Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal.
PLoS One. 2024 May 31;19(5):e0303634. doi: 10.1371/journal.pone.0303634. eCollection 2024.
Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey.
We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant's and husband's education, occupation, wealth quintile, parity, desire for child, and media exposure.
The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education.
Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.
计划生育（FP）对于改善母婴健康结果、促进性别平等和减少贫困至关重要。全球范围内仍然存在未满足的 FP 需求，特别是在南亚和撒哈拉以南非洲地区，导致意外怀孕、不安全堕胎和产妇死亡。本研究旨在从全国代表性调查中确定 FP 未满足需求的决定因素。
我们分析了来自全国代表性的尼泊尔 2022 年健康与人口调查的 11180 名已婚妇女的数据。我们在 R 统计软件中进行了加权分析，以考虑复杂的调查设计和非响应率。我们进行了单变量和多变量二项和多项逻辑回归，以评估 FP 未满足需求与独立变量之间的关联，包括居住地、省份、生态带、族裔、宗教、当前年龄、参与者和丈夫的教育、职业、财富五分位数、生育次数、生育愿望和媒体接触。
总 FP 未满足需求为 20.8%（95%CI：19.7，21.9），其中 13.4%（95%CI：12.5，14.4）为限制生育的未满足需求，7.4%（95%CI：6.8，8.0）为生育间隔的未满足需求。与<20 岁相比，20-34 岁和 35-49 岁的女性总 FP 未满足需求的可能性较低，与婆罗门/切特里相比，属于马德西族的女性（AOR：0.78；95%CI：0.64，0.95），与最富有的（AOR：0.69；95%CI：0.56，0.84）、较富有的（AOR：0.82；95%CI：0.68，0.97）和中等财富五分位数（AOR：0.82；95%CI：0.70，0.98）组相比，最贫穷的财富五分位数组和农村地区的女性（AOR：0.89；95%CI：0.80，0.99）相比，可能性较低。与没有教育的女性相比，具有基本（AOR：1.34；95%CI：1.17，1.54）和中等水平（AOR：1.32；95%CI：1.12，1.56）教育的女性更有可能需要 FP，与没有教育的女性相比，来自马德西（AOR：1.56；95%CI：1.22，1.98）、加德满都（AOR：2.11；95%CI：1.66，2.68）、蓝毗尼（AOR：1.97；95%CI：1.61，2.42）和苏尔杜帕希姆（AOR：1.64；95%CI：1.27，2.10）的女性相比，戈西省的女性可能性更高，而丈夫教育水平为基本水平（AOR：1.37；95%CI：1.15，1.63）或中等水平（AOR：1.32；95%CI：1.09，1.60）的女性可能性更高。
尼泊尔在各种社会人口统计学阶层都面临相对较高的 FP 未满足需求。要满足这些需求，需要针对年龄、族裔、宗教、教育和社会经济因素采取有针对性的干预措施，以确保普遍获得 FP 服务。
