Family Planning (based on Bachelor of Public Health Syllabus ) Family Planning program of Nepal

1. Sirjana Tiwari
Pokhara University
Unit II: Family Planning

2. Definition
 A way of thinking and living that is adopted
voluntarily upon the basis of knowledge, attitudes
and responsible decisions by Individuals and
couples, in order to promote the health and welfare
of the family group and thus contribute effectively
to the social development of a country.
 Family planning not only aims to improve the
health of women but also the family health and
ultimately contribute toward the development of
nation.

3.  Family planning is the planning of when to have
children.
 Family planning allows individuals and couples to
anticipate and attain their desired number of
children and the spacing and timing of their birth.
 It is achieved through use of contraceptive
methods and the treatment of involuntary
infertility.

4. History
 1959: planning program in Nepal was initiated
by the NGO, Family Planning association of
Nepal (FPAN)
 1968 : Government supported family planning
service
 1963 : Establishment of MCM under the
ministry of health
 1965 : Gov adopted a policy to bring
equilibrium bet population growth and
economic growth by emphasizing policy on
family planning

5.  1965-70 : Third five year development plan was
the first to clearly state the need for a population
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
 1995: Ministry of population and environment
was established following the FP and
reproductive health principles of ICPD

6.  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 Developed the new FP strategy

7. Activities
 Condom Box Distribution
 Provision of regular comprehensive FP service
 Provision of long acting reversible services
(LARCs)
 Expansion of family planning service at urban
health clinic
 Micro planning for addressing unmet need of FP in
low modern CPR district , low Permanent FP
Methods or lower rate of Voluntary Surgical
Contraception (VSC)
 Implementation of Public Private Partnership
program at high population district

8.  Family planning onsite coaching program
 Development of institutionalized family planning
service center as a training center
 Integration of FP and immunization service
 Satellite clinic services for long acting reversible
contraceptives
 Family Planning updates orientation for
Obs/Gyne doctors and other key players
 Roving ANM (RANM) for FP in Disadvantaged
Community (Mushar, Dom, Chamar, etc.

9. Scope of family planning services: It include in its preview:
 The proper spacing & limitation of births
 Advice on sterility
 Education for parenthood
 Sex education
 Screening for pathological conditions related to
reproductive system (Cervical cancer)
 Genetic counseling
 Premarital Consultation and examination
 Carrying out pregnancy test
 Marriage counseling
 Preparation of couples for their arrival of their first child.
Scope of family planning services:

10. 2. Family Planning as Basic Human
Rights
 Family Planning has accepted as a basic human
right of an individual and couple.
 This is also considered as basic for the overall
development and quality of life.
 It was accepted as a basic human right in the
united Nation Conference on Human Right at
Teheran in 1968.
 The Bucharest conference in its ‘plan of action’
stated that “all the couples and individuals have the
basic human right to decide freely & responsibly
the number and spacing of their children & to have
the information, education , & means to do so.”

11. Cont..
“Family planning is a basic human right. However, it
remains meaningless unless individuals and couples
have access to contraceptives, information and services
to enable them to exercise that right……We have to
meet the needs of the 222 million women who want to
delay or avoid pregnancy but have no access to modern
contraceptives. This would help prevent 21 million
unplanned births; this would also help prevent 79,000
maternal deaths and 1.1 million infants deaths.”
Dr. Babatunde Osotimehin, UNFPA Executive Director (Part of message
for World Population Day july11, 2012)

12. 3. Role of FP in MDGs
 Family Planning, directly and indirectly plays greater
role in fulfilling the MDGs.
 It also can help to reduce global inequalities in health
a fundamental element of the MDGs agenda.
 Here are some details of how FP plays vital role in
fulfilling different MDGs.

13. MDG1: Family Planning alleviates poverty
and accelerates socio-economic development:
 With fewer, healthier children to provide for, families
are less likely to become poor.
 They also better able to feed and provide health care
for their child, which creates a healthier and more
productive workforce that can contribute to the
economic growth of the nation as a whole.

14. MDG2: FP can help ensure that all
children go to school:
 Families are more likely to be able to educate their
children if they have smaller families.
 For example, some girls are forced to drop out of
school early to care for younger siblings.
 Girls and young women may also be forced to leave
school early if they get pregnant.
 FP prolongs education and helps girls in particularly
to achieve their dreams for the future.

15. MDG3: FP promotes gender
equalities
 Women have greater opportunity for education, training &
employment when they can control their fertility.
 This can increase their financial security, decision- making
power in the household, status in the community.
 Because so much of women's works consist of unpaid
house hold labour and poorly paid work in the informal
economic, their increase productivity may go unnoticed and
unmeasured.
 Yet it is still of enormous importations for moving families
out of poverty.

16. MDG4: FP can reduce child mortality
 Spacing births 36 to 60 months apart reduced
malnutrition as well as neonatal and infant mortality.
 About 1.2 million infant deaths are averted globally
each year by preventing unintended pregnancies.
 If we could meet all demands for contraception,
another 640,000 newborn deaths would be prevented.
 Family planning increases child survival.

17. MDG 5: Family planning can reduce
maternal mortality
 FP reduces maternal mortality in three ways.
 It decreases the total number of pregnancies each of
which places a women at risk.
 It prevents pregnancies that are unwanted and hence
more likely to end in unsafe abortion which contribute
to one in eight maternal deaths.

18. MDG 6: Family planning can show
the spread of HIV/AIDS
 Condoms simultaneously prevent HIV transmission
and unwanted pregnancies.
 Contraception is the best-kept secret in HIV prevention
 Women with HIV who have unintended pregnancies
run the risk of transmitting the virus to their children

19. MDG 7: Family planning can help
protect environment
 A family with fewer children needs less food, land and
water and puts less pressure on a country forest and
tillable land.
 Moreover, family planning is five times less expensive
than conventional green technologies for reducing
atmospheric carbon dioxide that leads to climate
change

20. MDG 8: Global partnership
 Four decades of global investment in family planning
programs have contributed to strong collaboration
among international agencies, governmental
ministries, multinational organization and local
community groups.
 Recognizing the role family planning plays in meeting
the Millennium development goals, a 2005 World
summit reviewed progress towards the MDG’s
 After five years, in October 2007, the 62nd United
National General Assembly adopted a new target
universal access to reproductive health and added to
MDG 5.

21. Role of FP in MDGs
 Large family size and coupled with more children
surviving into adulthood—are the major factors
driving population growth.
 women express an unmet need for family planning.
 In Nepal, women had an average of 4.3 children each,
and one in three (32%) married women ages 15–49
want to space or limit births but were not currently
using any method of family planning.
 after MDGs was incorporated their unmet need for
FP was met, resulting in fewer births
 Total fertility rate is 2.3% and Reduced in Maternal
and child mortality

22. Benefits of Family Planning
Family Planning has multiple benefits for men, women,
children, community and nation.

23. For saving women’s lives:
 Reduce maternal mortality and morbidity by reducing
the number of pregnancies, the number of abortion and
the proportion of the births at high risk.
 It has been estimated that meeting women’s need for
modern contraceptives would prevent about one
quarter to one third of maternal deaths.

24. Family Planning saves women’s lives by:
1. Avoiding unsafe abortion:
2. Limiting risks of pregnancy and child birth:
3. Limiting pregnancy to the healthiest ages, frequency
and interval:
4. Improve health status of adolescents:

25. Unmeasured benefits for women and
families:
 Health birth spacing and smaller families which
improve women’s health.
 Improved education and status for women
 Improved well being of families because of mothers
survival
 Better nutrition and education for children specially
girls
 More of parent’s time and income allocated to each
child.

26. For Children
 Family Planning is an important part of effort to
improve infant and child survival. Family Planning
saves the lives of children by:
1. Spacing Birth
2. Limiting child bearing to the healthiest age
3. Spacing births helps assure that babies are
adequately breastfed.

27. For prevention of HIV/AIDS and STIs
 Prevention of unintended pregnancies in HIV infected
women
 Prevention of transmission from a Hiv infected women
to her infant

28. For men
 Family Planning methods especially condom
helps men to protect STDs/HIV for themselves as
well as for their spouses.

29. Economic growth and development
 Having fewer, healthier children can reduce the
economic burdens on poor families, allow them to
invest more in each child’s care including food,
education, health care and thus help break the cycle of
proverty.

30. For saving women’s lives:
 Family Planning can reduce maternal mortality by
reducing the number of pregnancies, the number of
abortion and the proportion of the births at high risk.
 As contraceptive use increases in a population,
maternal mortality decreases.
 It has been estimated that meeting women’s need for
modern contraceptives would prevent about one
quarter to one third of maternal deaths.

31. Women's Health:
 Pregnancy can mean serious problems for many
women.
 It may damage the mother’s health or even endanger
her life.
 Family Planning by intervening in the reproductive
cycle of women, helps them to control the number,
interval and timing of pregnancies and birth and
thereby reduces maternal mortality and morbidity and
improves health.

32. Cont…
 The health impact of family planning occurs
primarily through:
1. The avoidance unwanted pregnancies.
2. Limiting the number of births and proper
spacing and
3. timing of the births, particularly the first and
last, in relation to the age of the mother

33. 1. The avoidance unwanted pregnancies:
 The essential aim of family panning is to prevent the
unwanted pregnancies. An unwanted pregnancies may
lead to an induced abortion.
 From the point of view of Health, abortion outside the
medical setting (Criminal abortion) is one of the most
dangerous consequence of unwanted pregnancy.
 There is also evidence of higher incidence of mental
disturbance among mothers who have had unwanted
pregnancies.

34. 2. Limiting the number of births and
proper spacing
 Repeated pregnancies increase the risk of maternal
mortality and morbidity.
 Anemia is a common problem in mothers with many
children and the rate of stillbirths tends to increase
significantly with high parity.
 The somatic consequences of repeated pregnancies may
also be exemplified in the clear association between the
incidence of cancer of the cervix and high parity.
 FP is the only way to limit the size and control the interval
between births with a view to improving the health of the
mother.

35. 3.Timing the births:
 Generally mother face greater risk of dying below the
age of 20 and above the age of 30 to 35.
 In may countries complication pregnancies and
delivery show the same pattern of risk, with the
highest rate below 20 and over 35 years of age.

36. Foetal Health:
 A number of congenital anomalies(e.g., Down’s
syndrome) are associated with advancing maternal age.
 Such congenital anomalies can be avoided by the
births in relation to the mother’s age .
 Further, the quality of population can be improved
only by avoiding completely unwanted births.
 In the present state of our knowledge, it is very
difficult to weight the overall genetic effect of family
planning.

37. Child Health
 Issues relating to family planning are highly relevant
to pediatrics.
 It would seem that family size and birth spacing, if
practiced by all will yield substantial child health
benefit. These are:
a)Child mortality
b)Child growth, development and nutrition
c)Infectious diseases

38. Type of contraceptives
1. Spacing methods ( These methods can help in
timing and spacing of pregnancies, preventing
unwanted children)
i. Natural methods (do not involve the use of any
of the man made devices)
ii. Barrier methods:-
a) Physical barrier methods (condom,
Diapharagm) Vaginal Sponge
b) Chemical barrier methods
c) Intra- uterine devices
d) Hormonal methods
e) Post conceptional methods

39. Physical Barrier Methods
 It is a thin rubber sheath which is use by men.
 It is rolled over the erect penis before having sex.
 This rubber sheath prevents the entry of semen into
the vagina.
 The condom must be held carefully when taking
out the penis from the vagina to prevent spilling of
semen into the vagina.
 It is available free of cost from Urban Health
center, FPAN center in community level.

40. Merit of physical barrier methods
(condom)
 It is most simple and effective methods
 Easy to use
 Disposable
 No medical supervision is required
 Protects from sexually transmitted disease
DEMRITS :
 If not used correctly it may slip or get tear of and the
semen gets spilled into vagina.
 In some rare cases the person may have allergic to
rubber.
 Some people may not enjoy sex because of
interference with the sensation.

41. Chemical Barrier Methods
 These method usually kills the sperms and this
way chemical contraceptives help in preventing the
pregnancy.
The chemical contraceptives which are in use are:-
 FORM OF TABLETS AROSOLS
 CREAM JELLY
 SUPPOSITORIES

42. Merit
 They are easy to administer , Available free in health
centers
 Not very expansive
DEMERITS
 Most be inserted deep down and in all such points where
sperms are likely to reach.
 Must be applied each time before sex.
 May cause irritation and burning.

43. Intra Uterine Devices
 These are the devices which are placed in the
uterine cavity.
 Earlier these devices were made up of silk worm
gut, silk and gold
 Three different types of IUD’S generations are:
 First Generation IUD’S
 Second Generation IUD’S Home work: what
is
difference
between this IUDs?
 Third Generation IUD’S

44. Contd..
 The non medicated or inert IUD are often refereed
to as first generation IUD.
 The copper IUD comprises of second generation
IUD.
 The hormone – related IUD are the third
generation IUD.

45. 1st generation IUD
 These devices were made of polyethylene and are
non-medicated.
 These are available in different sizes and shapes
such as coils, spirals, loops.
 The lippes loop is the most popular and commonly
used devices.
 It is made of polyethylene and contains barium
sulphate which makes it possible to be located
when required by x-ray.
 The loop is double ‘S’ shaped and has an attached
made of Fine Nylon Threads.

46. Second Generation IUD’S
 These are also made of polyethylene but copper is
added into these.
 The copper enhances the contraceptive effect.
 Variety of copper devices are :-
 Copper-7 and copper t-200
 Variants of T devices: TCU: 220C and TCU: 380A
 Multi load devices: ML-CU: 250, ML:375
 Nova T : TCU- 380
 All cu devices are more effective and less chances
of side effects I.e. pain and bleeding.

47. Third Generation IUD’S
 These contains hormones which is released slowly
in the uterus.
 The hormone affects the lining of the uterus and
cervical mucus.
 It may affects the sperm
 There are two types of hormone IUD’S:-
1. 1. Progestrel
2. Levonogestrel device

48. Merit and Demerit of IUCD
 Can be used for longer period
 Can be easily removed when couple wants to
have child
 Do not interfere with coitus
 Inexpensive
 Very effective and failure rate if less
 Do not require hospitalization
DEMERITS : Bleeding, pain, perforation of uterus,
expulsion.

49. Post Con-ceptional Methods
 These are the methods which are used after the
missed period and pregnancy may or may not
have occurred. This method is used in regulating
and inducing the menstruation and terminating
the pregnancy or aborting the fetus. These
methods are:-
 Menstrual Regulation
 Menstrual induction
 Abortion

50. Menstrual Regulation
 it is done with in 14 days of missed period when
pregnancy is doubted but it is not confirmed. In
this the uterine contents are evacuated. The
procedure is very safe. There is no legal
restriction.
 Complication which can occur are:- local injury,
perforation of uterus, infection.

51. Menstrual induction
 This is done with in few days of missed period.
 It is done by application of prostaglandin F2
under sedation.
 This induces continuous contraction of uterus
lasting for 7 min. it is followed by cyclic
contraction which continues for next 3-4 hours.
 This initiates bleeding which lasts for a week or
so.

52. Abortion
 Abortion refers to the termination of pregnancy
before the fetus become viable i.e. before it is
able to live outside the womb.
 This period is fixed at 28 weeks when the fetus
weights 1000 grams, abortion are either
spontaneous or induced.

53. TERMINATION METHODS:
Sterilization
Vasectomy
 sterilization of male.
 simple and minor operation which takes hardly
15-20 min.
 The operation involves a small cut on both sides
of scrotum then a small portion of vasdeferens
(about 1cm) on either side of the scrotum is cut
and ligated, folded back and sutured.
 The operation is done not affect the sexual
characteristics and sex life in any form.
 The sperms are produces but not ejaculated
along with semen.

55. TUBECTOMY
 Sterilization of female.
 By resecting a small part of fallopian tubes or by
closing of fallopian tubes
 The operation can be done through abdominal or
vaginal approach.
 The most common abdominal procedure are
laproscopy and minilaprotomy.
 The tubectomy can be done between delivery
and after abortion.

56. minilaparoscopy

57. Fertility Care Services
Involves
In vitro Fertilization
Assisted Insemination
(Donor/Husband) Aid
Surrogacy
Re - canalization

58. Fertility Care Services
Involves
In vitro Fertilization
Assisted Insemination
(Donor/Husband) Aid
Surrogacy
Re - canalization

59. In vitro Fertilization
 In vitro fertilization (IVF) is a process
of fertilization where an egg is combined
with sperm outside the body, in vitro ("in glass").
 The fertilized egg (zygote) undergoes embryo
culture for 2 to 6 days, & is then transferred to the
same or another woman’s uterus, with the
intention of establishing a successful pregnancy

60. Indications of IVF
 Blocked or damaged fallopian tubes
 Male factor infertility including decreased
sperm count or sperm motility
 Women with ovulation disorders, premature
ovarian failure, uterine anomaly.
 Women who have had their fallopian tubes
removed
 Individuals with a genetic disorders
 Unexplained infertility

61. Assisted Insemination Donor/Husband
AID
 Consists inserting the sperms artificially in the
woman’s uterus, so that fertilization occurs and
hopefully a successful pregnancy.
 It is a painless procedure, and less invasive than
other reproductive treatments such as in vitro
fertilization (IVF).

62. AI by Husband (Indications)
 Female infertility due to cervical disorders
 Mild-to-moderate endometriosis
 Menstrual irregularities
 Mild Male Fertility Problems
 Seminal parameters alterations
 Erectile dysfunctions, premature ejaculations
 Unexplained Fertility

63. AI by Donor (Indications)
Opted for couples whose own
sperm is non-viable
Male genetic diseases
Severe male fertility problems

64. Surrogacy
 Surrogacy is a method or agreement whereby a
woman agrees to carry a pregnancy for another
person or persons, who will become the newborn
child's parent(s) after birth.
 2 types of surrogacy are
Traditional Surrogacy(partial
surrogacy)
Gestational Surrogacy (full surrogacy)

65. Fertility Related Indicators
 Contraceptive Prevalence Rate
Measures the proportion of women of
reproductive age (WRA) who are using
(or whose partner is using) a modern
method of FP at a particular point in
time.
Calculation depends on a population-
based household survey: number of
women age 15–49 who are using a
modern method of FP/total number of

66. CPR

67. Fertility Related Indicators
Couple-Years of Protection
(CYP): Expresses the number
of years for which a couple
would be protected from being
pregnant by modern
contraceptive methods provided
during the year.

68. Evaluation of Family Planning
 Measured by number of unplanned pregnancies
that occur during a specified period of exposure
and use of a contraceptive method.
 2 methods
 Pear index
 Life table methods

69. Evaluation of Family Planning
contd…
 Pearl index
 Number of failures per 100 women years of
exposure (HWY).
 The formula is given by
 A high pearl index means high chance of getting
pregnant

70. Unmet Need of FP
 Condition of wanting to avoid pregnancy or
postpone child birth but not using any method
of contraception.
 This concept is applied to married women,
however can also be applied to fecund women &
men too.
 But, its measurement has only been limited to
married women.

71. Common Reasons for Unmet
Need
 Lack of information
 Unsatisfactory services
 Fear of side effects
 Taboos
 Opposition from husband and
family etc

72. Contraception and Adolescent
 Adolescent is the period between
the onset of puberty and the end of
physiological maturation.
 A period of transition from childhood
to adult stage
 They are often ‘at risk’

73. Contraception and adolescent contd..
 Pregnancy in adolescent constitute about
20% of total pregnancies and the number has
been rising.
 They are unsure on seeking FP because of
stigma i.e. asking for FP means revealing
owns sexuality
 The risks are
 Unintended pregnancy
 STI’s and HIV/AIDS
 Risk of maternal & infant deaths
 Risks of unsafe abortion seeking behavior
 Secondary Sterility

74. Contraception for Adolescents
 Barrier Methods:
 Condoms would be better but diaphragms and
cervical caps are invasive & they are unwilling.
 Hormonal Contraception
 Suitable for adolescents as there will be no such
diseases contraindications for adolescents.
 Reversible and no effect in future fertility.
 Implants are way too long covered for some
adolescents.

75. Contraception for Adolescents
 IUD
 Theoretically contraindicated for adolescents since
it bears a risk of pelvic infections and secondary
sterility.
 However, protects from illegal repeated abortions
and death
 Other Methods
 Periodic abstinence is not easy for irregular cycles
 Withdrawal is not very reliable method for
contraception.
 But in some religions, there are only practical
methods available

76. Counseling for FP
 Counseling
 The face-to-face, personal communication in
which one person helps another for making
decisions and then to act on them.
 FP Counseling
 FP counseling is a process of communication,
where the counselor gives accurate and complete
information to clients and assists them to make
informed and voluntary decisions about their
fertility and contraceptive options.

77. Purpose of Counseling
 Counseling helps clients to :
 Arrive at an informed choice of reproductive
options
 Select a family planning method with which they
are satisfied
 Use the chosen method safely and effectively
 Initiate and continue family planning
 Learn objective, unbiased information about
available methods of family planning

78. Types of FP Counseling
 General Counseling
 Discuss about client’s need/concerns
 Ask what they already know and need to know
 Method Specific Counseling
 Decision making & method of choice
 Instructions on how to & when to use etc.
 Return/Follow up Counseling
 Problems & side effects discussed & managed
 Instructions should be repeated

79. Steps of FP: GATHER Approach
 G = Greet the client respectfully.
 A = Ask them their family planning needs.
 T = Tell them the different contraceptive
options
 H = Help them to make decisions for choices
 E = Explain and demonstrate how to use the
methods.
 R = Return/refer schedule and carry out a
return visit and follow up.

80. Qualities of Good Counselors
 Self confidence
 Empathy
 Non-judgmental
 Acceptance
assurance
 Genuineness
 Trustworthiness
 Confidentiality
 Supportive
attitude
 Professionalism

81. Family Planning Program of
Nepal
 Family planning (FP) is priority one program of
Government of Nepal, Ministry of health.
 The main aim of the National Family Planning Program is
to ensure that individuals and couples are able to fulfill
their reproductive needs by using appropriate family
planning methods based on informed choice.
 Family planning is not only aims to improve the health of
women but also the family health and ultimately contribute
towards the development of nations.

82. General Objective:
Overall objectives of the family planning
program is to improved health status of all people
through accountable and equitable health services
delivery system through informed choice to access
and use voluntary FP(through increased and
equitable access to quality FP information and
services)

83. Specific objectives
 To increase access to and utilization of quality FP
services which are safe, effective and acceptable to
individuals and couples. Special focus is given to rural,
poor, Dalit, other marginalized people;
 To create an enabling environment for increasing
access to quality family planning services;
 To increase demand of family planning services by
implementing various behavior change communication
activities.

84. Polices and strategies
Enabling
Environment
Demand
Generation
Capacity
Development
Service
Delivery
Research and
Innovation

85. 1. Enabling environment
Strengthen the enabling environment for family planning by:
 increasing advocacy for family planning;
 addressing legal and socio-cultural barriers to access to
family planning services for young people and other
groups;
 advocating for the integration of family planning services;
 promoting task shifting and sharing; and
 establishing family planning as the reproductive right of
females and males.
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Policy and Strategies

86. 2. Demand generation:
Increase health care seeking behaviour among
populations with high unmet need for modern
contraception by:
 using innovative approaches to reach adolescents with
family planning messages;
 designing, implementing and evaluating programmes
to increase access to and the use of family planning
among adolescents and young people;
 increasing knowledge about family planning among
individuals and couples to facilitate decision-making
on contraceptive use;
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Policy and Strategies

87. 2. Demand generation:
 reducing socio-cultural barriers to accessing family
planning services;
 reducing the fear of side-effects and dispelling myths
and misconceptions about family planning;
 targeting hard-to-reach people;
 providing information on family planning to
postpartum and post-abortion women; and
 increasing male involvement in family planning
including by conducting male-friendly reproductive
health programmes.
11/25/2021
Policy and Strategies

88. 3. Service delivery
Enhance family planning service delivery including
commodities to respond to the needs of marginalized people,
rural people, migrants, adolescents and other special groups by:
 improving integrated family planning services provided by
FCHVs in communities;
 improving services at PHC-ORC clinics, health posts and
PHCCs, including birthing centers;
 improving services in district, zonal and regional hospitals;
 increasing the availability of a broad range of modern
contraceptives and an improved method mix;
Policy and Strategies

89. 3. Service delivery
 promoting the delivery of family planning services through
government, private, NGO and social marketing;
 supporting medical college teaching hospitals to deliver family
planning services;
 improving the integration of family planning services with
other non-health and health services like immunization, HIV,
postpartum, post-abortion and urban health;
Policy and Strategies

90. 3. Service delivery
 improving facility recording and reporting;
 improving the quality of family planning care including
contraceptives;
 strengthening contraceptive security and procurement and
logistics management to ensure the availability of family
planning commodities.
Policy and Strategies

91. Policy and Strategies
4. Capacity Building:
Strengthen the capacity of service providers to expand family planning
service delivery by:
• strengthening the training of service providers on contraceptive
technology;
• task-shifting and sharing non-scalpel vasectomy (NSV) training;
• strengthening family planning training capacity, preparing a pool of
clinical mentors and expanding recanalization training and post-
training follow-up.
5. Research and Innovation: Strengthen the evidence base for
programme implementation through research and innovation:
• Generate evidence through operational research to promote family
planning innovations.

92.  Voluntary surgical contraception- Vasectomy and minilaps
including postpartum FP services and post abortion FP
services.
 Spacing methods — Spacing methods such as three monthly
injectables (e.g. Depo-Provera), oral pills and male condoms,
implant and IUCD
 Family planning counselling, community participation for
promoting
 Referral
 Micro planning for unmet need of family planning services
 Integration of FP and immunization service
 Satellite clinic services for long acting reversible
contraceptives for example: vasectomy and minilap
Major activities in 2076/77

93. Indicators 2006 2011 2016
TFR(Births per women 3.1% 2.6% 2.3%
Unmet need 25% 27% 24%
Modern contraceptive use 44% 43% 43%
Total demand for family planning among
married women
76%
Contraceptive prevalence rate (currently
married women using family planning
method)
53%
Nepal demographic Health Survey major findings

94. Summary of FP program in 2076/77
 The National family planning program experience
downturn in uptake of family planning service in
national level decreased by 61,229 than previous year
 Female sterilization (41%) occupies the greatest part
of the contraceptive method mix among all current
user followed by Implant (15%), Depo (14%), male
sterilization (12%),condom (7%), pills (6%) and lastly
IUCD (5%).
 Province no 2 has the greatest share (23%) to the
national total users, followed by province no 1 (18%),
Bagmati (18%), Lumbini (17%), while Karnali province
has the lowest share (6%) in 2076/77
 Nationally the current users of permanent methods is
in decreasing trends while long acting reversible
contraceptives is in increasing trends.
94

97. Contraceptive defaulters
 Contraceptive defaulters (excluding condom), a
proxy indicator for contraceptive discontinuation
is high in Nepal.
 About 42% of contraceptive users have
discontinued using the method in 2076/77 which
has increased from 39% in 2075/76 .
 Sudurpaschim has the highest defaulter rate
(67%) while that Lumbini and Gandaki has the
lowerst defaulter rate at 34%.

100. Family Planning Service comparison
2074/75 - 2076/77

102. FAMILY PLANNING 2020
(FP2020)
 Family Planning 2020 (FP2020) is a global
partnership to empower women and girls by
investing in rights-based family planning (FP).
 FP2020 works with governments, civil society,
multilateral organizations, donors, and the private
sector to enable 120 million more women and
girls to use modern contraceptives by 2020.
 Achieving the FP2020 goal is a critical milestone
to ensure universal access to sexual and
reproductive health (SRH) and reproductive rights
by 2030 as laid out in Sustainable Development
Goals 3 and 5

103.  In terms of coverage, Nepal is well within range of
achieving its target of 49% modern contraceptive
prevalence (MW) by 2020,
 An important achievement that implies delivering
services to over 3.2 million women in 2019. As a
result of this
 1.3 million unintended pregnancies were averted
 over 500,000 unsafe abortions and
 1,200 maternal deaths were averted

105. Challenges of FP program of
Nepal
 Suboptimum access to and use of FP services by
hard to reach communities and underserved
populations
 Limited health facilities providing five
contraceptive methods
 High contraceptive discontinuation
 Underutilized LARCs
 Inadequate trained human resources on LAFPM
 Functionality of IFPSC