Terracing in the Rapti Valley, between Tulsipur and Salyan
Courtesy John N. Gunning

Although Nepal's population continued to grow at a rapid pace in the face of deteriorating per capita land availability, the country's economy as a whole remained underdeveloped. Economic growth barely kept pace with population growth. Given this reality, many viewed effective family planning as a national imperative. The need for family planning was recognized as early as 1958, when a private organization, the Nepal Family Planning Association, was established in Kathmandu. Although the government formally adopted a national family planning policy in 1965, its availability was limited to the Kathmandu Valley until 1968, when a semiautonomous board was established. This Nepal Family Planning and Maternal Child Health Board was authorized to formulate and to implement family planning policy and programs for the entire country. Under the auspices of the board, attempts have been made to provide family planning and maternal-child health services outside the Kathmandu Valley, with the help of paramedics and health-care workers who have some basic training. As of 1989, the board offered family planning services in fifty-two of Nepal's seventy-five districts. Despite these efforts, the rural population generally lacked access to family planning services.

Such services were provided by three means: stationary offices, mobile facilities, and door-to-door campaigns. The stationary offices generally were attached to a health-care institution, such as health posts, health centers, or hospitals. In addition to the staff at these institutions, the board assigned a minimum of two full-time workers to deliver family planning and maternal-child health services. However, it has been reported that most health and family planning workers in rural health posts rarely were found in their assigned units. As a result, the availability of such services in rural areas remained poor.

The mobile facilities were a product of necessity, given the remoteness of much of the population and the lack of local family planning facilities, or easy accessibility to such a facility. They reached a large part of the country and almost exclusively stressed permanent family limitation, that is, sterilization. Mobile sterilization camps moved around the country local residents were notified of their scheduled arrival in advance and asked to take advantage of the service. A few days or even weeks prior to the arrival of the camp, a campaign was launched to motivate and to educate people about the benefits and needs of family planning. The camp generally lasted only a few days, rarely more than a week. Because most villagers were unwilling to come to family planning centers to obtain services, the Nepal Family Planning and Maternal Child Health Board launched a door-to-door campaign to educate villagers about family planning and to distribute oral contraceptives and condoms on a periodic basis.

The government's direct expenditu7de ture on family planning in fiscal year (FY--see glossary) 1985 was about 1 percent, or NRs54.7 million (for value of the Nepalese rupee--see Glossary), of the national budget. In the same year, the government spent almost 16.5 percent of its total budget on health services. It was difficult to determine what percentage of the health budget was channeled to provide family planning services. Although the expenditure on family planning appeared to be relatively low given the gravity of the issue, the absolute budget amount had gone up significantly in the 1970s and 1980s: from NRs2.0 million in FY 1969, when the board was set up, to almost NRs55 million in FY 1985. In FY 1981, more than 60 percent of the board's budget was borne by foreign agencies.

In terms of absolute numbers, the diffusion of family planning increased significantly over two decades. In FY 1969, only 7,774 persons had adopted family planning by FY 1985, the number who had adopted family planning had climbed to almost 340,000 persons.

Data as of September 1991