Spousal Separation and Use of and Unmet Need for Contraception in Nepal: Results Based on a 2016 Survey

Abstract

Nepal is facing a large-scale labour migration—both internal and international—driven by economic and employment opportunities. There is sparse literature available at the national level which examines the link between migration and contraceptive use. This study aimed at identifying contraceptive use and the unmet need for family planning (FP) and exploring its correlates among the married women of reproductive age (MWRA) by their husbands’ residence status, using data from Nepal Demographic Health Survey 2016–a nationally representative cross-sectional survey. A stratified two-stage cluster sampling in rural and a three-stage sampling in urban areas were used to select the sampling clusters, and data from 11,040 households were analyzed. Reported values were weighted by sample weights to provide national-level estimates. The adjusted odds ratio (aOR) was calculated using multiple logistic regressions using complex survey design, considering clusters, and stratification by ecological zones. All analyses were performed using Stata 15.0. Among the total MWRA, 53% were using a contraceptive method, whereas the proportion of contraceptive use among the cohabiting couple was 68%. The unmet need for contraceptive use was 10% among cohabiting couples and 50% among the noncohabiting couples. Contraceptive use was significantly low among the women reporting an induced abortion in the last five years and whose husbands were currently away. A strong negative association of spousal separation with contraceptive use was observed (aOR:0.14; p<0.001) after controlling other covariates, whereas a positive association was observed with the unmet need (aOR:8.00; p<0.001). Cohabiting couples had a significantly higher contraceptive use and lower unmet need compared with the couples living apart. Between 2006 and 2016, contraceptive use increased by 1% per year among cohabiting couples, although this increase is hugely attributable to the use of traditional methods, compared with modern methods. The labour migration being a significant and indispensable socioeconomic phenomenon for Nepal, it is necessary to monitor fertility patterns and contraceptive use by cohabitation status in order to ensure that the national family planning interventions are targeted to address the contraceptive and fertility needs of the migrant couples.

Factors associated with modern contraceptive demands satisfied among currently married/in-union women of reproductive age in Ethiopia: a multilevel analysis of the 2016 Demographic and Health Survey

“…The DSFMCs among Muslims was reduced by 42% compared with Orthodox Christians. This is supported by studies in Zambia,35 Ghana,37 38 Tanzania,39 Nigeria40 and rural Nepal 41 42. The findings show that the governments of the countries need to consider addressing different social determinants such as engagement of religious leaders; pieces of evidence have shown that those women who get FP-related massages from religious leaders have a high uptake of FP services 40.…”

“…This study demonstrated that demand satisfaction among women whose husbands were living elsewhere distant from them was reduced by 58% than those living together. This is complemented by studies in Nepal 42 43. Those women whose husbands lived elsewhere apart from them may have less often sexual contact.…”

Migration and family planning in the state with highest total fertility rate in India

“…One of the factors that could have played a role in low mCPR is male out-migration. A great deal of evidence from Nepal, sharing an open border with Bihar, suggests that women with migrant husbands were less likely to use contraceptives and access FP services though they had greater autonomy than those with resident husbands [9][10][11][12]. Primary research conducted in Nepal also noted that women with migrant husbands were less likely to discuss FP issues with their spouses [10,13,14].…”

The Effect of Migration on Family in Nepal: A Review on the Family Structure, Livelihood, Education, Aging Parents, Reproductive Health and Marital Relationship

“…The 2011 census revealed that one in every four households (25.4%; 1.38 million households) had at least one absent or migrant member, making internal migration rate of 18% from rural to urban areas and 3.8 million Nepalese obtained international work permits in 2014/2015 fiscal year (S. Ghimire et al, 2018). However, Mehata et al (2020) mention that about a third of the households (30%) had a least one member of the family migrated and the proportion of migration is higher in the rural and disadvantaged regions of Nepal. Employment is the main reason for migration (70%), with remittances from international migrants the primary income source for many households (Thapa et al, 2020).…”

“…The literature on migration and health presents the complex relationship of migration on health and fertility. Spousal separation is more common among married women of reproductive age in rural areas (37%) than their urban counterparts (32%) (Mehata et al, 2020). Shattuck et al (2019) describe that there are health disparities among women with migrant husbands, and negative consequences of migration on the health of other family members including mental health issues such as the feeling of loneliness, isolation depression, and higher levels of reproductive morbidity, sexually transmitted infections than women married to nonmigrants.…”