Reproductive Health and Family Planning in Nepal
Reproductive Health and Family Planning

Reproductive health and family planning

Sexual and reproductive health (SRH) services save lives. They are a universal right and an essential part of Universal Health Care. Yet millions globally still do not have access to the services they need, where and when they need them, and at a price they can afford.

SRH services include:

  • Contraceptives
  • Abortion
  • Sexually transmitted infections (STI)
  • HIV prevention and treatment
  • Gender-based violence and other related services.

Sexual and reproductive health and rights contribute to equity. When women can choose when they have children and how many they have, it has a positive impact on their health and economic well-being, and that of their families.

We help to increase access to sexual and reproductive health services and rights, through:

1. Evidence-based solutions to improve service use amongst those who find accessing services difficult or shameful: for example youth, people with disabilities and unmarried women.

  • We use our formative PEER (Participatory Ethnographic Evaluation and Research) research to understand how the social context impacts the ways people access services, particularly in relation to accessing contraception and safe abortion. This includes PEER projects in Bangladesh, India, Nigeria, Sierra Leone, Zambia and Zimbabwe.
  • In Pakistan, we worked in partnership with MSI Reproductive Choices to increase women’s access to sexual and reproductive health services. We used rapid qualitative PEER research to design and develop voucher programmes to reach families in more remote areas and provided access to much-needed reliable long-term contraception.

2. Advocacy and behaviour change communications to change social norms, promote use of family planning services, and to advocate for better provision of sexual and reproductive health services and end gender-based violence.

  • In Nigeria and Kenya, we use a human-centred design approach to support access to integrated sexual and reproductive health services for adolescents and dramatically reduce deaths and injury from unsafe abortions among girls.
  • We employ local media and campaigns and global advocacy to support the Africa-led movement to female genital mutilation/cutting in sub-Saharan countries, to accelerate positive change in social attitudes towards ending female genital mutilation/cutting in countries where the programme is operational.

3. Strengthening delivery and coverage of services to make sure that quality sexual and reproductive health care is accessible to all.

  • As part of the Women's Integrated Sexual Health (WISH) programme, we have been working with governments and civil society partners to promote an enabling environment for increased public investment in SRHR. We are using evidence, advocacy and accountability to foster policy change, ensure quality of services and protect and fulfil SRHR financing. In Zambia we conducted a bottleneck analysis of the last mile distribution of contraceptives to service delivery points that provided valuable evidence to the Ministry of Health to take a confident stewardship role in coverage of SRH/FP services. This has also catalysed policy reforms.

4. Improve accountability of service providers, health and government leaders for ensuring the resources are available to deliver high quality services for all.

  • Accountability is crucial to ensuring countries’ FP2020 commitments turn into action. In Nigeria, our Gates-funded Evidence 4 Action programme uses evidence-based advocacy to drive accountability at federal and state level. For example, in Lagos State, the State-Led Accountability Mechanisms (SLAM) evidence-based approach contributed to increasing the Lagos health budget allocation from 6% in 2017 to 10% in 2021 and reducing commodity stock outs in Lagos facilities from 65% in 2016 to zero in 2020, sustained into mid-2021.

5. Ensuring continuity of services during emergencies

  • We promote innovative, flexible and responsive approaches in emergency settings that protect and enhance women’s access to family planning and trigger broader health system improvements.
  • The COVID-19 outbreak has exacerbated the weaknesses in health systems w, threatening continuity of essential services, including contraceptives. Under WISH, the programme was designed to be adaptive, allowing us to seize opportunities opened by the public health emergency to strengthen the resilience of health systems. In Bangladesh, for example, health emergency indicators were added to the digital quality of care dashboard as well as the digital financial management system. The work has led to the development of two new tools: the first to assess facility readiness to provide SRH/FP services during a pandemic, and the second to measure the disruption to stewardship of SRH/FP quality improvement and identify quality gaps.

Results

  • In Pakistan, the contraceptive prevalence rate increased in programme areas from 27% to 48% after 1.5 years.
  • In the same period, the contraceptive prevalence increased in the programme areas by 77% compared to 7% in control areas.
  • In Yemen uptake of implants and IUDs increased by 134% and 46% respectively in 2014
  • In earthquake affected districts in Nepal, users of long acting reversible contraceptives increased by 36.6% in 2016 compared to 2015
  • In Nigeria, we supported creation of the first ever budget line for Family Planning Services (FP) in Jigawa State in 2019. The following year, we contributed to a doubled allocation of N20 million.

Our experts

  • Ronke Atamewalen
    Ronke is a public health nurse/midwife committed to improving access to safe, sustainable, high-quality reproductive health services for women and girls. With over 20 years’ experience in clinical and preventive interventions in the public, private and NGO sectors, Ronke’s technical expertise includes institutional capacity building, health system strengthening and quality assurance. She is currently responsible for Clinical Quality Assurance.

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