Determining an effective and replicable communication-based mechanisms for improving young couples\u27 access to and use of reproductive health information and services in Nepal—An operations research study

This operations research study sought to determine an effective communication-based model for increasing the involvement of community-based groups in improving access to and use of reproductive health services and information by young married couples. The study employed a quasi-experimental design with two experimental and two nonequivalent control groups in the Udaypur district of Nepal. As stated in this report, this OR study clearly demonstrates the effectiveness of communication-based models such as the formation and reactivation of Youth Communication Action Groups and Mother’s groups, basic and refresher training, group interaction and mobilization, and social events in creating an enabling environment for young married couples to learn and interact about sexual and reproductive health issues. The increase in reproductive health-related knowledge and practice among young married women has been high in both experimental areas. However, changes in the practice of family planning and antenatal care have not shown consistent trends probably because of the conflict situation in the project sites during the implementation phase

Correlates of unintended pregnancy among currently pregnant married women in Nepal

<p>Abstract</p> <p>Background</p> <p>Women living in every country, irrespective of its development status, have been facing the problem of unintended pregnancy. Unintended pregnancy is an important public health issue in both developing and developed countries because of its negative association with the social and health outcomes for both mothers and children. This study aims to determine the prevalence and the factors influencing unintended pregnancy among currently pregnant married women in Nepal.</p> <p>Methods</p> <p>This paper reports on data drawn from Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey. The analysis is restricted to currently pregnant married women at the time of survey. Association between unintended pregnancy and the explanatory variables was assessed in bivariate analysis using Chi-square tests. Logistic regression was used to assess the net effect of several independent variables on unintended pregnancy.</p> <p>Results</p> <p>More than two-fifth of the currently pregnant women (41%) reported that their current pregnancy was unintended. The results indicate that age of women, age at first marriage, ideal number of children, religion, exposure to radio and knowledge of family planning methods were key predictors of unintended pregnancy. Experience of unintended pregnancy augments with women's age (odds ratio, 1.11). Similarly, increase in the women's age at first marriage reduces the likelihood of unintended pregnancy (odds ratio, 0.93). Those who were exposed to the radio were less likely (odds ratio, 0.63) to have unintended pregnancy compared to those who were not. Furthermore, those women who had higher level of knowledge about family planning methods were less likely to experience unintended pregnancy (odds ratio, 0.60) compared to those having lower level of knowledge.</p> <p>Conclusion</p> <p>One of the important factors contributing to high level of maternal and infant mortality is unintended pregnancy. Programs should aim to reduce unintended pregnancy by focusing on all these identified factors so that infant and maternal mortality and morbidity as well as the need for abortion are decreased and the overall well-being of the family is maintained and enhanced.</p

Utilisation of sexual health services by female sex workers in Nepal

Background The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. Methods This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. Results The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. Conclusion FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The ‘education’ to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary

Factors associated with contraceptive use in rural Nepal: Gender and decision-making.

INTRODUCTION: Gender norms and roles influence many decisions related to reproductive health behaviours including contraceptive use. There are very few studies related to gender norms and decision-making in contraceptive use in Nepal, hence this paper addresses these issues in a quantitative study. METHODS: A secondary data analysis of a primary study conducted in 2012 as a quantitative cross-sectional study in four villages of a hilly district in Nepal. This study included data that were collected from either the woman or the man in 440 couples of childbearing age with at least one child. The secondary analysis included (adjusted) regression analysis to investigate factors associated with contraception use with the variables of interest being gender roles and decision-making, whilst considering demographic and socio-economic controls. RESULTS: The secondary data analysis found gender roles were associated with current/ever use of contraceptives as reported by the respondents. Socio-economic factors such as husband's and wife's education and gender roles such as indicators showing sharing of childcare responsibilities affected contraceptive use positively. However, decision making regarding contraceptive use was not found to be associated with current/ever use of contraceptives. CONCLUSION: Gender has a role in the use of contraceptive, however decision-making may not be associated with contraceptive use. Educational, health promotional and family planning programmes are recommended to promote use of contraceptives. It is important that husbands get involved in these programmes to encourage discussions related to contraceptive use