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Field Placement: Nepal Family Health Program II
Location: Nepal
Preceptor: Dr. Kedar Baral
Student Name: Priti Gautam
Year: 2008
Nepal Family Health Program II (NFHP II) aims to support the Nepal government and NGOs to build capacity and collaborations with stakeholders and to improve the delivery and use of the family planning, maternal, newborn, child health and literacy life skills services. NFHP II is a community-based organization that serves 24 of the 75 districts in Nepal. NFHP II is a five-year John Snow, Inc. program, funded by USAID and is at its second phase; will be evaluated in 2012. NFHP II has been a key component of the achievements that Family Planning Programs have made in Nepal; the contraceptive prevalence rate (CPR) is at an increasing trend, the total fertility rate is decreasing, and the availability of contraceptives is improving over the years. Challenges in FP programs appear when looking at the method mix; Voluntary Surgical Contraceptive (VSC) is the most preferred method while Intra-Uterine Contraceptive Device (IUCD) and Norplant is the least. Although there continues to be a high demand for limiting and spacing births, long acting methods like IUCD and Norplant account for less than three percent of the method mix. Previous studies have identified challenges in both quality of service delivery and community/client acceptance of methods. In terms of service delivery, many IUCD/Norplant users (continued and discontinued users) expressed that service providers did not provide adequate information about the side affects of the methods or how to cope with side affects when they occur, while others expressed that initial and follow-up check ups were not thorough enough. One fifth of IUCD and Norplant discontinued users complained that they needed to request for removal more than once before service providers removed the devices. Misconceptions and myths were also shown to be a major barrier in the acceptance, use, and continued use of both methods. My internship’s primary focus was to conduct a small-scale qualitative case study to explore the continued low use of long acting methods among contraceptive users in Nepal. The study’s objectives were to understand the use and non-use of IUCD/Norplant through service provider interviews as well as observations of facility equipment, family planning counseling, and IUCD/Norplant insertions and removals. Data was collected from the Terai districts of Parsa, Rautahat and Banke. I worked mainly with the Reproductive Heath team at NFHP II, which has a major focus on family planning issues including a special focus on low use of IUCD and Norplant in Nepal. Dr. Kedar Baral, who is the reproductive health specialist for the Program, was my preceptor. Along with other smaller tasks, my main responsibilities included creating data collection tools for my site visits, conducting interviews and observations in at least two districts, and writing a report of my findings with future recommendations The findings from the case study revealed that many of the factors found in previous studies do affect the use and non-use of Norplant and IUCD such as misconceptions, perceptions of access to removal services and counseling among others. Other issues that affect the use and non-use of the methods also transpired during the course of interviews including preferences, religious beliefs and culture of specific populations.

Source: http://chs.ph.ucla.edu/sites/default/files/downloads/Nepal%20Family%20Health%20Program%20II.pdf