Attitude towards family planning in Dharan, east Nepal: implications for the family planning programme

A survey of the knowledge, attitude and practice of family planning was conducted in Dharan, Nepal. The town offers a full range of family planning services free of charge. There was a strong desire to limit family size; 52.5% of couples were currently using some modern method of family planning. Of the current users, 62.3% had been sterilized, including 92.3% of those in the lowest socioeconomic group. Health risks and incompleteness of the family were the most common reasons for non-use of contraception, the latter reason reflecting ignorance of the temporary nature of some methods. There was a strong preference for male children and couples rarely used contraception until at least one so had been born. Even in this prosperous town where couples were highly motivated towards family planning and all methods were readily available, there was heavy reliance on sterilization. This is typical of Nepal and has largely been responsible for the failure of the family planning programme--as most couples choosing sterilization are in the older age group and have completed a relatively large family. If Nepal is to succeed in meeting its target of reducing the total fertility rate (i.e., births per woman) from the current 5.8 to 4 by the year 2000 it will need not only to expand services but actively to promote temporary methods of contraception, particularly the more reliable longer acting reversible methods such as Depo-Provera, Norplant and intrauterine contraceptive devices.