Sociodemographic and Decision-Making Factors Associated with Unmet Family Planning Needs among Married Women in Madi Municipality, Chitwan, Nepal

doi:10.21203/rs.3.rs-3222972/v1

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Research Article

Sociodemographic and Decision-Making Factors Associated with Unmet Family Planning Needs among Married Women in Madi Municipality, Chitwan, Nepal

https://doi.org/10.21203/rs.3.rs-3222972/v1

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Background

Sustainable Development Goal of Nepal targets universal access to family planning (FP) services and increasing the contraceptive prevalence rate to 75% by 2030. Despite continuous efforts from the government of Nepal in the FP sector, the prevalence of unmet need for FP is high. This study aimed to identify sociodemographic and decision-making factors associated with the unmet need for FP among married women of reproductive age.

Methods

This is a community-based cross-sectional study conducted in Madi municipality, Chitwan, Nepal. Face-to-face interviews were conducted with 218 married women of reproductive age using a semi-structured questionnaire. Descriptive statistics, chi-square tests and multivariate logistic regression were used to analyse the data.

Results

The overall unmet need for FP was 38%. Respondents whose husbands were involved in foreign employment were more likely [aOR: 4.408; CI: 2.068–9.399] to have an unmet need for FP than those employed within the country. The likelihood of the unmet need was higher [aOR: 3.212; CI: 1.368–8.135] among couples who did not discuss using FP methods compared to those who discussed three or more times. Women with up to two children [aOR: 5.212; CI: 1.163–23.363] and three or more children [aOR: 8.758; CI: 1.691–45.355] were more likely to have a higher unmet need for FP than women without a child.

Conclusion

A significant proportion of women had an unmet need for FP. Intervention should focus on addressing the FP needs of migrants and their spouses, promoting spousal discussion on FP and counselling on the treatment as well as side effects of contraceptives. Furthermore, empowering women would enable them in the decision-making process and in accessing FP services.

Contraception

Cross-sectional

Factors associated

Foreign employment

Nepal

Spousal communication

Unmet need

Sustainable Development Goal (SDG) of Nepal has focused on ensuring healthy lives and promoting well-being for all age groups. One of the targets of the SDGs of Nepal is ensuring universal access to sexual and reproductive health care services, including family planning (FP). It aims to increase the contraceptive prevalence rate (CPR) to 75% by 2030 [1]. Globally, the CPR is 76%, and the prevalence of unmet need is 10% [2], while in Nepal, a larger unmet need of 24% exists when CPR is 53% [3]. Women with an unmet need for FP are those who are not currently using any contraceptive method but want to postpone childbirth for at least two years[4]. In Nepal, the unmet need declined by only 7.4% in two decades, from 31.4% in 1996 to 24% in 2016 [3]. Unwanted pregnancy is associated with higher unsafe abortion [5].

The government of Nepal is providing short-acting reversible contraceptive methods (male condoms, oral pills, and injectables) through primary health care centers (PHCCs), health posts and primary health care outreach clinics. Long-acting reversible contraceptive methods such as Intra Uterine Contraceptive Device (IUCD) and Implant are only available in hospitals, PHCCs, and health posts through trained and skilled providers. Last, male and female sterilization are usually performed in mobile camps and hospitals. Clinics/centers, private hospitals/clinics, and pharmacies run by nongovernmental organizations are also providing quality FP services. Female community health volunteers (FCHVs) are responsible for raising awareness in the community regarding FP as well as distributing male condoms and oral contraceptive pills[6]. Despite the availability of FP services, the CPR for the modern FP method has remained stagnant (43%) since 2006, and a significant proportion of unmet needs exists [3].

The underlying reasons for the nonuse of contraception among women with an unmet need for FP are a lack of awareness regarding the details of specific methods of contraception and the concept of fertility control, fear of side effects or health risks and the inconvenience of using contraceptives [7].

The unmet need for FP among married women is influenced by several factors, such as their age, caste/ethnicity, place of residence, education, occupation, education and occupation of husband, number of living children, number of living sons, approval of husband and spousal communication [8–11].

Unlike previous studies on the unmet need for FP in Nepal [8–11], this study was conducted in a semiurban setting of a newly formed municipality. There are a limited number of unmet need studies conducted in Nepal [4, 8, 9, 11, 12]. This study aimed to identify the sociodemographic and decision-making-related factors influencing the unmet need for FP among married women of reproductive age (MWRA).

Study area

This study was conducted in the Madi Municipality of Chitwan District. In Chitwan, in addition to two preexisting municipalities, village development committees were merged, and five new municipalities were gradually formed, including Madi. Madi was declared a municipality with 9 wards in 2014. It has nine public health facilities, including one hospital, three health posts, one community health care unit, and four urban health care centers. FP service is available at all the health facilities as well as from an FCHV of the respective ward. According to the record of household survey conducted by the municipality in 2017 [Unpublished data], Madi Municipality has a total population of 43,402, of which 12,577 are females of reproductive age (15–49). It comprises a total of 8,649 households inhabiting 37 types of caste/ethnicity groups. The major caste/ethnicity are Brahmin, Chhetri, Chaudhary, Chepang, Damai, Gurung, Tamang, Bote, Magar, Kami and Sarki [14].

Study design and study participants

This was a cross-sectional study conducted among MWRA (15–49 years) who were residents of Kalyanpur of Madi Municipality.

Sampling and sample size

A multistage sampling technique was used in the study. Among the newly formed municipalities in Chitwan, Madi was selected purposively, being farthest in distance from Bharatpur – the district headquarters – that takes a two-hour drive. A ward was selected randomly using the lottery method. Then, a systematic sampling technique was used to select households for data collection. The selected ward (ward number 7) had a total of 978 households and 1,373 females in the reproductive age group [14]. The sample size for the study was calculated as follows:

\(n=\frac{{Z}^{2}p\left(1-p\right)}{d²}\) = (1.96)² x 0.24 x 0.76/0.06² = 195

where n is the sample size, Z is the z score (set to 1.96 at the 95% confidence level), p is the prevalence of unmet need (24%) and d is the margin of error (6%).

By considering a nonresponse rate of 10 percent, the final sample size (n) = 215

Then, the sampling interval was calculated as follows:

Sampling Interval = total households/sample size = 978/215 = 4.54

Every fifth house was selected after random selection of a first house. A total of 218 MWRAs were included in the study to cover all the remaining houses in the ward.

Study variables

Dependent variable

The dependent variable was ‘Unmet need for FP’.

Independent variables

Independent variables include the age of the respondent, religion, caste/ethnicity, wealth index, educational status of the respondent, occupation of the respondent, educational status of the husband, occupation of the husband, number of living children, decision-maker, frequency of discussion, and approval of husband.

Operational Definition

Unmet need for FP

Fecund women who desired to postpone birth for two or more years or stop childbearing altogether but were not currently using a contraceptive method, as well as pregnant women whose current pregnancy was unwanted/mistimed, were considered to have an unmet need for FP. The unmet need was categorized as ‘Yes’ (coded 1) and ‘No’ (coded 0) [15].

(1) Age of respondent: Completed years of life of respondent. It was classified into three categories: ‘≤24 years’, ‘25–34 years’ and ‘35 years & above’[16].

(2) Religion: Religion followed by the respondents. It was classified into two categories: ‘Hindu’ and ‘Non-Hindu’ (Buddhist, Christian, and Muslim). [17, 18].

(3) Caste/ethnicity

This was categorized as ‘Advantaged caste/ethnicity’ and ‘Disadvantaged caste/ethnicity’. So-called upper caste group, i.e., Brahmin & Chhetri and relatively advantaged Janajati were classified as ‘Advantaged caste/ethnicity’, whereas Dalits and Disadvantaged Janajati were classified as ‘Disadvantaged caste/ethnicity’[13, 17].

(4) Wealth index

A wealth index was created using a principal component analysis of a number of household assets. It was classified into ‘Poor’ and ‘Rich’.

(5) Educational status refers to completed years of schooling of the respondents and their husbands. It was measured in three categories – ‘no schooling’, ‘primary education’, ‘secondary education’ and ‘postsecondary or higher education’. Respondents who had completed any grades from 1 to 5 were classified as having ‘primary education’, respondents who had completed 9th grade up to 12th grade were classified as having ‘secondary education’, and respondents with any completed education higher than 12th grade were classified as having ‘postsecondary or higher education’[3].

(6) Occupation of respondent: Occupation of the respondent at the time of data collection was classified into three categories: ‘Housewife’, ‘Agriculture’ and ‘Employed within country’ (service/labor/business)’[19, 20].

(7) Occupation of husband: Occupation of the respondent’s husband at the time of data collection. It was classified into three categories: ‘Agriculture’, ‘Foreign employment’, and ‘Employed within country’ (Service/Business/Labor) [19, 20].

(8) Number of living children

The number of living children of the respondents. It was classified as ‘No child’, ‘Up to 2 children’, or ‘3 or more children’[21].

(9) Decision maker

The individual who makes decisions regarding the use of the FP method. It was categorized as ‘By woman herself’ and ‘Husband and wife jointly’[22, 23].

(10) Frequency of discussion

This variable assessed the number of discussions on FP that a couple had regarding family planning. It was measured as ‘Never’, ‘Once or twice’ and ‘Three or more times’[24]

(11) Approval of husband

The variable assessed perceived approval of husband for using contraceptives. The response was categorized as ‘Approves’ and ‘Disapproves’.

Data collection procedure

Data were collected from June 30 to July 20, 2019. Data were collected using a structured questionnaire that was developed from relevant literature [3, 16, 24, 25] in the local Nepali language. The questionnaire was pretested in a similar setting of another municipality (Kalika municipality) in Chitwan. The questionnaire was then customized based on the findings of the pretesting, which included the addition of a ‘skip’ label, deletion of vague words, and ‘reordering’ the questions to make it friendly to both the data collector and respondents. The final questionnaire consisted of variables related to sociodemographic characteristics, knowledge and practice of FP, and decision-making.

Data were collected through face-to-face interviews by visiting women at their homes. After explaining the objectives of the study prior to data collection, most women who were infecund reported their status themselves. Among the seven pregnant women found during the survey, two had unwanted pregnancies. The first house was selected by taking the community school as a landmark [26]. A direction was randomly chosen by tossing a pen and following the direction of the point of the pen [27]. Then, every fifth house was chosen until the required sample size was met. Additionally, two more eligible women were included from the remaining houses following the same procedure. Any fifth house where there was no eligible woman or was not available, the house just next to that was chosen as a sample, and then the next fifth house was selected. If there was more than one eligible woman in a house, one was randomly selected using the lottery method for interviews. Data were collected by the first (RG- BPH Student) and third author (YR- BPH Student) themselves.

Data processing and analysis

The data were entered and analysed using SPSS version 20 software. The frequency and percentage of data were calculated in descriptive analysis. Pearson’s chi-square test was used to assess the statistically significant association of the independent and dependent variables. The variables that were significant at P value ≤ 0.25 were entered in multivariate analysis [28]. A P value < 0.05 was considered to indicate statistical significance.

Ethical considerations

Ethical approval for the study was obtained from the Institutional Review Committee (IRC) of Shree Medical & Technical College (SMTC), Bharatpur, Chitwan (SMTC-IRC-2020720-2). Written informed consent was obtained from the respondents before initiating the interview using an informed consent form. Voluntary participation of the respondents was ensured throughout the study. The information collected was kept confidential and was used for research purposes only.

Sociodemographic characteristics of the respondents

Nearly half of the respondents (47%) were aged 25–34 years, and 58% of the respondents were living in nuclear families. Approximately three-quarters (76%) of the respondents belonged to advantaged ethnic groups, and approximately 9 out of 10 were Hindus. The majority of the respondents (67%) and their husbands (75%) were educated at least to secondary and higher levels. The majority of women (59%) and their husbands (44%) were involved in agriculture and foreign employment, respectively. Two-thirds of the respondents had up to two children (Table 1).

Table 1

Sociodemographic characteristics of the respondents (n = 218)
Variables	Frequency	Percentage
Age of the respondent
≤24 years	51	23.4
25–34 years	102	46.8
35 years &above	65	29.8
Type of family Nuclear 127 58.3 Joint 91 41.7 Caste
Advantaged	166	76.1
Disadvantaged	52	23.9
Religion
Hindu	195	89.4
Non Hindu	23	10.6
Occupation of respondent
Housewife	59	27.1
Agriculture	128	58.7
Employed within country	31	14.2
Occupation of husband
Agriculture	59	27.1
Foreign employment	95	43.6
Employed within country	64	29.4
Education of respondent
No schooling	39	17.9
Primary education	32	14.7
Secondary &higher education	147	67.4
Education of husband
No schooling	13	6
Primary education	41	18.8
Secondary & higher education	164	75.2
No. of living children No child	19	8.7
Up to 2 children	143	65.6
3 & more children	56	25.7

Knowledge and practice of FP

Depo-Provera was the most commonly (91%) heard FP method. Most of the respondents had knowledge about FP methods from health posts (60%) and FCHV (34%). Approximately half of the respondents (51%) used the FP method. Among the current users, 84% were using modern methods, while the remaining (16%) were following traditional methods of FP. Nearly 37% of the users had permanent FP, including vasectomy (31.3%) and Minilap (5.4%). Among nonusers, approximately 62% of the respondents reported husbands being abroad as a major reason for not using any FP methods (Table 2).

Table 2

Knowledge and practice of FP (n = 218)
Variables	Frequency	Percentage
Heard method of FP*
Depo-Provera	199	91.3
Pills	190	87.2
Condom	162	74.3
Implant	128	58.7
Vasectomy	111	50.9
Minilap	111	50.9
IUCD	109	50
Withdrawal	21	9.6
Calendar method	17	7.8
Source of knowledge on FP*
Health post	131	60.1
Neighbors/Friends	81	37.2
FCHVs	73	33.5
Newspaper	36	16.5
Radio	22	10.1
Teachers	16	7.3
Television	15	6.9
Internet	8	3.7
Family member	3	1.4
Training	3	1.4
Current status of FP use
Yes	112	51.4
No	106	48.6
Currently used FP method
Vasectomy	35	31.3
Pills	23	20.5
Withdrawal	16	14.3
Depo-Provera	14	12.5
Condom	10	8.9
Mini lap	6	5.4
Implant	4	3.6
IUCD	2	1.8
Calendar method	2	1.8
*Reasons for not using FP method(#=106)**
Husband away	66	61.7
Breast feeding	16	15
Desire of child	11	10.3
Rare sex	10	9.3
Fear of side-effects	9	8.4
Poor health	3	2.8
*Multiple response

Husband involvement in FP

Approximately 84% of the respondents had discussed FP with their husbands. Of them, 60% had discussed three or more times. Approximately 91% of the respondents perceived that their husbands would approve of using contraceptive methods. The majority of the couples (87%) decided jointly regarding the use of the FP method (Table 3).

Table 3

Husband’s involvement in FP (n = 218)
Variables	Frequency	Percentage
Spousal discussion on FP
Never	36	16.5
Once or twice	52	23.9
Three or more times	130	59.6
Approval of husband
Approves	198	90.8
Disapproves	20	9.2
Decision maker on use of FP
By women herself	29	13.3
Husband and wife jointly	189	86.7

Relationship between Predictor Variables and Unmet Need for Family Planning

Among sociodemographic variables, husband’s occupation (p < 0.001) showed a strong association in Pearson’s Chi-square test with unmet need for FP. Furthermore, spousal discussion on FP (p = 0.025) and approval of husband (p = 0.034) were also significantly associated (Table 4).

Table 4

Association of predictor variables with unmet need for FP (n = 218)
Variables	Unmet need			P value*
	No f (%)		Yes f (%)
Age of respondent
≤ 24 years	30(58.8)		21(41.2)
25–34 years	61(59.8)		41(40.2)	0.517
35years &above	44(67.7)		21(32.3)
Religion
Hindu	121(62.1)		74(37.9)	0.921
Non-Hindu	14(60.9)		9(39.1)
Caste
Advantaged	101(60.8)		74(37.9)
Disadvantaged	34(65.4)		18(34.6)	0.556
Education of respondent
No schooling		28(71.8)	11(28.2)
Primary education		18(56.2)	14(43.8)	0.338
Secondary & higher education		89(60.5)	58(39.5)
Education of husband
No schooling		7(53.8)	6(46.2)
Primary education		25(61)	16(39)	0.807
Secondary & higher education		103(62.8)	61(37.2)
Occupation of respondent
Housewife	36(61)		23(39)
Agriculture	77(60.2)		51(39.8)	0.531
Employed within country	22(71)		9(29)
Occupation of husband
Agriculture	47(79.7)		12(20.3)
Foreign employment	38(40)		57(60)	< 0.001
Employed within country	50(78.1)		14(21.9)
Number of living children
No child	16(84.2)		3(15.8)
Up to 2 children	84(54.7)		59(41.3)	0.099
3 & more children	35(62.5)		21(37.5)
Wealth Index
Poorer	74(67.9)		35(32.1)	0.07
Better	61(56.6)		48(44)
Decision maker on FP
By women herself	16(55.2)		13(44.8)	0.421
Husband and wife jointly	119(63)		70(37)
Spousal discussion on FP
Never	16(44.4)		20(55.6)
Once or twice	30(57.7)		22(42.3)	0.025
More often	89(68.5)		41(31.5)
Approval of husband
Approves	127(64.1)		71(35.9)	0.034
Disapproves	8(40)		12(60)
*P value from Pearson chi-square test

Results of multivariate logistic regression analysis

Of the five variables included in multivariate logistic regression analysis, only three variables had a statistically significant association with unmet need for FP. The respondents whose husbands were involved in foreign employment were 4 times [aOR: 4.408; CI: 2.068–9.399] more likely to have unmet needs than those employed within the country. The couples who had no discussion on FP were 3 times [aOR: 3.212; CI: 1.368–8.135] more likely to have unmet needs than those who discussed three or more times. Similarly, women who had 3 or more children [aOR: 8.758; CI: 1.691–45.355] or up to 2 children [aOR: 5.212; CI: 1.163–23.363] were more likely to have unmet needs than women with no children (Table 5).

Table 5

Multivariate logistic regression analysis (n = 218)
Variables	Unadjusted OR (95% CI)		P value (Crude)	Adjusted OR (95% CI)	P- value (adjusted)
Occupation of husband
Agriculture	0.912(0.383–2.172)		0.835	0.640 (0.248–1.650)	0.355
Foreign employment	5.357(2.605–11.01)		0.00	4.408 (2.068–9.399)	< 0.001
Employed within country		1		1
Spousal discussion on FP
Never	2.713(1.276–5.769)		0.009	3.212(1.368–8.135)	0.014
Once or twice	1.592(0.820–3.089)		0.169	1.840(0.855–3.959)	0.119
Three or more times	1			1
Number of living children
No child	1			1
Up to 2 children	0.313(0.81–1.201)		0.090	5.212(1.163–23.363)	0.031
3 & more children	1.17(0.620–2.21)		0.627	8.758(1.691–45.355)	0.010
Wealth Index
Poorer	0.601(0.346–1.044)		0.71	0.610(0.318–1.171)	0.138
Better	1			1
Approval of husband
Approves	1			1
Disapproves	2.683(1.048–6.873)		0.040	2.257(0.732–6.964)	0.157

This study aimed to identify the factors associated with the unmet need for FP among MWRA. The prevalence of unmet need for FP was 38%, which is higher than the national figure (24%) [3]. The probable reasons for the higher unmet need in this study might be due to the study setting with easy access to abortion services [29] and a significant proportion of husbands being away from home. A consistent result (38%) was found in another study of Nepal [9]. The proportion was higher (49%) in a study conducted among women from disadvantaged caste/ethnicity [8]. Similarly, a higher proportion (48%) of women had unmet needs in a study of a rural hilly area of Nepal [11], whereas it was 31% in Debre Berhan Town, Amhara of Ethiopia [30].

Among several reasons for nonuse of contraceptives, the most common ones are fear of side effects and health concerns, husband and family opposition, perceived low risk of pregnancy due to breastfeeding/not menstruating after birth/infrequent sex, and inconvenience in using contraceptives [8, 10, 27, 31–35]. Limited knowledge of contraceptive methods and reproduction is one of the major reasons for nonuse of contraception [36].

The current study showed that the husband’s occupation, spousal discussion on FP, and number of living children are statistically associated with unmet need for FP. In this study, respondents whose husbands were involved in foreign employment were more likely [aOR: 4.408; CI: 2.068–9.399] to have an unmet need for FP than those employed within the country. In Nepal, at least one member of approximately one-third of households, with the majority of them husbands, migrates for employment. Among them, nearly 85% go to other countries[37]. Temporary work-related migration is increasing in Nepal. In the 2009 survey, 64% of spousal separation cases were for three or more months. Among these, 37% were in India and 54% were in other countries [38].

A qualitative study in rural areas of far western Nepal found almost every young male Dalit migrating to India yearly, most of them after crop harvesting and returning during the rice planting season[39]. Couples living separately also need to use contraceptives whenever husbands visit home[38]. A national-level survey of Nepal found that women whose husbands live away from home have a higher unmet need for FP, as they are less likely to use contraceptives than those living with husbands [40]. Consistently, a study from the Nepal Demographic and Health Survey 2016 showed that spousal separation was associated with a higher unmet need for contraceptive use (aOR: 8.00; p < 0.001) [41]. Less time to prepare about FP on the husband’s arrival and the communication gap between spouses might have influenced the lower use of contraceptives among migrants [42]. It is difficult for women to make decisions alone about using FP methods as well as accessing contraceptives. Furthermore, using contraceptives while husbands are away might be challenging to women due to fear of being considered unfaithful by the community and husband [42]. However, we were unable to assess the sexual activity of women in this study due to privacy reasons.

Furthermore, the findings of this study indicated a higher likelihood [aOR: 3.212; CI: 1.368–8.135] of having an unmet need for FP among couples who did not discuss using the FP method compared to those who discussed it three or more times. Likewise, a study found that spousal communication about FP increased contraceptive use in a rural area of Nepal [43]. Similarly, another study of Nepal also concluded that those who communicated with their spouse had a higher likelihood of making decisions jointly and using the FP method [20]. Consistent results were found in studies conducted in Botswana [25], Cameroon [27] and Ethiopia [44], and couples who discussed FP were more likely to have lower unmet needs.

Only a small proportion of women become involved in decision making with regard to reproductive preference [36, 45]. Husbands are usually the decision makers for the number of children and use of FP methods [36]. Males being decision-makers in most households are supposed to start discussion on FP[45]. Even discussion on FP is not perceived as important by many couples[45].

Similarly, the study showed that women with three or more children were more likely to have a higher unmet need for FP [aOR: 8.758; CI: 1.691–45.355] than women with no child. This is consistent with the findings of studies conducted in Nepal [9, 12], Ethiopia [46] and Burundi [47]. The unmet need for FP is greater among women with a higher number of living children[9, 35, 47]. Women do not use the FP method even after they find their family size complete[48]. Many women resort to induced abortion rather than using contraception mainly due to fear of side effects[48, 49]. Consistently, in Sub-Saharan Africa, women chose abortion as a method of limiting family size instead of using contraceptives, especially in places where abortion services were accessible [29].

Fear of side effects and health concerns among women is the major reason for not using contraceptives in Nepal and elsewhere [8, 10, 27, 35, 49]. Most of the nonusers reporting fear of side effects have already used contraceptives and discontinued them [31].

Strengths and limitations

The study has some strengths as well as limitations. It has underlined the factors associated with the unmet need for FP and the reasons behind not using FP methods. Data collection was performed by the first and third authors themselves using a pretested questionnaire prepared in the understandable Nepali language. With regard to limitations of the study, due to resource and time constraints, the study was limited to only one ward, and the findings may not be generalizable in all places of Nepal. However, the findings might reflect the situation of an unmet need for FP in other similar semiurban settings. Being a quantitative study, the information might be limited. Being a small-scale study, we could not explore whether the unmet need is for spacing or limiting. Similarly, we only relied on a small sample size in a ward of the municipality of semiurban areas. Furthermore, due to privacy reasons, we could not explore the sexual activities of migrants’ wives. Therefore, a more comprehensive study exploring more qualitative information is needed.

This study showed that there is a high prevalence of unmet need for FP among married women in the study area. Husbands involved in foreign employment, couples who did not discuss FP and those having three or more living children were more likely to have an unmet need for FP. FP programs should prioritize their focus on the needs of migrants and their wives by providing regular FP services and counselling them about FP choices. Promoting spousal discussion on FP, along with the empowerment of women to fully participate in decision making, is needed. Counselling and treating the side effects of contraceptives are necessary.

aOR	Adjusted odds ratio
CPR	Contraceptive prevalence rate
FCHV	Female community health volunteer
FP	Family Planning
IRC	Institutional review committee
IUCD	Intrauterine contraceptive device
MWRA	Married women of reproductive age

Acknowledgement

We would like to thank Shree Medical and Technical College as well as Madi Municipality for their support during the study period.

Availability of data and materials

All the data associated with this study will be available freely upon request with the corresponding author.

Authors’ Contributions

RG conceptualized the design of the study, prepared tools, collected and analysed data, interpreted results, and drafted the manuscript. RS contributed to the design of the study, development of tools, analysis and interpretation of data, review of literature and drafting of the manuscript. YB contributed to the data collection, data analysis, review of literature and drafting of the manuscript. DKM contributed to data analysis, review of literature and drafting of the manuscript. All authors have read and approved the final version of the manuscript. KT finalized the final manuscript, supervision of works, review of literature, data analysis, submission of the manuscript,

Data availability

Data will be available from the corresponding author on reasonable request.

Ethical approval and consent to participate

Ethical approval was obtained from the Shree Medical and Technical College-Institutional Review Committee. Written informed consent was obtained from each respondent before data collection. Confidentiality of the information and privacy were maintained.

Consent for publication

No individual details, images or video in form are included of the respondents.

Competing Interests

The authors declare that they have no competing interests.

Funding Statement

The study received no funding for research and publication.

Author Details

¹Shree Medical and Technical College, Bharatpur, Chitwan, Nepal. ²Nepal Public Health Foundation, Kathmandu, Nepal ³Birendra Multiple Campus, Bharatpur, Chitwan, Tribhuvan University, Nepal. ⁴Noble Shivapuri Research Institute, Budhanilkantha, Kathmandu, Nepal

Commission NP. Nepal’s Sustainable Development Goals, Baseline Report, 2017. Government of Nepal, National Planning Commission, Kathmandu, Nepal. URL: https://www.npc.gov.np/images/category/SDGs_Baseline_Report_final_29_June-1 (1). pdf (дата обращения: 10.10. 2018), 2017.
United, Nations. D.o.E.a.S.A., Population Division Family Planning and the 2030 Agenda for Sustainable Development: Data Booklet. 2019.
Ministry of Health, N.N.E.a.I. Nepal Demographic and Health Survey 2016. Ministry of Health, Nepal: Kathmandu, Nepal; 2017.
Mehata S, et al. Unmet need for family planning in Nepal during the first two years postpartum. BioMed research international; 2014.
Khatri RB, Poudel S, Ghimire PR. Factors associated with unsafe abortion practices in Nepal: Pooled analysis of the 2011 and 2016 Nepal Demographic and Health Surveys. PLoS ONE. 2019;14(10):e0223385.
DOHS. Annual Report 2017/18. 2018, Government of Nepal, Ministry of Health and Population, Department of Health Service Kathmandu, Nepal.
Sedgh G, Hussain R. Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Stud Fam Plann. 2014;45(2):151–69.
Bhusal CK, Bhattarai S. Factors affecting unmet need of family planning among married Tharu women of Dang District, Nepal. International journal of reproductive medicine; 2018.
Lamichhane K. Unmet Need for Family Planning among Currently Married Young Women in Nepal. J Dev Administrative Stud. 2017;25(1–2):83–94.
Paudel I, Budhathoki S. Unmet needs for family planning in Sunsari, eastern Nepal. Health Renaissance. 2011;9(3):148–51.
Kandel N. Unmet need for contraception and its associated factors among married women of reproductive age in Simichaur VDC of Gulmi District. Health Prospect: Journal of Public Health, 2012. 11: p. 11–14.
Bhandari G, et al. Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal. Kathmandu Univ Med J. 2006;4(2):203–10.
Bennett L, Dahal DR, Govindasamy P. Caste, ethnic, and regional identity in Nepal: further analysis of the 2006 Nepal Demographic and Health Survey. Population Division, Ministry of Health and Population, Government of Nepal; 2008.
Municipality M. Household Survey 2017. 2017.
Ministry of Health, N.N.E.a.I. Nepal Demographic Health Survey 2006. Ministry of Health, Nepa: Kathmandu, Nepal; 2007.
Yadav D, Dhillon P. Assessing the impact of family planning advice on unmet need and contraceptive use among currently married women in Uttar Pradesh, India. PLoS ONE, 2015. 10(3).
Mishra SR, Joshi MP, Khanal V. Family planning knowledge and practice among people living with HIV in Nepal. PLoS ONE, 2014. 9(2).
Vohra R, et al. Determinants of the unmet need for family planning among women of Jaipur, Rajasthan. Int J Adv Med Health Res. 2014;1(1):20.
Anthony OI, Joseph OU, Emmanuel NM. Prevalence and determinants of unmet need for family planning in Nnewi, south–east Nigeria. Int J Med Med Sci. 2009;1(8):325–9.
Sharan M, Valente TW. Spousal communication and family planning adoption: effects of a radio drama serial in Nepal. International Family Planning Perspectives; 2002. pp. 16–25.
Pokharel R, et al. Knowledge and utilization of family planning methods among people living with HIV in Kathmandu, Nepal. BMC Health Serv Res. 2018;18(1):836.
Hameed W et al. Women's empowerment and contraceptive use: the role of independent versus couples' decision-making, from a lower middle income country perspective. PLoS ONE, 2014. 9(8).
Paudel YR, Acharya K. Fertility limiting intention and contraceptive use among currently married men in Nepal: evidence from Nepal demographic and health survey 2016. BioMed research international; 2018.
Korra A. Attitudes toward family planning and reasons for nonuse among women with unmet need for family planning in Ethiopia. Citeseer; 2002.
Letamo G, Navaneetham K. Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study. BMJ open. 2015;5(3):e006603.
Oye-Adeniran BA, et al. Community-based study of contraceptive behaviour in Nigeria. Afr J Reprod Health. 2006;10(2):90–104.
Ajong AB, et al. Determinants of unmet need for family planning among women in Urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, Yaoundé. BMC Womens Health. 2015;16(1):4.
Bursac Z, et al. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17.
Lauro D. Abortion and contraceptive use in sub-Saharan Africa: how women plan their families. Afr J Reprod Health, 2011. 15(1).
Worku SA, Ahmed SM, Mulushewa TF. Unmet need for family planning and its associated factor among women of reproductive age in Debre Berhan Town, Amhara, Ethiopia. Volume 12. BMC research notes; 2019. p. 143. 1.
Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. Volume 2. New York: Guttmacher Institute; 2016. pp. 2015–6.
Cleland J, Harbison S, Shah IH. Unmet need for contraception: issues and challenges. Stud Fam Plann. 2014;45(2):105–22.
Genet E, Abeje G, Ejigu T. Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; a cross sectional study. Reproductive health. 2015;12(1):42.
Embafrash G, Mekonnen W. Level and correlates of unmet need of contraception among women in extended postpartum in Northern Ethiopia. International journal of reproductive medicine; 2019.
Wulifan JK, et al. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2015;16(1):2.
Najafi-Sharjabad F, et al. Barriers of modern contraceptive practices among Asian women: A mini literature review. Global J health Sci. 2013;5(5):181.
Thapa N, et al. Status of migration and socioreproductive impacts on migrants and their families left behind in Nepal. Migration and Development. 2019;8(3):394–417.
Ban B, et al. Spousal separation and interpretation of contraceptive use and unmet need in rural Nepal. Int Perspect Sex reproductive health. 2012;38(1):43–7.
Bam K, et al. Sexual behavior and condom use among seasonal Dalit migrant laborers to India from Far West, Nepal: a qualitative study. PLoS ONE. 2013;8(9):e74903.
New E. Family planning, maternal, newborn and child health situation in rural Nepal: A mid-term survey for NFHP II. 2010.
Mehata S, et al. Spousal Separation and Use of and Unmet Need for Contraception in Nepal: Results Based on a 2016 Survey. The Scientific World Journal; 2020.
Uprety S et al. Access to family planning services by migrant couples in Nepal–barriers and evidence gaps. 2016.
Link CF. Spousal communication and contraceptive use in rural Nepal: an event history analysis. Stud Fam Plann. 2011;42(2):83–92.
Biadgie A, et al. Prevalence and Associated Factors of Unmet Need for Family Planning among Married Women in Rural Communities of Gonji Kolela District, North West Ethiopia: Cross-sectional Study. J Community Med Health Educ. 2019;9(642):2161–0711.
Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health. 2013;13(1):1–13.
Duressa L, et al. Unmet need for family planning and related factors among currently married women in Sibu Sire district, 2016. J Women's Health Care. 2018;7(446):2167–0420.
Nzokirishaka A, Itua I. Determinants of unmet need for family planning among married women of reproductive age in Burundi: a cross-sectional study. Contracept reproductive Med. 2018;3(1):11.
Khanal V, et al. Practices and perceptions on contraception acceptance among clients availing safe abortion services in Nepal. Kathmandu Univ Med J. 2011;9(3):179–84.
Otoide VO, Oronsaye F, Okonofua FE. Why Nigerian adolescents seek abortion rather than contraception: evidence from focus-group discussions. International family planning perspectives; 2001. pp. 77–81.

No competing interests reported.

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Sociodemographic and Decision-Making Factors Associated with Unmet Family Planning Needs among Married Women in Madi Municipality, Chitwan, Nepal

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Abstract

Background

Methods

Results

Conclusion

Background

Methods

Study area

Study design and study participants

Sampling and sample size

Study variables

Independent variables

Operational Definition

Unmet need for FP

Data collection procedure

Data processing and analysis

Ethical considerations

Results

Sociodemographic characteristics of the respondents

Knowledge and practice of FP

Husband involvement in FP

Relationship between Predictor Variables and Unmet Need for Family Planning

Results of multivariate logistic regression analysis

Discussion

Strengths and limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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