Barriers to Family Planning Use in Eastern Nepal: Results from a Mixed Methods Study 2016
Demographic and Health Survey, Special [hh/dhs-sp]
This study, which took place in Eastern Nepal, was a follow-up to the 2016 Nepal Demographic and Health Survey (NDHS). The follow-up study reinterviewed a sample of married female NDHS respondents age 15-39 in 17 clusters of Province 1, typically within a week following their NDHS interview. It included a range of in-depth questions about family planning use, fertility preferences, and perceived barriers to family planning.
The study was funded, planned, and fielded independently from the main survey, but it selected respondents from among those already interviewed by the main survey. In this way respondents could be selected based on characteristics of interest to the follow-up study. Interviews could be conducted quickly because the NDHS had already gathered a great deal of background information. Repeated questions were asked, both to set up the skip sequence for additional probes, and to provide information on alignment between responses to the NDHS and the follow-up study.
The study was designed in advance of the 2016 NDHS and reinterviewed a selected number of respondents to examine barriers to family planning use among married women in Eastern Nepal. The study in particular focuses on some of the unique contraceptive challenges faced by married women with migrant husbands. Non-use of family planning during a husband’s extended absence may be a strategy to avoid side effects of modern methods, or may even be encouraged as evidence of the wife’s faithfulness, but it can put women at risk of unwanted pregnancies when their husbands return. The study also probes in depth a number of other potential barriers to family planning use, including fear of side effects, attitudes toward family planning, access, cost, and the influence of husbands, family members, and religion. Data produced by the study also provide evidence about the consistency of responses to relevant NDHS questions. Current family planning users were included in the study as a reference group.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Woman age 15-39
The 2016 Eastern Nepal Results from a Mixed Methods Study covered the following topics:
• Respondent's background
• Family planning use
• Postpartum family planning
• Marriage and husband's residence
• Fertility preferences, pregnancy risk
• Emergency contraception and post-abortion family planning
• Family planning satisfaction and non-use/barriers
The study covered Eastern Nepal.
Producers and sponsors
Ministry of Health (MOH)
Government of Nepal
Government of Nepal
Funded the study
United States Agency for International Development
Funded the study
This study was designed as a mixed methods follow-up study to the 2016 Nepal Demographic and Health Survey (NDHS). The 2016 NDHS is a nationally representative survey of 12,862 women age 15-49 and 4,063 men age 15-49 residing in 11,040 interviewed households.
Out of 44 eligible clusters in the Terai and Hill areas of Province 1 (most of the former Eastern Region), 17 were ultimately selected for the follow-up study. These clusters were chosen based primarily on timing of the NDHS fieldwork in the area, with a desire for geographic diversity and urban-rural representativeness within each altitudinal belt balanced against logistical practicality: during the monsoon season, roads changed quickly and a cluster that DHS had just completed was not always accessible for follow-up.
Initially, a total of 10 urban and 7 rural clusters were sampled; 11 clusters were in the Terai and 6 were in the Hill region. This produced a cluster composition that was largely consistent with the overall composition of eligible clusters in the region, although slightly more representative of urban and Terai areas. Importantly, during NDHS fieldwork, some rural clusters in Nepal were officially reclassified as urban. This classification affected three of the rural clusters selected for this study, which are now considered urban under the new designation. As a result, 13 of the 17 selected study clusters are classified as urban, which is similar to the revised cluster composition of the 44 eligible clusters.
Response rate was 194 of 215, or 90.2%.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The study design used computer-assisted personal interviewing (CAPI) in both the NDHS and the followup. Because the NDHS used CAPI, it was possible for the program to determine which women were eligible for follow-up immediately after the cluster was closed and securely transfer relevant data from the NDHS to computer tablets for the follow-up study.
A single field team of three female interviewers conducted the entire follow-up study over the course of 3 months. The follow-up interviewers met with the NDHS team to receive maps and guidance on household numbering and to transfer selected DHS data entry from eligible respondents. Follow-up interviewers or a supervisor typically met the NDHS teams while in the field to walk the cluster and view the household map, and then returned to the cluster immediately after the NDHS team completed to receive preliminary data about selected respondents via Bluetooth. In three clusters the follow-up team was not able to meet the NDHS team prior to their departure, and data from the NDHS were transmitted remotely to the follow-up interviewers via the Internet File Streaming System (IFSS) system.
Interviews were conducted using a CAPI program implemented in Windows tablet computers. The CAPI program used exported NDHS data to enable interviewers to relocate respondents and reconfirm their identity through repeated questions about background characteristics. Upon respondents’ consent, interviewers also used an audio recorder to capture responses to open-ended questions. The study benefited from a multi-modal design: responses to closed-ended questions could be used to confirm consistency with NDHS and to provide supplemental information about barriers to family planning, while responses to openended questions could shed light on the intended meaning behind those responses.
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