“Spouses, especially husbands, who work abroad and spend hardly a few months a year with their partners back home do not try permanent methods,” explains Kanak Shrestha, program officer at Nepal Family Health Program (NFHP). “They opt for temporary methods instead.”
According to a survey conducted by NFHP last year, 33 percent of married couples of reproductive age live in separation for years as either the husbands or the wives go overseas for work. They resort to quick and simple family planning methods like use of condoms, pills or injections.
Currently, over 1.4 million people are working in different foreign countries, excluding those who go to India or the Gulf through informal channels. More than 200,000 people go abroad every year. Officials say that the total number of overseas job-seekers may actually be double those figures.
According to data compiled by the Health Management Information System (HMIS) at the Department of Health Service (DoHS), the number of users of temporary methods has gone up to 492,750 in 2008/09 from 442,371 in 2004/05. The number of those using permanent methods has declined to 80,641 in 2008/09 from 87,298 in 2004/05.
However, the growing trend of migration is not the only reason. The government itself has focused on promoting the use of temporary methods, in keeping with the latest international trend that deems family planning to be a means of reducing Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) rather than controlling population growth.
“Until two decades ago, couples wanted to produce as many children as they wanted within a few years of
marriage,” a family health expert says. “Now, times have changed; couples prefer gaps in births, for which temporary methods of family planning may be appropriate.”
At the same time, government officials also point to recent political upheavals resulting in frequent strikes as one reason for increasing use for temporary methods. They say the government has been facing difficulty in recent years in organizing health camps where permanent methods like vasectomy and mini-lap are provided.
Sexologist Dr Rajendra Bhadra, however, is of the view that the increasing number of temporary-method users cannot easily be linked to the changing behavior of married couples. “The high number of condom users does not indicate that more married couples are inclined towards temporary methods,” he says.
Dr Bhadra argues that condoms are being used more for prevention of sexually transmitted disease including HIV/AIDS than for family planning. “Lots of condoms are used every day in the Thamel area of Kathmandu,” he says. “They are obviously not used for family planning.”
Despite the growing number of temporary method users, the number of women of reproductive age opting for Intra-Uterine Contraceptive Devices (IUCDs) and Implants remain low, though these devices also fall under the category of temporary methods. In 2008/09, the numbers of IUCD and Implant users were just 375 and 783 respectively.
“It is mainly because women need to expose private parts in front of doctors to have IUCDs planted,” Shrestha says. He says the government must promote IUCDs and Implants as they are very reliable and cost-effective.
CPR RATE DOWN, MDG ATTAINMENT UNLIKELY
HMIS data show that Contraceptive Prevalence Rate (CPR) has been dipping in recent years, indicative of the difficulty in attaining the Million Development Goal (MDG) in family planning. It has dipped by two percent in the past three years alone.
Nepal aims at increasing CPR, the rate of contraceptive use by sexually active women and their partners, to 67 percent by 2015 to achieve the MDG. But the rate is just around 40 percent at present; with just six years left to go, Nepal needs to increase CPR at an annual rate of four percent. However, instead of progressing at four percent rate, Nepal’s CPR has been decreasing steadily, albeit slightly.
In 2006/07, Nepal’s CPR was 42.1 percent. It decreased to 40.9 percent the following year. It again dipped to 40.7 percent in 2008/09. “The consistent dip in CPR indicates that scores of challenges lie ahead in achieving the MDG,” says Dr Meera Ojha, who was actively involved in formulating family planning policies for the government for over 35 years.
According to Dr Ojha, a still low level of public awareness, sporadic unavailability of services and inadequate number of health workers are the main reasons behind the consistent dip in CPR. Dr Ojha stresses the need of a more comprehensive work-plan to increase CPR and attain the MDG by 2015.
“A significant number of women still do not know that they can get family planning services if they approach nearby health posts,” Dr Ojha says. “Apart from that, sometimes health posts run without family planning tools for long periods and posts of health workers lie vacant after some of them quit.”
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