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Papers by Dirgha Raj Shrestha
DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2012
Family planning is a priority program of the Government of Nepal. Despite political instability i... more Family planning is a priority program of the Government of Nepal. Despite political instability in the last two decades, Nepal has achieved remarkable progress in the overall status of reproductive health, including family planning. Married women of reproductive age have been increasingly using contraceptive from 1980s to2006. However, Nepal Demographic Health Survey 2011 has shown unexpected results on contraceptive prevalence rate. There had been a notable decline in the prevalence rate between 2006 and 2011, creating concerns among various stakeholders working in family planning programs. This paper analyzes this situation and identifies possible reasons for the stagnated contraceptive prevalence rate in Nepal. High proportion of spousal separation, an increased use of traditional methods, abortion, emergency contraception, and a lack of innovative approaches to cater services to difficult-to-reach or special subgroups are possible reasons. To improve the contraceptive prevalence, the family planning program should be implemented more strategically. Further data analysis, initiation of best practices to fulfill family planning needs of special groups, functional integration of family planning services into general health services, effective counseling and behavior change communication to prevent unwanted pregnancies, and increased access to modern family planning methods could be the stepping stones to improve contraceptive prevalence rate and the overall FP program in Nepal.
Journal of Nepal Health Research Council, Mar 18, 2018
Unsafe abortion is affecting a lot, in health, socioeconomic and health care cost of many countri... more Unsafe abortion is affecting a lot, in health, socioeconomic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approach. The existence of abortion stigma and the shifting of the government structure from unitary system to federalism in absence of a complete clarity on how the safe abortion service gets integrated into the local government structure might create challenge to sustain existing developments. There is, therefore, a need for all stakeholders to make a lot of efforts and allocate adequate resources to sustain current achievements and ensure improvements in creating a supportive social environment for women and girls so that they will be able to make informed decisions and access to safe abortion service in any circumstances.
Journal of Nepal Health Research Council, Jan 21, 2021
Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents ... more Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Contraceptives can prevent early pregnancy and its consequences. However, there is a low use of contraceptives among adolescents. Global evidence has shown which programmatic approaches are effective to increase the use of contraceptives among adolescents. Methods: This is not a systematic review. Desk review was done using Google Scholar and PubMed. Different policies, strategies, and reports published by agencies were also reviewed. Results: There is a low use of contraceptives and high unmet need for family planning and high adolescent fertility rate. Various studies conducted in different parts of the world have shown that there are some programmatic approaches implemented which are effective to improve the contraceptives use among adolescents. We have categorized the findings into three parts; i) delivery of services ii) increasing demand for services, and iii) creating an enabling environment. Conclusions: The use of contraceptives is low among adolescents in low- and middle-income countries including Nepal. So, the current programmatic approaches should be reviewed and the evidence-based practices implemented to bring better results. Ministry of Health and Population and partner agencies in Nepal also need to review the current programmatic approaches and implement them based on the evidence-based practices to improve contraceptives use among adolescents.Keywords: adolescents; contraceptive; evidence-based
A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong D... more A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong District, Chon Buri Province eastern Thailand with the aim to determine factors affecting health center utilization. A cross-sectional survey was conducted on 206 randomly selected households in which household head or senior person in each household was interviewed using a structured questionnaire. The study household was classified as either high or low health center utilization group on the basis of using health services more than 50% of total health services needed in each household. The results revealed that age group, sex, education, family size, and distance from household to health center were not associated with the utilization of health center, whereas occupation, economic status, knowledge and attitude towards health center and quality as well as convenience of health services were found to be associated with health center utilization. It was seemed that underutilization of health centers was multifactorial, in which some factors were related with the personality of individual whereas others were concerned with the health center itself.
Journal of Nepal Health Research Council, 2021
Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents ... more Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Contraceptives can prevent early pregnancy and its consequences. However, there is a low use of contraceptives among adolescents. Global evidence has shown which programmatic approaches are effective to increase the use of contraceptives among adolescents. Methods: This is not a systematic review. Desk review was done using Google Scholar and PubMed. Different policies, strategies, and reports published by agencies were also reviewed. Results: There is a low use of contraceptives and high unmet need for family planning and high adolescent fertility rate. Various studies conducted in different parts of the world have shown that there are some programmatic approaches implemented which are effective to improve the contraceptives use among adolescents. We have categorized the findings into three parts; i) delivery of ser...
Journal of Nepal Health Research Council, 2018
Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countr... more Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approa...
Journal of Midwifery & Women's Health, 2016
The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. ... more The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods: This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11). Results: By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion: The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion.
This report presents findings from a further analysis study undertaken as part of the follow-up t... more This report presents findings from a further analysis study undertaken as part of the follow-up to the 2011 Nepal Demographic and Health Survey (NDHS). Funding for the further analysis of the survey was provided by the United States Agency for International Development (USAID), the United Kingdom's Department for International Development (DFID) and the United Nations Population Fund (UNFPA). ICF International provided technical assistance for the survey and further analysis, and New ERA provided in-country coordination and technical assistance through the MEASURE DHS program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the US government or other funding agencies.
DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2012
Family planning is a priority program of the Government of Nepal. Despite political instability i... more Family planning is a priority program of the Government of Nepal. Despite political instability in the last two decades, Nepal has achieved remarkable progress in the overall status of reproductive health, including family planning. Married women of reproductive age have been increasingly using contraceptive from 1980s to2006. However, Nepal Demographic Health Survey 2011 has shown unexpected results on contraceptive prevalence rate. There had been a notable decline in the prevalence rate between 2006 and 2011, creating concerns among various stakeholders working in family planning programs. This paper analyzes this situation and identifies possible reasons for the stagnated contraceptive prevalence rate in Nepal. High proportion of spousal separation, an increased use of traditional methods, abortion, emergency contraception, and a lack of innovative approaches to cater services to difficult-to-reach or special subgroups are possible reasons. To improve the contraceptive prevalence, the family planning program should be implemented more strategically. Further data analysis, initiation of best practices to fulfill family planning needs of special groups, functional integration of family planning services into general health services, effective counseling and behavior change communication to prevent unwanted pregnancies, and increased access to modern family planning methods could be the stepping stones to improve contraceptive prevalence rate and the overall FP program in Nepal.
Journal of Nepal Health Research Council, Mar 18, 2018
Unsafe abortion is affecting a lot, in health, socioeconomic and health care cost of many countri... more Unsafe abortion is affecting a lot, in health, socioeconomic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approach. The existence of abortion stigma and the shifting of the government structure from unitary system to federalism in absence of a complete clarity on how the safe abortion service gets integrated into the local government structure might create challenge to sustain existing developments. There is, therefore, a need for all stakeholders to make a lot of efforts and allocate adequate resources to sustain current achievements and ensure improvements in creating a supportive social environment for women and girls so that they will be able to make informed decisions and access to safe abortion service in any circumstances.
Journal of Nepal Health Research Council, Jan 21, 2021
Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents ... more Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Contraceptives can prevent early pregnancy and its consequences. However, there is a low use of contraceptives among adolescents. Global evidence has shown which programmatic approaches are effective to increase the use of contraceptives among adolescents. Methods: This is not a systematic review. Desk review was done using Google Scholar and PubMed. Different policies, strategies, and reports published by agencies were also reviewed. Results: There is a low use of contraceptives and high unmet need for family planning and high adolescent fertility rate. Various studies conducted in different parts of the world have shown that there are some programmatic approaches implemented which are effective to improve the contraceptives use among adolescents. We have categorized the findings into three parts; i) delivery of services ii) increasing demand for services, and iii) creating an enabling environment. Conclusions: The use of contraceptives is low among adolescents in low- and middle-income countries including Nepal. So, the current programmatic approaches should be reviewed and the evidence-based practices implemented to bring better results. Ministry of Health and Population and partner agencies in Nepal also need to review the current programmatic approaches and implement them based on the evidence-based practices to improve contraceptives use among adolescents.Keywords: adolescents; contraceptive; evidence-based
A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong D... more A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong District, Chon Buri Province eastern Thailand with the aim to determine factors affecting health center utilization. A cross-sectional survey was conducted on 206 randomly selected households in which household head or senior person in each household was interviewed using a structured questionnaire. The study household was classified as either high or low health center utilization group on the basis of using health services more than 50% of total health services needed in each household. The results revealed that age group, sex, education, family size, and distance from household to health center were not associated with the utilization of health center, whereas occupation, economic status, knowledge and attitude towards health center and quality as well as convenience of health services were found to be associated with health center utilization. It was seemed that underutilization of health centers was multifactorial, in which some factors were related with the personality of individual whereas others were concerned with the health center itself.
Journal of Nepal Health Research Council, 2021
Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents ... more Background: Adolescent pregnancy is a global health problem. Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Contraceptives can prevent early pregnancy and its consequences. However, there is a low use of contraceptives among adolescents. Global evidence has shown which programmatic approaches are effective to increase the use of contraceptives among adolescents. Methods: This is not a systematic review. Desk review was done using Google Scholar and PubMed. Different policies, strategies, and reports published by agencies were also reviewed. Results: There is a low use of contraceptives and high unmet need for family planning and high adolescent fertility rate. Various studies conducted in different parts of the world have shown that there are some programmatic approaches implemented which are effective to improve the contraceptives use among adolescents. We have categorized the findings into three parts; i) delivery of ser...
Journal of Nepal Health Research Council, 2018
Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countr... more Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approa...
Journal of Midwifery & Women's Health, 2016
The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. ... more The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods: This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11). Results: By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion: The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion.
This report presents findings from a further analysis study undertaken as part of the follow-up t... more This report presents findings from a further analysis study undertaken as part of the follow-up to the 2011 Nepal Demographic and Health Survey (NDHS). Funding for the further analysis of the survey was provided by the United States Agency for International Development (USAID), the United Kingdom's Department for International Development (DFID) and the United Nations Population Fund (UNFPA). ICF International provided technical assistance for the survey and further analysis, and New ERA provided in-country coordination and technical assistance through the MEASURE DHS program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the US government or other funding agencies.