Health facilities nationwide could soon run out of contraceptives such as condoms, pills, implants and emergency pills as the Ministry of Health and Population lacks funds to procure them.

Officials blamed the reduction in the health budget as the main reason for their inability to purchase essential contraceptives to be distributed from health care facilities. A possible shortage of the items will eventually cause multiple problems including a rise in unwanted pregnancies, unsafe abortions and maternal deaths.

“This year we borrowed 50,000 implants from the United Nations Population Fund (UNFPA). They have already been used,” said Kabita Aryal, chief at the Family Planning and Reproductive Health Section of the Family Welfare Division under the Department of Health Services. “Due to the reduction in the budget allocated by the government, we could not purchase contraceptives on time.”

Several other programmes including awareness campaigns and training and orientation of health workers have also been affected by the budgetary cut, according to officials.

“Health care facilities should maintain a stock of the commodities for at least 20 months to ensure their smooth supply,” said Aryal. “But currently, the stock has dwindled to 10 months, which means health facilities could run out of stock at any time and those in need may not get the services.”

The Health Ministry needs around 120,000 birth-control implants every year for free distribution from state-run health facilities. The purchase of such commodities declined in the previous years as well, as the government diverted the budget to procure Covid-19 vaccines.

Officials say aid agencies, which used to provide such commodities as demanded by the government, have introduced a co-financing model, which means the government too has to pay for the commodities now.

Officials at the ministry said that around 40 percent of the total budget for healthcare was slashed this year. The budget for family planning and reproductive health has been reduced to Rs80 million from Rs120 million in the past.

Experts warn that multiple effects of the shortage of contraceptives at healthcare facilities could include a rise in unwanted pregnancies and maternal and child death rates, which have improved over the years after making huge investments in the programmes.

Nepal had reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 in 2016— for which the country even received a Millennium Development Goals award.

A report on maternal mortality carried out by the National Statistics Office in 2021 showed that in every 100,000 live births, 151 women died from maternity-related complications.

“Contraceptive prevalence rate [the percentage of couples using contraceptives] will decline if people do not get commodities at health facilities and this will have multiple effects,” said Dr Naresh Pratap KC, head of the Family Planning Association of Nepal. “Unwanted pregnancies, unsafe abortion, and maternal and infant mortality will rise and people may stop seeking contraceptives if they don’t get them when sought.”

The modern contraceptive prevalence rate has increased from 26 percent in 1996 to 43 percent in 2016. Similarly, the unmet need for family planning [women who want to avoid pregnancy but aren’t using contraceptives] decreased from 32 percent to 24 percent, which has been constant for the last several years. Experts say lack of such commodities will further increase unmet needs.

Studies show that nearly half of the pregnancies in Nepal still are unintended and close to two-thirds of them end in abortions.

The UNFPA’s “State of World Population 2022” report titled, “Seeing the Unseen”, says half of the 1.2 million pregnancies in 2017 in Nepal were unintended and nearly 359,000 were aborted.

“Unintended pregnancy is a reality for millions each year, accounting for nearly half of all pregnancies,” said the UNFPA’s report. “Sixty percent of these unintended pregnancies will end in abortion.”

The UN agency’s report stated that the toll of these pregnancies is—and has for long been—unseen.

“Though we can estimate healthcare costs, monitor school dropout rates and project levels of workforce attrition due to unintended pregnancies, these only scratch the surface. No number could adequately represent the loss of life, agency and human capital that results from unintended pregnancies,” the report added.

Unintended pregnancy is often, tragically, linked to violence. The report shows how unintended pregnancies result in additional social and fiscal burdens, including through greater demand for healthcare, unsafe abortion, loss of income and productivity, fewer resources for children in a family, and more fraught and unstable family relationships.

Every year, around 100,000 women undergo abortions in Nepal at legally authorised clinics and health facilities. Gynaecologists, however, say the actual number of abortions could be several times more than the government figure, as all abortions do not get reported, especially the medical abortions.