The document discusses family planning and reproductive health in Nepal. It provides background on family planning, objectives and policies, targets, and major activities in FY 2075/76. Key achievements include modern contraceptive prevalence reaching 39% nationally, with the highest in Province 2 at 46%. New acceptors of spacing methods increased in 2075/76 compared to previous years. The total fertility rate target for 2030 is 2.1 births per woman.

1. Family Planning and
Reproductive Health
(Source : DOHS annual report FY 2075/76)
Prepared by :-
Binam Raj Shrestha
Master of public health (MPH)

2. outline
• Background
• Objectives, policies and strategies
• The five policies and strategic
• Target of Family Planning
• SDG targets and indicators
• Major activities in 2075/76
• Achievements
• Issues, constraints and recommendations

3. Background
• Family planning (FP) refers to a conscious effort by a couple to limit or
space the number of children through the use of contraceptive methods.
• Modern methods include
• female sterilization (e.g. minilap),
• male sterilization (e.g. no-scalpel vasectomy),
• intrauterine contraceptive device (IUCD),
• implants (e.g. Jadelle),

4. • injectables (e.g. Depo Provera),
• the pill (combined oral pills),
• condoms (male condom),
• lactational amenorrhea method (LAM) and
• standard days method (SDM).

5. • The main aim of the National Family Planning Programme is to ensure
that individuals and couples can fulfil their reproductive needs by using
appropriate FP methods voluntarily based on informed choices.
• To achieve this, the Government of Nepal (GoN) is committed to equitable
and right based access to voluntary, quality FP services based on informed
choice for all individuals and couples, including adolescents and youth,
those living in rural areas, migrants and other vulnerable or marginalized
groups ensuring no one is left behind.

6. • GoN also commits to strengthen policies and strategies related FP within
the new federal context, mobilize resources, improve enabling environment
to engage effectively with external development partners and supporting
partners, promote public-private partnerships, and involve non-health
sectors.
• National and international commitments will be respected and implemented
(such as NHSSIP 2015- 2020, Costed Implementation Plan 2015-2020 and
FP2020 etc.).

7. • From program perspective, GoN through its subsidiary (FWD, PHD, Health section MoSD, and
municipalities) will ensure access to and utilization of quality FP services through improved
contraceptive use especially among hard to reach, marginalised, disadvantaged and vulnerable
groups and areas, broaden the access to range of modern contraceptives method mix including
long acting reversible contraceptives such as
• IUCD and implant from service delivery points,
• reduce contraceptive discontinuation,
• scale up successful innovative evidence informed FP service delivery and
• demand generation interventions.

8. • In Nepal, FP information, education and services are provided through the government,
social marketing, NGOs and the private sector (including commercial sectors).
• In the government health system, short acting reversible contraceptive methods (SARCs:
male condoms, oral pills and injectables) are provided through PHCCs, health posts and
PHC-ORCs.
• FCHVs provide information and education to community people, and distribute male
condoms and resupply oral contraceptive pills.

9. • Long acting reversible contraceptive (LARC) services such as intrauterine contraceptive
devices (IUCDs) and implants are only available in hospitals, PHCCs and health posts
that have trained and skilled providers.
• Access to LARC services is provided in remote areas through satellite clinics, extended
visiting service providers and mobile camps.
• Male and female sterilization services (e.g. voluntary surgical contraception [VSC]) are
provided at static sites or through scheduled seasonal and mobile outreach services.

10. • Quality FP services are also provided through private and commercial
outlets such as NGO run clinic/ centre, private clinics, pharmacies, drug
stores, hospitals including academic hospitals.
• FP services and commodities are made available by some social marketing
(and limited social franchising) agencies.
• FP services are part of basic health care services and are provided free in
all public sector outlets.

11. Milestones
Year History
1959 The family planning program in Nepal was initiated by the NGO, family
planning association of Nepal (FPAN)
1968 Government – supported family planning services
1963 Establishment of MCM under the ministry of health
1965 Government adopted a policy to bring equilibrium between population
growth and economy growth by emphasing policy on family planning
1965-70 Third five development plan the first to clearly state the need for a policy
in Nepal. FP was considered a crucial instrument in addressing high
fertility.
1978 Established contraceptive retail sale company (CRS) non profit
organization to distribute condom. pills

12. Year History
1995 Ministry of population and environment was established following the
FP and reproductive health principles of ICPD 1994
1998 National reproductive health strategy is formed
1998 Safe motherhood policy : need of FP services as a key components of
maternal care
2000 National adolescent health and development strategy is endorsed
2005 MoPE dissolved and its population division was merged in the MoH and
The MoH renamed as MOHP
2003 National safe abortion policy
2068 Development the new FB strategy

13. Objectives, policies and strategies
• The overall objective of Nepal’s FP programme is
• To improve the health status of all people through informed choice on accessing and using
voluntary FP.
• The specific objectives are as follows:
• To increase access to and the use of quality FP services that is safe, effective and
acceptable to individuals and couples. A special focus is on increasing access in rural and
remote places and to poor, Dalit and other marginalized people with high unmet needs and
to postpartum and postabortion women, the wives of labour migrants and adolescents.

14. • To increase and sustain contraceptive use, and reduce unmet need for
FP, unintended pregnancies and contraception discontinuation.
• To create an enabling environment for increasing access to quality FP
services to men and women including adolescents.
• To increase the demand for FP services by implementing strategic
behaviour change communication activities.

15. The five policies and strategic
1. Enabling environment: Strengthen the enabling environment for FP
2. Demand generation: Increase health care seeking behaviour among populations with high
unmet need for modern contraception
3. Service delivery: Enhance FP service delivery including commodities to respond to the needs of
marginalized people, rural people, migrants, adolescents and other special groups
4. Capacity building: Strengthen the capacity of service providers to expand FP service delivery
5. Research and innovation: Strengthen the evidence base for programme implementation through
research and innovation

16. Target of Family Planning
• Selected FP goals and indicators to ensure universal access to sexual
and reproductive health-care services, including for FP/SRH
programmes are as follows:

17. SDG targets and indicators
Target and Indicators 2022 2025 2030 sources
Proportion of women of reproductive age (aged
15-49 years) who have their need for family
planning satisfied with modern methods
74 76 80 NDHS, NMICS
Contraceptive prevalence rate (CPR) (modern
methods)(%)
53 56 60 NDHS, NMICS
Total Fertility Rate (TFR) (births per women
aged 15-49 years)
2.1 2.1 2.1 NDHS, NMICS
Adolescent birth rate (aged 10-14 years; aged 15-
19 years) per 1,000 women in that age group
51 43 30 NDHS, NMICS

18. Major activities in 2075/76
• Provision of regular comprehensive FP service
• Provision of long acting reversible services (LARCs)
• FP strengthening program through the use of decision making tool (DMT)
and WHO medical eligibility for contraceptive (MEC) wheel
• Micro planning for addressing unmet need of FP in low modern CPR
district

19. • Permanent FP Methods or Voluntary Surgical Contraception (VSC)
• Implementation of PPP program at high population district
• Development of institutionalized family planning service center as a
training center
• Provision of RANM and VSP service to increase FP service user
• Integration of FP and immunization service

20. • Satellite clinic services for long acting reversible contraceptives
• Orientation on family planning services for Obstetrician/Gynecologist &
Concerned key players
• Micro planning to address unmet need of FP in targeted communities with low
CPR District/ Council & follow up
• Interaction program on FP in marginalized communities
• Initiation of school health nurse programme in selected school of some Provinces

21. Achievements
• Current users
• Female sterilization (40%) occupies the greatest part of the contraceptive
method mix among all current user, followed by Depo (14.8%), implant
(5%) ,male sterilization (12.6%),oral pills(6.4%) and lastly in IUCD (5%)
and 2075/76
• Province 2 has the highest proportion (24%) of current users while karnali
province(5%) has the lowest in FY2075/76.

22. • The modern contraceptive prevalence rate (mCPR) at national level is 39%
in 2075/76
• Province 2 has the highest mCPR of 46% while Bagmati has the lowest
(32%)ecological region wise, mCPR of terai (46%) , although in decreasing
trend , is higher than national average (39%) while that of mountain and
hill ecological region remain below the national average .

23. New acceptors
• Depo (37%) occupies the great part of the contraceptive method mix for all
method among new acceptors, followed by condom (24%), pill (19%) ,implant
(13%) , IUCD(3%) ,female sterilization (ML3%) and lastly male sterilization
(NSV1%) in 2075/76.
• province 2 recorded the highest number of VSCs / permanent methods (12,562)
while karnali province the lowest (827)
• Nationally, new acceptors of all modern methods(absolute numbers) have
increased by 25,000 plus in 2075/76 than previous year..

24. New acceptors of spacing methods
• Nationally , new acceptors of all temporary methods( absolute
numbers) have increased in 2075/76 than in pervious years.
• Highest number of new acceptors for spacing (temporary) method in
2075/76 are reported in province 5
• Likewise , implant acceptors are higher than IUCD in all ecological
regions. .

25. • Implant uptake within 48 hours of delivery as reported in HMIS
reports needs to be verified as the national family planning protocol
(NMS Vol 1,2010) has yet to approve this practice In Nepal.

26. Issues, constraints and recommendations
Issues and constraints Recommendations Responsibility
• Suboptimum access to and use of FP
services by hard to reach communities
including adolescents
• Limited health facilities providing
five contraceptive methods
• High contraceptive discontinuation
• Underutilized LARCs
• Implementation of FP microplanning in
low mCPR wards/ municipalities
• Conduct targeted mobile outreach and
satellite clinics focusing on LARCs
• Mobilize VSPs for LARC services
• Ensure availability of LARCs commodities
• Improve delivery of quality of FP services
• Improve FP education, information and
services for adolescents including CSE
FWD, PHD, MoSD,
municipalities

27. Issues and constraints Recommendations Responsibility
• Inadequate trained
human resources
on LAPM
• Functionality of
IFPSCs
• Scale up school health nurse programme
• Scale up integrated FP/EPI clinics and postpartum and post-
abortion Services
• Strengthen FP services in urban health and community health
Clinics
• Strengthen and expand the capacity of FP training sites
• Strengthen FP services in private Hospital
• Update the knowledge of FCHVs on LARC
• Establish the rolr and responsibility of IFPSC in the federal
context to ensure FP service delivery
FWD, PHD, MoSD,
municipalities

28. Bibliography
• https://dohs.gov.np/wp-content/uploads/2020/11/DoHS-Annual-
Report-FY-075-76-.pdf