Nepalese men generally want more than one son and are unlikely to choose permanent contraceptive methods until they have at least two sons, according to a new analysis of data from a nationally representative survey of more than 2,000 married men in Nepal. Authors Govinda P. Dahal et al., found that 62% of men who had two sons and one daughter relied on male or female sterilization, compared with 20% of men who had only daughters.

Seven in 10 men in Nepal said they wanted no more children; however, one in four of these men were not currently using any contraceptive method. For men who said they had achieved their desired family size, the contraceptive methods they chose depended on the number of sons they had. Men who had not yet had as many sons as they wanted were more likely to use condoms and other temporary methods. Men with at least two sons and one daughter or three or more sons were the most likely to choose permanent methods, while men with only daughters were least likely to do so.

A large majority (82%) of men who said they didn’t want any more children reported that they made all the decisions about their wives’ health care. In addition, 41% said that they had never discussed family planning with their wives. Men who had never discussed family planning with their wives were more likely than those who had done so to rely either on permanent contraceptive methods or no method at all, and were far less likely to use condoms and other temporary methods.

The authors propose a number of policy recommendations based on these findings, beginning with wider availability of contraceptive services and supplies. The authors also suggest that programs should target men, especially in the remote mountainous regions of Nepal, to enhance their awareness of the safety, cost benefits and other advantages of a range of contraceptive methods, including vasectomy. In addition, because men are often the sole decision makers about health care, efforts are needed to promote communication and shared decision making among Nepalese couples.

"Fertility-Limiting Behavior and Contraceptive Choice Among Men in Nepal," appears in the March 2008 issue of International Family Planning Perspectives.

Also in this issue:

"Links Between Sex-Related Expectations About Alcohol, Heavy Episodic Drinking and Sexual Risk Among Young Men in a Shanytown in Lima, Peru," by Juan Antonio Gálvez-Buccollini et al.

"Women’s Sexual and Reproductive Health in Post-Socialist Georgia: Does Internal Displacement Matter?" by Khatuna Doliashvili and Cynthia J. Buckley

"Changing Family Formation in Nepal: Marriage, Cohabitation and First Sexual Intercourse," by Marcantonio Caltabiano and Maria Castiglioni

"Severity and Cost of Unsafe Abortion Complications Treated in Nigerian Hospitals," by Stanley K. Henshaw et al.