Barriers to sustained use of contraception in Nepal: quality of care, socioeconomic status, and method-related factors

Biodemography Soc Biol. 2009;55(1):52-70. doi: 10.1080/19485560903054671.


Owing to previously limited data availability, low contraceptive prevalence, and predominance of permanent method use in Nepal, there have been few studies of contraceptive-use dynamics. The aim of this article is to examine contraceptive use dynamics in Nepal in light of the country's ongoing fertility transition and change in contraceptive method-mix. Drawing on the 2003 Contraceptive Acceptance and Use Patterns Survey of Nepal and the quality-of-care framework, a proportional hazards model is used to explore contraceptive discontinuation of injections and pills. Results show that source of method from non-government services, high level of information given, one-to-one counseling, satisfaction with services, and shorter travel time to source are associated with lower odds of discontinuation. Despite the experience of side effects, women in Nepal are highly motivated to regulate their fertility. Results suggest detailed information given to users can have significant influence on continuation of methods rather than merely providing information on alternative methods and group counseling.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Contraception Behavior*
  • Efficiency
  • Family Planning Services / standards
  • Family Planning Services / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand
  • Humans
  • Multivariate Analysis
  • Nepal
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Proportional Hazards Models
  • Quality of Health Care / statistics & numerical data*
  • Social Class*
  • Socioeconomic Factors
  • Time Factors