Corrected May 30, 2019. See note below.

Access to modern contraceptives and maternal and newborn health care is essential for promoting the well-being of Nepali women and their children, but a new report published by the Guttmacher Institute and the Center for Research on Environment, Health and Population Activities (CREHPA) in Nepal shows that many women are not receiving the services they need.

In Nepal, there are an estimated 539,000 unintended pregnancies each year—45% of all pregnancies—the majority of which result from an unmet need for modern contraception. Among Nepali women of reproductive age who want to avoid a pregnancy, 44% are considered to have an unmet need for modern contraception because they either use no contraceptive method or use a traditional method of family planning.

Further, only 64% of pregnant women in Nepal obtain the minimum of four antenatal care visits recommended by the World Health Organization, and only 61% of births are assisted at delivery by a skilled birth attendant. These components of care are crucial for preventing and managing health complications that could arise during pregnancy and delivery, and they are critical to improving maternal and newborn health.

According to the authors, the current cost of providing modern contraceptive services in Nepal is $17 million per year (all costs are expressed in 2017 U.S. dollars). Expanding those services to cover all women with unmet need, in addition to current users, would cost a total of $30 million. The cost of providing all pregnant women with a comprehensive package of maternal and newborn health care (with no change in contraceptive services) would be $131 million, more than a doubling of current costs. However, if investments were made in both sets of services simultaneously, maternal and newborn care costs would be only $101 million annually. This is because increased contraceptive use would reduce the number of unintended pregnancies and eliminate the health care costs they would otherwise entail.

The study showed that for every additional dollar spent on expanding modern contraceptive use, the country would save $2 on maternal and newborn health care, thereby allowing the country to reduce maternal and infant death and disability more affordably than if it were to expand maternal and newborn services alone.

Moreover, providing modern contraception to all Nepali women who need it would yield large returns. Compared with 2017 levels, increased contraceptive services alone would result in:

• 469,000 fewer unintended pregnancies (an 87% decline)
• 306,000 fewer induced abortions (an 87% decline)
• 300 fewer maternal deaths (a 16% decline)

Maternal and newborn health care is costly, and providing a comprehensive package of care can pose challenges for low-income countries. Yet, simultaneously investing in modern contraceptive services actually helps mediate that cost. Together, these investments would yield benefits to women, their families and society. 

"The evidence is clear and compelling," says lead author Aparna Sundaram, senior research scientist with the Guttmacher Institute. "Investing in modern contraception and maternal and newborn health care pays huge dividends for women, babies and families, while simultaneously supporting social and economic development overall."

"Enabling women to determine if and when to have children in the first place through modern contraception is an effective strategy for reducing maternal and infant death and disability," says author Mahesh Puri, associate director of CREHPA. "Because women and couples in Nepal increasingly desire smaller families, the demand for modern family planning methods will only grow."

The responsibility for fulfilling this demand will have to be shared by national, provincial and local governments, the private sector, and national and international development partners. Improving and increasing access to publicly funded services will be especially important for meeting the needs of those who are most economically disadvantaged and those living in remote areas.

This press release is also available in Nepali.

Note: Changes were made in the calculation of cost estimates in Adding It Up: Costs and Benefits of Meeting the Contraceptive and Maternal and Newborn Health Needs of Women in Nepal based on a revised unit cost of gauze from $2.67 to $0.04. These corrections do not change the study’s summary findings or conclusions.