Unmet need for family planning and associated factors among currently married women in Nepal: A further analysis of Nepal Demographic and Health Survey - 2022

Introduction Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. Nepal, despite efforts, faces significant unmet FP needs, particularly among specific groups. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey. Methods We analyzed the data from nationally representative Nepal Health Demographic Survey 2022. There was a total of 14,845 participants in the survey selected through systematic random sampling technique. Weighted analysis using R statistical software was conducted binary and multinomial logistic regression were performed to assess associations between independent variables and unmet FP needs. Results The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. In multivariable regression model, age, ethnicity, religion, participants and partners education level, province, occupation, wealth quintile, parity and desire for child were statistically associated with total unmet need of FP. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group(AOR: 0.79, 95% CI:0.65, 0.97) compared to brahmin/Chhetri, women from richest (AOR: 0.73, 95% CI:0.59, 0.90) and middle wealth quintile (AOR: 0.83, 95% CI:0.70, 0.99) group compared poorest wealth quintile and women belonging to rural area (AOR: 0.89, 95%CI: 0.80, 0.99) compared to urban area. Whereas higher odds of total unmet need for FP were present in non-Hindu women (AOR: 1.30, 95% CI:1.10, 1.53) compared to Hindu women and women belonging to Madhesh, Lumbini and Sudurpaschim province compared to Bagmati province. Conclusion Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.