Wasti S P, Simmons R, Limbu N, Chipanta S, Haile L, Velcoff J, Shattuck D
Institute for Reproductive Health, Georgetown University, USA, Based in Save the Children, Kathmandu, Nepal.
Institute for Reproductive Health, Georgetown University, USA.
Kathmandu Univ Med J (KUMJ). 2017;15(59):222-229.
Background Effective family planning (FP) programs promote modern contraceptives and help individuals achieve their reproductive goals. Despite Nepal's relatively high contraceptive prevalence rate (50%), 27% of married women have an unmet need for FP, and almost half of Nepalese women give birth by the age of 20. This formative study explored the factors that influence the use of contraceptives in Nepal. Objective To provide information about barriers to family planning use, general fertility awareness, and barriers to family planning use among difficult to reach groups communities. Method This qualitative study was implemented in five districts in Nepal. A total of 36 focus group discussions, 18 participatory group discussions, and 144 in-depth interviews were conducted. Participants included young married women, men and FP service providers in eight village development committees and two municipalities. The interviews were digitally recorded, transcribed in Nepali and then translated into English. Data was organized using Atlas Ti 7 and coded using a thematic analysis. Result Four key themes emerged from the analyses: 1) limited knowledge on fertility awareness and family planning methods, 2) religious-cultural factors including social norms impediments contraceptives use, 3) fear of side-effects, myths and misconceptions about modern contraceptives, and 4) structural barriers such as limited family planning services, and lack of same gender providers make it difficult for many women to access modern contraceptives services. Conclusion Continuing Nepal's recent gains in contraceptives prevalence rate will require strong educational interventions addressing fertility awareness, social norms around son preference, dispelling fear of side-effects while increasing the family planning method-mix. Health service providers should continue counseling clients on the management of potential side-effects and ensure accurate information about modern contraceptives.
背景 有效的计划生育项目推广现代避孕方法，并帮助个人实现其生育目标。尽管尼泊尔的避孕普及率相对较高（50%），但27%的已婚妇女有未满足的计划生育需求，且几乎一半的尼泊尔妇女在20岁前生育。这项形成性研究探讨了影响尼泊尔避孕方法使用的因素。
目的 提供关于计划生育使用障碍、一般生育意识以及难以触及群体社区中计划生育使用障碍的信息。
方法 这项定性研究在尼泊尔的五个地区开展。共进行了36次焦点小组讨论、18次参与性小组讨论以及144次深入访谈。参与者包括八个乡村发展委员会和两个市镇的年轻已婚妇女、男性以及计划生育服务提供者。访谈进行了数字录音，先用尼泊尔语转录，然后翻译成英语。数据使用Atlas Ti 7进行整理，并采用主题分析进行编码。
结果 分析得出四个关键主题：1）对生育意识和计划生育方法的了解有限；2）宗教文化因素，包括阻碍避孕使用的社会规范；3）对副作用的恐惧、对现代避孕方法的误解和错误观念；4）结构性障碍，如计划生育服务有限，以及缺乏同性别的提供者，使得许多妇女难以获得现代避孕服务。
结论 要继续保持尼泊尔近期在避孕普及率方面取得的进展，需要开展强有力的教育干预措施，以提高生育意识、消除重男轻女的社会规范、消除对副作用的恐惧，同时增加计划生育方法的种类。卫生服务提供者应继续就潜在副作用的管理为客户提供咨询，并确保提供关于现代避孕方法的准确信息。
