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Family planning among women in Nepal: Strong knowledge but weak practice

Family
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The practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilisation, is simply known as family planning. In fact, family planning services mean enabling a couple to decide and maintain the size and space of the family through educational, comprehensive medical and social activities including appropriate methods and means. The use of contraceptives do not maintain the size of the family only; these also help to create a positive impact on maternal and child health. This ultimately increases care, support, nutrition to the children which lead to better educational opportunities and finally help to increase the economic status of the family. That is why the means of family planning help a nation manage proper resources and increase per capita income.

In Nepal, all family planning services are free of cost and most of the services are available at the grassroots. Nepal Demography and Health Survey 2016 shows all the women aged 15 to 45 years know about the means of family planning. But, the use of contraceptives among them is decreasing. The issue, hence, is interesting to discuss.

Myths and reality

Most women have myths regarding contraception. They are very sensitive to their body weight, and they think all contraceptives cause obesity. In fact, hormonal contraceptives have some metabolic effects that may cause obesity but can be maintained by exercise and diet. Non-hormonal contraceptives do not have any impact on body weight.

There are different other myths and rumours in our society such as contraceptive devices may lose fertility permanently, disrupt the regular menstrual cycle, cause infections and even cancer. Educated families also believe in these myths as do the illiterates. The NDH Survey 2016 shows only 34 per cent of women having a secondary level or higher education use modern contraception while 52 per cent of women having no education use it.   

Though the women are well aware of the contraceptives, the usage of the contraceptives could not rise for 10 years. Most of the women have a fear of infertility in the case of using contraceptives. It has been found a few women have fear of irregular periods, impact on the uterus and even the risk of cancer in the organ with the use of contraceptives. These couples in society have misinformation about contraceptives and family planning as they do not have proper consultations with the experts but listen to the people who lack the proper knowledge of family planning and usage of the contraceptives. As a result, there are women who have unwanted pregnancies looking for abortion services.

Education plays important role in family planning. There is a practice of marriage at the right age and having a small family with an appropriate age gap between two children in an educated family. Studies, however, show the people of this group use very less contraceptives though they seem to be responsible and sensible towards the family. Nevertheless, it could be assumed these groups of educated women might use the natural process of family planning or use the contraceptives in their own way without visiting the private or public clinics.  

Need for family planning consultation

Contraception
Reproductive Health Supplies Coalition for Unsplash.

It is quite clear that most of the couples have ‘only heard but have not practised’ the proper way of using contraceptives though it has been said that they know everything about it. Of course, it is really important to know about family planning. Without the proper knowledge, one might be at the risk of unsafe abortion or giving birth to an unwanted child. It is understood that around one million women have already done safe abortion between 2002 and 2017 whereas it is suspected that there might be many more cases of unsafe abortion.

Hence, now, it is very important to expand the awareness of family planning consultation. At the time when they look for a consultation for normal health disorders, looking for experts for family planning is not a big deal. It is necessary to have proper family planning advice at the time when people are suffering from diseases like diabetes and blood pressure.

One should not take decisions in haste in selecting the contraceptives. They should take proper information regarding the advantages and disadvantages of the contraceptives from the doctors, health experts and health assistants before using them. One should be well aware of the contraceptives before using them, but they should not hesitate or have fear while using them.

The consultation and the service of family planning are free at all public hospitals and health institutes. One can visit the private clinics to see the gynaecologists for the proper consultations and services of the family planning without any hesitation and fear as there are many doctors who have started the services in their own private clinics.

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Dr Shah is a gynaecologist at the Morang Cooperative Hospital, Biratnagar.

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