Contraceptive use in Nepal

Abstract

This thesis presents three inter-related studies investigating different aspects of contraceptive use in rural Nepal.

The intrauterine device (IUD) is one of the most cost effective methods of reversible contraception available but is not well known or understood and consequently not well used in Nepal. This has not always been the case, when family planning was first introduced in Nepal the IUD was the most widely used method. Over the decades its use has dwindled to a point where less than one percent of women of reproductive age use it as their preferred method of contraception.

This thesis identifies the reasons behind the low use of the IUD in eastern rural Nepal, by employing qualitative methodology. These qualitative findings are then further employed to create demand for the IUD. The thesis draws attention to the various roles different routes of increasing awareness and demand for the IUD have. By creating demand it is shown that the uptake of the IUD is increased. Increasing demand alone does not equate to satisfaction with the method so the thesis points to quality of care being an important factor in high satisfaction leading to high continuation of the IUD.

Male influence is shown to have an influence on the uptake of the IUD within two of the studies so a third study investigates the knowledge, attitudes and practice of Nepalese men towards family planning and reproductive health. This thesis identifies a number of factors that are influencing positive changes in Nepalese men’s knowledge, attitudes and practice that may have an effect on future contraceptive use, family planning and sexually transmitted infection rates. These changes may have an effect on fertility rates, contraceptive prevalence and levels of unmet need.

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ORCID for Nyovani Madise: orcid.org/0000-0002-2813-5295

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