Explanations of unmet need for contraception in Chitwan, Nepal

This article explores reasons why women's fertility preferences and their contraceptive behaviors often appear to be contradictory. Ninety-eight separate interviews with women and their husbands conducted in rural Chitwan District, Nepal, over a 12-month period in 1993-94 revealed that people continually and self-consciously weigh the perceived benefits and risks of practicing family planning relative to their situations. Temporary and, especially, hormonal methods are perceived to carry unacceptable health risks. Contraceptive technologies are evaluated in relation to competing priorities and interests. Household poverty heightened the perceived risk of family planning use; poor people fear they can ill afford negative effects to their health that might result. People assess their health status and physical workload, factors that they believe condition their ability to use family planning methods without experiencing damaging health effects. Strategies employed to lower contraceptive risk include altering the method of choice, manipulating relationships with spouses, timing the adoption of contraceptives, managing the context of service provision, and acting in light of the experiences of others. Qualitative findings from the fieldwork are complemented by analysis of data from a standardized fertility survey.