Nepal’s health sector is at a critical juncture with public health infrastructures on the verge of running out of contraceptive tools that give women the right to make reproductive choices. This picture is alarming as it can lead to unintended pregnancies, unsafe abortions and an increase in maternal and child mortality. Unfortunately, the country is already failing its maternal health commitments, with 151 women dying in every 100,000 live births, according to a 2021 report on maternal mortality by the National Statistics Office. The scarcity of contraceptives would be a major setback for a country with decades of well-targeted investments in maternal health, if timely intervention is not made.

While family planning is the government’s priority programme, and it has committed to investing in and strengthening related policies, the promises are limited to paper, as evidenced by a recent 40 percent health budget cut. The budget for family planning and reproductive rights, which was Rs120 million last fiscal year, has shrunk to Rs80 million this fiscal year, which is nearly insufficient to meet the growing demand for family planning services. In addition, awareness campaigns, training and orientation of health workers on family planning have declined owing to budget cuts. This in a country where the unmet need (not using any method of contraception) for family planning is 21 percent among married women aged 15-49, with the highest percentage (31 percent) among young women aged 15-19. There is also lack of knowledge among women and men on the proper use of contraceptives, including standard days method and emergency contraception. Such lack of awareness may exacerbate the problem of unwanted pregnancies, putting the lives of more women in danger. Nepal’s Demographic and Health Survey highlights the public sector as the most common source of modern contraceptives. This makes it necessary for the government to make quality contraceptives affordable and accessible at public health centres and collaborate with the private sector and international organisations in times of crisis.

Various studies show that women with decision-making power and who are exposed to media awareness programmes are more inclined to use contraceptives than women who do not have such opportunities. Moreover, health officials and family planning tool providers should inform the potential users of contraceptives about possible side effects, which could help people deal with the effects and avoid discontinuation of contraceptives. Further, comprehensive sexuality education and awareness in schools could help young women to make the right choice. We must also realise that using contraception is not only a woman’s responsibility, and encourage more men to adopt them.

Over two decades, Nepal reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 in 2016. For this, the country even received a Millennium Development Goals award. However, given the shortage of birth control methods, Nepal’s commitment to ensuring reproduction rights for women and the government’s target of increasing contraceptive prevalence from the current 57 percent to 75 percent by 2030 could be challenged. The government’s apathy to providing quality health services puts the achievements thus far at risk. Safer reproductive choices can help young women return to schools, engage in economic activities, continue their careers and live with dignity. It goes without saying that the government should provide reproductive rights to all women, regardless of the cost.