title: Do mobile family planning clinics facilitate vasectomy use in Nepal?
abstract: BACKGROUND
  Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy.
  
  
  METHODS
  A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages.
  
  
  RESULTS
  The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21-2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters.
  
  
  CONCLUSIONS
  Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning.
  
  
  CONCLUSIONS
  Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.
authors.affiliation: Department of Social Statistics and Demography, Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social & Human Sciences, University of Southampton, Southampton, United Kingdom. Electronic address: S.Padmadas@soton.ac.uk.
authors.forename: Sabu S
authors.initials: SS
authors.lastname: Padmadas
authors.affiliation: Department of Social Statistics and Demography, Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social & Human Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Fiifi
authors.initials: F
authors.lastname: Amoako Johnson
authors.affiliation: Department of Social Policy, LSE Health, London School of Economics and Political Sciences, London, United Kingdom.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Leone
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Govinda P
authors.initials: GP
authors.lastname: Dahal
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003268:Contraception Behavior / Q000208:ethnology; D005193:Family Planning Services; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D009390:Nepal; D009679:Nuclear Family / Q000208:ethnology; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D019035:Rural Health Services; D019037:Urban Health Services; D014659:Vasectomy; D055815:Young Adult
keywords: Demographic and health surveys; Family planning; Mobile clinics; Nepal; South Asia; Vasectomy