The Health Office in Jajarkot district has only around 50 shots of Depo-Provera, a birth control shot for women, left in stock. Officials say they do not know the exact status of stocks at local health facilities, but the nearby district hospital has only around a dozen shots remaining.

“We have demanded Depo-Provera from the Province Health Logistics Management Centre, but they too are out of stock,” Krishna Bahadur Khatri, information officer at the health office, told the Post over the phone from Jajarkot. “Women seeking the service will be deprived if the birth control shots are not supplied immediately.”

Depo-Provera is a popular and widely used contraceptive in Nepal. It is a birth control shot that has the hormone progestin, which often stops the ovaries from releasing eggs, meaning that there is no ovulation.

Data provided by the Ministry of Health and Population show that among new users of contraception, Depo-Provera ranks highest, followed by pills and implants. Experts warn that shortages of contraceptives for a prolonged period could lead to a rise in unwanted pregnancies that ultimately result in unsafe abortions and jeopardise the lives of thousands of women.

“We do not have Depo’s shots in stock and have not been able to supply to the district health offices, which in turn supply to health facilities at the local level,” said Pratiksha Rawal, an official at the Province Health Logistics Management Centre, Karnali. “We have asked the federal government to supply contraceptives, but they too have informed us they have none left in central stores.”

The centre is responsible for supplying birth control shots and other means of contraception to 10 districts: Humla, Dolpa, Mugu, Jumla, Kalikot, Salyan, West Rukum, Dailekh, Surkhet, and Jajarkot.

Officials say they have been piloting ‘slime press’, a birth control shot similar to Depo-Provera, in the Dailekh, Dolpa, and Surkhet districts.

“We don’t know much about the new birth control shots,” said Rawal. “The centre supplied and asked us to use it as a pilot, and we are following the instructions.”

Officials at the Family Planning Section of the Family Welfare Division under the Department of Health Services admitted shortages of Depo-Provera shots at health facilities and asked health facilities with larger stocks to share the shots with those facing shortages.

“Demand for family planning instruments in state-run health facilities has increased compared to the past, and the lack of free services in some private centres could be the reason,” said Sharmila Dahal, chief of the section. “We have asked health facilities for reverse supply from the health facilities having more shots in stock to send them to those facing shortages.”

It has been several months since health facilities ran out of Depo-Provera and several other contraceptives. Officials say they have supplied condoms, pills and implants to health facilities, which were provided to them from the United Nations Population Fund.

Officials say that past attempts to purchase Depo-Provera in 2024 could not succeed due to price issues.

In Nepal, nearly half of all pregnancies are unintended, and close to two-thirds of them end in abortion, according to a report by the UNFPA.

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 ended in abortion.

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

The report stated that the toll of unintended pregnancies is—and has long been—unseen.

“Although 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 result from unintended pregnancies,” the report says.

Unintended pregnancy is often, tragically, linked to violence. The report shows how unintended pregnancies result in additional social and fiscal burdens, including 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. Experts say that family planning services are directly linked to women's empowerment and the country's economic growth.

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 many abortions, especially medical ones, go unreported.

The Ministry of Health and Population provides around 200,000 Depo-Provera shots free of charge through health facilities every year. Apart from this, UN agencies and other organisations provide contraceptives worth millions of rupees every year.