leading to increased use. Moreover, worries about side effects or health risks associated with modern contraceptives can discourage people from using them. This often leads to a preference for traditional methods instead,” said Jiblal Pokhrel, managing director at Nepal CRS Company.
Of those using modern contraceptive methods, 13.4 percent opt for female sterilization, 3.6 percent choose male sterilization, 1.3 percent use intrauterine contraceptive devices (IUCD), 9.3 percent prefer injectables, 6.1 percent utilize implants, 4.5 percent rely on pills, 4.5 percent use condoms, and 0.1 percent employ other methods, according to the data.
To achieve the desired contraceptive prevalence rate, Nepal must address barriers to contraceptive access and education. Experts say there is a need for comprehensive sex education and destigmatization of contraceptive use. “Improving access to contraceptives and promoting open dialogue about sexual health are the must to achieve the target,” they say.
Among currently married women aged 15–49, total demand for family planning increased from 61 percent in 1996 to 77 percent in 2011 but has changed only minimally over the past decade. Unmet need for family planning decreased from 32 percent to 25 percent between 1996 and 2006, increased to 28 percent in 2011, and then declined once again to 21 percent in 2022.
Within 2030 Nepal targets to achieve 70 percent of modern contraceptives use but 2020 data shows only 55 percent have been achieved.
“Achieving the remaining 15 percent increase in modern contraceptive use by 2030 is challenging but feasible with concerted efforts. To bridge this gap, Nepal can focus strategies including improved access and distribution to modern contraceptives, enhanced awareness campaigns, youth friendly family planning services, engagement of private sectors, and addressing the cultural and social norms that influence contraceptive choice,” said Jiblal Pokhrel. “Promoting gender equality and women’s empowerment can positively impact modern contraceptive uptake.”
“By implementing these strategies and potentially exploring additional innovative approaches, Nepal can work towards achieving its target of 70 percent modern contraceptive use by 2030, ensuring better reproductive health outcomes and contributing to overall health and well-being in the country,” he further said.
Such an issue directly related with health and wellbeing of women and families has not received much attention at the federal level, provincial ministers complain.
Dirgha Bahadur Pokharel, secretary at the Ministry of Social Development in Karnali Province said that such issues do not come under the priority of the federal government. “The federal government does not allocate the budget for such issues. These problems do not come under the priority and are sheerly neglected by the government.” “There is no budget to work on these women’s health issues, especially related to safe sex practice and contraceptives. We are also helpless.”
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