However, experts warn that Nepal’s declining fertility rate may not mean that population growth will reach replacement level — one in every four married women still have an unmet need for family planning. A third of young married women aged 15-19 do not use contraceptives, making them more vulnerable to unintended pregnancies and unsafe abortion.
Kristine Blokhus at the UN Population Fund (UNFPA) says Nepali women are aware of the benefits of having fewer babies, but face barriers in accessing contraceptives: “Health facilities often run out of contraceptive stocks, and there are not enough trained health workers to provide long-term contraceptives like implants and IUD.”
A 2016 UNFPA assessment showed most health posts provide only condoms, pills and injectables because of the lack of trained staff. Only one third of the facilities provide all five types of modern contraceptives including implants and IUDS. In most villages, women have to choose between oral pills or Depo-Provera, which they cannot use if there are side effects. Male or female sterilisation is available occasionally, and most women complain their husbands do not want to use condoms.
With rising female literacy, the number of women opting for traditional family planning like withdrawal and the rhythm method instead of modern contraceptives is also going up. In 1996, only 3% of married women used such natural methods, now it is 10%. However, the NDHS 2016 showed that 62% women using the rhythm method to avoid pregnancy did not have an accurate knowledge about the ovulation cycle.
Nepal’s target is to increase its contraceptive prevalence rate to 52% by 2020, but it may not meet that goal because of male migration, the preference for natural methods, and family planning programs being scaled back due to a drop in U.S. funding after the gag rule under President Trump. The United States has traditionally been the main supporter of family planning projects in Nepal, through organisations like Marie Stopes International that provide abortion services.
Beth Schlachter, Director of Family Planning 2020, who recently visited Kathmandu to take stock of Nepal’s progress, says: “The US gag rule might affect Nepal’s family planning programs if organisations delivering safe abortion services here do not find other resources to supply contraceptives.”
Since Nepal is poised to become an ‘aging’ society by 2030 and an ‘aged one’ by 2050, there is an even greater need to scale up family planning. For the country to reduce its dependency ratio and reap the demographic dividend, many more women must have easier access to a much wider range of contraceptives.