Contraceptive Education for Reproductive-Age Women in Kathmandu, Nepal

Background: In Nepal, there is an unmet need for family planning. The unintended pregnancy rate remains high despite numerous strategies by the government to improve the use of contraception. Unintended pregnancy can negatively affect a woman's health and, in Nepal, may increase a woman's risk of unsafe abortions. Unintended pregnancies often result from a lack of contraceptive use or failure to use it correctly. Women in Nepal are generally unaware of their contraceptive choices and lack knowledge about reproductive health and family planning. The use of contraceptives is also influenced by social taboos, misconceptions, and myths.Purpose: The purpose of this quality improvement project was to deliver a community-based health education program aimed to improve Nepali women's knowledge of reproductive health and contraception. Women's intention to use a family planning method was addressed through a culturally sensitive teaching session that focused on barriers and knowledge gaps. Methods: Thirty Nepali women of reproductive age received a 60-minute group education session by a native speaker. Through discussion, lecture, and pictures, women received information on reproductive health and the use and efficacy of available contraceptive methods. This project was a mixed method of study with qualitative and quantitative data. Before the educational session, participants' baseline knowledge was assessed using 17 selected questions from the Contraceptive Knowledge Assessment (CKA) tool. Following the session, participants completed a matched questionnaire to measure a change in knowledge, attitudes, and intent to use a contraceptive method. Results: Analysis of pre and post questions was calculated using the McNemar test for directional change in scores on paired questions. Participant data showed significant change (P < 0.05) in overall contraceptive knowledge with the most significant changes (P < 0.0001) on questions about condom use, the possibility of pregnancy after stopping birth control pills, instruction on missing a pill, and location of implant placement. The two most common barriers to contraception, identified by the participants, were cost (20%) and side-effects (20%) followed by access and availability (17%). In addition, 53% of the participants reported that their birth control options were not discussed by their Health Care Provider (HCP). At the end of the session, 87% of the participants reported learning something valuable about contraceptives, and 100% of the participants indicated that they were more likely to use a contraceptive method. Implications: This project demonstrated that a culturally sensitive educational session might improve women's contraceptive and reproductive health knowledge and intention to use a contraceptive method. If women's improved knowledge and use of contraceptives are sustained, there is hope for enhanced women's health and a decreased rate of unintended pregnancies for this community. Contraceptive prevalence may also be influenced by other factors in Nepal, such as lack of counseling by HCP. Future studies should aim to explore the quality of family planning counseling and service delivery by health care providers in Nepal. Exploring sources of misconception and cultural values would also enlighten further efforts to promote contraception for this community.