Nepal’s Family Planning Program has Come a Long Way: A Conversation with Dr. Badri Raj Pande

It has been nearly six decades since Nepal introduced a family planning program.1,2 At present, the average number of children that a woman in Nepal has is just two, which is defined as a ‘replacement level’ of fertility (that is, two offspring to replace the couple themselves).3 In contrast, about fifty-years ago (in the mid-1970s), the average was more than six children for a married woman in Nepal.4,5 This change in reproductive behavior (certainly influenced by attitudes towards smaller family size) should be considered a ‘reproductive revolution’ in an essentially patriarchal and patrilocal society like Nepal – a transition several other countries have experienced in recent decades as well.6,7 This reproductive revolution is driven principally by the adaption of modern methods of contraception. In 1966, Nepal became one of only a handful of countries where family planning was officially adopted as a ‘fundamental human right and a policy tool in long-range national planning’.1 Sterilization (mainly female sterilization) has been the principal method of fertility control.8,9 At present, more than 50% of married women in Nepal use some form of contraception.8 By all measures, the country’s family planning program must be considered a success. In more recent years however, other factors including abortion and rising age of marriage, as well as male-selected out-migration, have also contributed to the further decline in fertility.10-14