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Hormonal Contraception in Nepal: A Necessary
Enquiry
Corresponding Author:
Dr. Brijesh Sathian,
Assistant Professor & Managing and Chief Editor NJE, Community Medicine, Manipal College of Medical
Sciences, Department of Community Medicine, Manipal College of Medical Sciences, 155 - Nepal
Submitting Author:
Dr. Brijesh Sathian,
Assistant Professor & Managing and Chief Editor NJE, Community Medicine, Manipal College of Medical
Sciences, Department of Community Medicine, Manipal College of Medical Sciences, 155 - Nepal
Article ID: WMC003460
Article Type: Review articles
Submitted on:07-Jun-2012, 06:56:14 PM GMT Published on: 08-Jun-2012, 02:14:39 PM GMT
Article URL:
Subject Categories:OBSTETRICS AND GYNAECOLOGY
Keywords:Hormonal Contraception, Awareness, Nepal
How to cite the article:Sathian B , Sreedharan J, Chandrasekharan N, Mittal A, Banerjee I. Hormonal
Contraception in Nepal: A Necessary Enquiry . WebmedCentral OBSTETRICS AND GYNAECOLOGY
2012;3(6):WMC003460
Copyright: This is an open-access article distributed under the terms of the , which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
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Downloaded from http://www.webmedcentral.com on 08-Jun-2012, 02:14:39 PM Hormonal Contraception in Nepal: A Necessary
Enquiry
Author(s): Sathian B , Sreedharan J, Chandrasekharan N, Mittal A, Banerjee I
expected, a high proportion of respondents in rural areas, nine in ten employed women and six in ten employed men, are engaged in agricultural work.
Overall, 90 percent of pregnancies result in a live birth In recent years, Americans have begun to use Depo and 10 percent end as non-live births. Women are only through prescription. Women's organizations and more likely to report abortions as spontaneous (5 pro-feminist groups have developed a positive attitude percent) than they are to report them as induced (2 towards its use in recent years. They regard Depo as percent). Two percent of births are reported as one of the more convenient contraceptive methods; in stillbirths. There is some variation in pregnancy contrast, oral contraceptive pills are highly used in outcomes across age groups and non live births America. There is a need of study intends to explore generally increasing with age. Childbearing begins the socioeconomic status, uses of female hormonal early in Nepal. The median age at first birth is 19.6 contraceptives and adverse health effects (including years for the younger cohort (ages 25-29) of women warnings and side effects) of hormone among female.
for whom a median age can be computed and varies Similarly, norplant and pills are in worldwide use, between 19.9 and 20.1 years among the older cohorts.
which have several health effects but to the best Almost one-quarter of Nepalese women have given knowledge of the researcher, has not been studied in birth before reaching age 18, while over half have had Nepal. So, there is an urgent need of a study focusing a birth by age 20. The median age at first birth is about mainly on the rising warning effects and side effects 20 years across all age cohorts, indicating virtually no due to hormones used by female, in relation to health change in the age at first birth. Half of the women have given birth by age 20 and almost 90 percent have given birth by age 25 [1]. Health effects of contraceptives found to be less in Nepal. Bhattrai et al reported that irregular menstrual cycle 54.68 percent, weakness 25.18 percent, headache 8.63 percent and In Nepal, studies have shown that education is one of remaining 9.11 were other effects in the use of overall the major socioeconomic factors that influence a female hormonal contraceptive in Jhojhikatiya of person’s behaviour and attitudes. In general, the Dhanusa district [2]. The major factor about higher the level of education of a woman, the more discontinuation of Depo appears to be the side effects.
knowledgeable she is about the use of health facilities, Majority of acceptors of Depo discontinue it because family planning methods, and the health of her of side effects immediately after taking the first dose children [1]. More than one in two women between the [3]. Female sterilization and injectable contraceptives ages of 15-49 have never been to school (nearly are the most popular methods among all women who 53%), 12 percent have only some primary education, 5 have less than an SLC level of education. In general, percent have completed primary, 21 percent have only as women’s level of education increases they are some secondary education, and less than 10 percent more likely to use modern spacing methods, especially have completed secondary or higher level of education.
condoms. There is a direct association between use of The level of education and economic status are modern family planning methods and the number of directly associated with exposure to the specific health children women have, except among women with five programs. Respondents who are highly educated and or more children. Only 7 percent of women with no come from wealthier households are more likely to living children use modern contraception; the have heard or seen these programs [1]. The percentage increases to 60 percent among women relationship between occupation and age is mixed.
with three to four children and falls to 46 percent One notable finding is the relatively high percentage of among women with five or more children [1]. Trends in women (10 percent) between the ages of 25 to 29, current use of family planning can be used to monitor employed in sales and services, and men (10 percent) the success of family planning programs over time.
of ages 25-29 engaged in professional, technical and The trend in modern contraceptive use among managerial occupations. Place of residence has a currently married women from 1996 to 2006, data from significant effect on the type of occupation. As WebmedCentral > Review articles Page 2 of 5
Downloaded from http://www.webmedcentral.com on 08-Jun-2012, 02:14:39 PM three DHS surveys conducted in Nepal over the last is found highly used in the national health report as decade show an impressive increase in the use of between 70-73 percent in all three years 2005/06, modern contraceptives. Comparison of the data from 2006/07 and 2007/08. The highest percent of depo the DHS surveys in Nepal over the last ten years used is also proved by NDHS 2006 of Nepal which is shows that current use of modern contraception has found 66.9 percent. Likewise, family planning pills increased from 26 percent in 1996 to 44 percent in ranks second, in those years pills user were around 25 2006, a 70 percent increase over the decade. The percent. In this period, Norplant user ranked third, increase in the use of modern contraceptive methods which was nearly 4 percent in every year. The Nepal is mainly due to increased use of female sterilization, government has developed the clinical protocol for the pill, condoms, and injectables. Use of injectables reproductive health which mentions the warning signs more than doubled while use of female sterilization and side effects of different female family planning increased by 49 percent over the last ten years [1]. In used in modern hormonal contraceptive methods. At terms of specific modern family planning methods, the present female hormonal methods are available percentage of current use accounted for by female worldwide. In Nepal, injectable hormones, oral pills and male sterilization together has declined over the hormone and implant hormones are in practice. So far, last decade. The share of female sterilization a study has not yet been done about those effects decreased from 47 percent of modern methods in among women who have been using such hormonal 1996 to 41 percent in 2006, while the share of male contraceptive from the government service in Pokhara sterilization declined from 21 percent to 14 percent city. All health facilities of government including over the same period. On the other hand, the share of several NGOs and medical shops are providing such temporary methods rose from 33 percent to 45 percent female contraceptive methods, with or without over the same period, an indication that more women prescriptions. The most widely known method of are using contraception to space rather than limit modern contraceptive usage among currently married births. Twelve percent of all women first used a women are injectables 99 percent, contraceptive pill is method of family planning when they had four or more known by 95 percent and 84 percent married women children. Only 6 percent of all women first used at the know of implants. 31 percent of married women time they had no children, and 14 percent first used currently would prefer to use injectables [1]. In recent after the birth of their first child. An understanding of years, Americans have begun to use Depo only the reasons women give for not using family planning through prescription. Women's organizations and methods is critical to designing programs that could pro-feminist groups have developed a positive attitude improve the quality of services. Nearly two-thirds of towards its use in recent years. They regard Depo as women do not intend to use contraception in the future one of the more convenient contraceptive methods; in because of fertility-related reasons. Most of these contrast, oral contraceptive pills are highly used in women (38 percent) report themselves to be America. There is a need of study intends to explore subfecund or infecund. Twelve percent of women do the socioeconomic status, uses of female hormonal not intend to use because of opposition to use, with contraceptives and adverse health effects (including most of them citing religious opposition as a reason for warnings and side effects) of hormone among female.
Similarly, norplant and pills are in worldwide use, method-related reasons for non-use, the most which have several health effects but to the best important of these being fear of side effects (10 knowledge of the researcher, has not been studied in percent). Women age 15-29 are most likely to cite Nepal. So, there is an urgent need of a scientifically opposition to use (57 percent), with religious designed study focusing mainly on the rising warning opposition being the primary reason (44 percent).
effects and side effects due to hormones used by Nineteen percent of young women also mentioned female, in relation to health effects[4-7]. What would method-related reasons; primarily fear of side effects be the level of use and the health effects of those (13 percent), as major reason for non-use in the future.
contraceptives in Pokhara city? Such studies with a On the other hand, 72 percent of women age 30-49 larger sample size to represent the population so far cited fertility-related reasons for non-use in the future, known have not been done in this regard. The study with 42 percent reporting themselves as subfecund or infecund. Eighteen percent of women in this age group 1. What are the demographic characteristics of the also cited method-related reasons and a fear of side effects (10 percent), as a major reason for non-use in future [1]. There are different methods of modern 2. What is the occupation of the women using those female temporary hormonal contraception. Here Depo WebmedCentral > Review articles Page 3 of 5
Downloaded from http://www.webmedcentral.com on 08-Jun-2012, 02:14:39 PM 3. What is the education level of the women who are Determination in Medical Research. Nepal Journal of 4. What is the income level of her family using the 5. What is the health effect of those women who are using the modern method of female temporary family Couples of fertile age in those days are in search of family planning contraceptives. It increases as the rate of literacy goes up. Males have only one method of temporary method, they have no options but women contraceptive methods. In Nepal, four female modern contraceptive methods are being used, and they are included in the regular health service and are provided free of cost in government organizations. It is already mentioned that those methods are not free of adverse health effects. The usage patterns and any adverse health effects arising from the usage of these common contraceptive methods must be studied on a wider scale and scope in Nepal for any effective 1. Ministry of Health and Population. Nepal Demographic Health Survey (NDHS). Kathmandu.
2. Bhattrai A. Assessment of Adoptation Problems of Family Planning Means Central Library. Tribhuvan University. Nepal- unpublished. 2001.
3. Karki & Kunwar. An Analysis of Continuation Rate, A study of Dep-provera Acceptor at Bhaktapu,r Clinic, Central Library. Tribhuvan University Kirtipur. Nepal- 4. Sathian B. Methodological Rigors in Medical Journals from Developing Countries: An Appraisal of the Scenario in Asia. Nepal Journal of Epidemiology 5 . S a t h i a n B , S r e e d h a r a n J , M i t t a l A , Chandrasekharan N, Baboo NS, Abhilash ES, et.al.
Case Control Studies in Medical Research. Nepal Journal of Epidemiology 2011;1(3): 77-8.
6. Sathian B. Reporting dichotomous data using Logistic Regression in Medical Research: The scenario in developing countries. Nepal Journal of 7. Sathian B, Sreedharan J, Baboo NS, Sharan K, Abhilash E S, Rajesh E. Relevance of Sample Size WebmedCentral > Review articles Page 4 of 5
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