Reproductive health care and family planning among women in Nepal.
OBJECTIVE
To describe findings from a validated survey examining access to care, contraceptive needs, access to surgical care, menstruation-related healthcare needs, and barriers to receiving reproductive health care in Nepal.


METHODS
An analysis was undertaken using data obtained through a two-part population-based, cross-sectional, cluster-randomized survey corroborated by a visual physical examination performed nationwide between May 25 and June 12, 2014. Women aged 12-50years were included. The odds of delivering exclusively in a health facility, having a cesarean delivery, and using contraception were modeled using logistic regression.


RESULTS
Overall, 876 female interviewees were of reproductive age (12-50years). Only 237 (27.1%) women were using contraception. Maternal education was the strongest predictor of delivering exclusively in a healthcare facility (odds ratio [OR] 7.57, 95% confidence interval [CI] 4.48-12.79; P<0.001). The odds of having a cesarean delivery were doubled by urban living (OR 2.20, 95% CI 1.09-4.13; P<0.001). On multivariable analysis, a predictor of using contraception was a history of having given birth (OR 9.61, 95% CI 4.62-20.01; P<0.001).


CONCLUSIONS
In Nepal, reproductive healthcare disparities for women are manifold. Education for women appears to be a significant determinant of accessing reproductive health care.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of Vermont, College of Medicine, Burlington, VT, USA. Electronic address: marisa.c.liu@gmail.com.
Marisa
M
Liu
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
Neeraja
N
Nagarajan
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA.
Anju
A
Ranjit
Surgeons OverSeas, New York, NY, USA; University of California San Francisco, East Bay, CA, USA.
Shailvi
S
Gupta
Department of Surgery, Nepal Medical College Teaching Hospital, Kathmandu, Nepal.
Sunil
S
Shrestha
Surgeons OverSeas, New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA.
Adam L
AL
Kushner
Surgeons OverSeas, New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
Benedict C
BC
Nwomeh
Surgeons OverSeas, New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
Reinou S
RS
Groen
D000293:Adolescent; D000328:Adult; D002648:Child; D003267:Contraception / Q000145:classification / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000193:education*; D005260:Female; D014943:Global Health; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009390:Nepal; D011247:Pregnancy; D034121:Reproductive Health Services / Q000592:standards*; D016387:Women's Health / Q000592:standards*; D055815:Young Adult
Family planning; Global health; Obstetrics; Reproductive health care; Women's health