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Abstract:
Nepal has transitioned from having a high total fertility rate (TFR) to having a replacement level of fertility, according to the 2022 Nepal Demographic and Health Survey (NDHS). The lower fertility rate was achieved despite a slow increase in the modern contractive prevalence rate (mCPR). This study examined the factors associated with stagnation in modern contraception use, declining fertility rates, increasing use of traditional family planning (FP) methods, and increasing rates of induced abortion in Nepal.
The study team used data derived from the 2016 NDHS (n=9,875) and the 2022 NDHS (n=11,180) among currently married women age 15–49. We analyzed percentage-point changes in the utilization of FP methods (any, modern, and traditional methods), unmet need for FP, demand for FP, and demand satisfied, by selected background variables. Proximate determinants of fertility were also identified. Induced abortion was separately considered using data from the 2022 NDHS among all women age 15–49 who had pregnancies that ended within 3 years prior to the survey (n=3,833).
The index of contraception and the index of spousal separation had the largest contributions to the current level of fertility reduction in Nepal. A significant increase of 5 percentage points in use of any FP method was observed from 2016 to 2022. Women from the Newar ethnic group, women from Bagmati province, and women in the lowest wealth quintile had the largest significant increases in traditional FP method use. Women living with their husbands/partners, those exposed to FP messages in the media, Muslim women, and women with living children had the largest increases in any FP method use.
Women living in Madhesh and Gandaki provinces had significantly decreased odds of using modern FP methods. Women in the fourth wealth quintile, women with any number of living children, women living with their husbands/partners, women exposed to FP messages in the media, and women with any level of education were among those with significantly increased odds of using a traditional FP method. Women had significantly increased odds of unmet need if they were from Gandaki province, had some level of education, were in the second wealth quintile, had any number of living children, had no experience of child loss, or lived with their husbands/partners. Women age 35 and older, women in the middle and fourth wealth quintiles, and women living in Karnali province were among the most likely to have had pregnancies ending in induced abortion.
Evidence-based recommendations for health systems include using advocacy to raise awareness about FP among populations with high unmet need and among returned immigrants, and increasing the availability of contraceptives at service delivery outlets. In the context of increased use of traditional FP methods, the effective use of these methods could reduce contraceptive failure rates, which lead to unintended pregnancies. Efforts to raise health awareness need to be implemented to reverse the practice of using induced abortion as contraception.
Factors Associated with Stagnation in Modern Contraceptive Use, Declining Fertility, Increased Use of Traditional Methods, and Induced Abortion, 2016–2022 Nepal DHS Surveys (PDF, 3034K)