Ethnic differentials of the impact of Family Planning Program on contraceptive use in Nepal

Abstract

Abstract There is wide variation of family planning services use among ethnic groups in Nepal. Despite three decades of implementation the need for family planning services is substantially unmet (25%), and there have been no systematic studies evaluating the impact of the family planning program. This study pooled data from nationally representative surveys conducted in 1996, 2001, and 2006. Multilevel logistic regression analysis of 23,381 married women of reproductive age nested within 764 clusters indicated that Muslims, Janjatis, and Dalits were significantly less likely to use contraceptives than Brahmins and Chhetries (OR=0.27, 0.88 and 0.82 respectively). The odds of using contraceptives by the Newar were higher than the odds for Brahmins and Chhetries, although it was not significant. Exposure of women to family planning messages through health facilities, family planning workers, radio, and television increased the odds of using modern contraceptives. However, the impact of family planning information on contraceptive use varied according to ethnicity. We also found that modern contraceptive use varied significantly across the clusters, and the cluster-level indicators, such as mean age at marriage, mean household asset score, percentage of women with secondary education, and percentage of women working away from home, were important in explaining this. (ProQuest: ... denotes formulae omitted.) 1. Introduction After more than thirty years of family planning program efforts, contraceptive use among married women of reproductive age in Nepal has increased from 26% in 1996 to 44% in 2006. At the same time, fertility has decreased from 4.6 to 3.1 per woman (Pradhan et al. 1997; Ministry of Health and Population (MoHP), New Era, and Macro International Inc. 2007). Yet the need for family planning is partly unmet (25%) (Karki and Krishna 2008) and some ethnic groups use family planning much more than others. For example, almost three times as many Newars (56%) use family planning as Muslims (17%). Use of family planning among Dalits (41%) and Muslims (17%) is less than the national average (44%) (Bennett and Dahal, 2008). This information suggests that family planning efforts are reaching some groups more than others. However the cause of this disparity is not clear, and systematic studies evaluating the impact of the family planning program have not been conducted in Nepal. This paper intends to fill the gap by examining the impact of the family planning program on modern contraceptive use among different ethnic groups in Nepal. The overall objective of this study is to examine whether the observed differences in the levels of modern contraceptive use among different ethnic groups over the last ten years in Nepal are associated with the family planning program. The specific objectives are: * To examine if the family planning program is effective in increasing contraceptive use * To explore if the impact of the family planning program differs by ethnicity * To provide policy recommendations to reduce ethnic disparity in impact. Family planning activities in Nepal were first initiated in 1958 by the Nepal Family Planning Association. The Family Planning Policy was adopted in 1965 and limited family planning services were made available in the Kathmandu Valley in 1968. Services were expanded all over the country only in the early 1990s (Aryal et al. 2008). Over the last two decades various interventions have been implemented to increase knowledge, acceptability, and use of contraceptives, through static and mobile services, door-to-door campaigns, and the mass media. Now knowledge of family planning among women of reproductive age is almost universal in Nepal (MoHP, New Era, and Macro International Inc. 2007). However the unmet contraceptive needs are considerably higher among poorer women (Johnson and Bradley 2008). Regional and ethnic disparities also exist in the utilization of family planning services. …