Designing Evidence-Based Family Planning Programs for the Marginalized Community: An Example of Muslim Community in Nepal

CONTEXT: Family planning (FP), considered as an encouraging trend for development, is thought to be positively correlated with family health and well-being and negatively correlated with poverty levels. Despite being a priority goal of government and development agencies, in a heterogeneous society like Nepal, FP can be an issue that needs to be dealt with consideration for religious and cultural beliefs of different sections of society. Despite steady progress in achieving FP goals, minority populations have lagged behind the rest of the country in achieving improved family health outcomes; Muslim community being one such example. OBJECTIVES: This study aims to explore the existing situation of FP use in Muslim communities and to identify key policy-related issues affecting the access to and utilization of FP services. SETTINGS AND DESIGN: Mixed approach was used in Kapilbastu district, which accommodated the larger proportion of Muslims in Nepal. MATERIALS AND METHODS: Interview was conducted among 160 married women using semi-structured questionnaire. Focus group discussion, key informant interviews, and consultative meeting were the qualitative techniques employed in this study. Quantitative data were analyzed using descriptive and inferential statistics (Chi-square test), while qualitative data by thematic approach. RESULTS: More than half of women (56.0%) expressed their interest in FP use, while reported users were just below the quarter (24.0%). Husband approval and secrecy of their personal identity affect use of any method of contraception. Future plan for children and prior information regarding FP found to affect current use of FP, significantly. FP word itself was found to be stigmatizing, so women prefer replacing the word FP with culturally appropriate one. Furthermore, incorporating it into comprehensive package for improving women’s health will definitely contribute to improve access and uptake of services. CONCLUSION: Discrepancy exists between current use and desire for use of FP among Muslim women in future. This highlights the inadequacy of implementing the current blanket policy and programs related to FP and offer ways to move forward with the national FP agenda ensuring the cultural rights and non-discrimination of women.