KATHMANDU: In Dolpa of Karnali, a 35-year-old mother of three is facing the dilemma of family planning.

Though her desire for more children has waned, the household stands against permanent vasectomy.

While her husband opposes temporary methods, she endures the physical toll of various temporary devices.

Despite the discomfort, she fears the consequences of vasectomy, particularly if something happens to her existing children, leaving her unable to bear more.

This woman’s predicament is reflective of the mindset prevalent among many women in Dolpa, where permanent sterilization is not a widely embraced option.

Instead, women resort to temporary measures oral contraceptive pills (OCP).

Notably, the reluctance extends to men, with Medical Officer Akhanda Upadhyaya stating that the number of men utilizing family planning tools is negligible in Dolpa.

According to Upadhyaya, women themselves discourage men from undergoing sterilization due to the perceived weakness that follows permanent vasectomy.

The responsibility of sustaining the family is often seen as solely the husband’s domain, leading to a misconception that women are incapable of managing work and mobility.

Contrary to common misconceptions, it does not adversely affect health, but some women may experience back pain, which is not directly related to the surgery.

Men, too, prefer temporary means over permanent sterilization, contributing to the prevailing mindset.

Despite the medical officer’s assurance that the weakness after vasectomy is temporary, there remains a challenge in conveying this information to rural communities.

Misunderstandings persist, with issues like irregular periods and heavy bleeding during menstruation clouding the decision-making process for women.

The need for comprehensive education on family planning options and dispelling misconceptions becomes evident in addressing the complex dynamics in Dolpa.

Understanding family planning

Family planning encompasses more than just reducing the number of children; it is a strategic approach to improving the health and well-being of both mothers and children.

Medical Officer Upadhyaya emphasizes that effective family planning contributes directly or indirectly to progress and balance in various sectors, including economic, social, health, and education.

A lower population facilitates efficient management of essential facilities such as health, education, and employment, prompting the government to prioritize and provide free family planning services in public health institutions.

Types of Family Planning Tools

Permanent vasectomy: Both men and women can undergo permanent vasectomy, known as sterilization.

Contrary to common misconceptions, it does not adversely affect health, but some women may experience back pain, which is not directly related to the surgery.

Education on proper use, potential side effects, and considerations based on age and health conditions is vital for maximizing the benefits of family planning.

Complications may arise if the procedure is not performed correctly, leading to situations like tubal pregnancies.

In men, permanent vasectomy does not reduce sexual desire; any reduction is due to personal reasons.

However, the procedure has a higher failure rate, resulting in unintended pregnancies.

Temporary Means

Condoms: Ideal for both men and women, proper use significantly reduces failure rates and provides protection against sexually transmitted diseases.

Pills: Taking pills regularly at the same time each day minimizes the risk of pregnancy and also offers protection against uterine cancer.

However, prolonged use may lead to side effects such as nausea and decreased appetite, and excessive use may increase the risk of breast cancer.

Pills should be avoided after the age of 40 and in cases of high blood pressure.

Depoprovera, Narplant, IUCD, Diaphragm: These temporary methods offer various options, and proper usage is crucial to their effectiveness.

Understanding the nuances of family planning tools helps individuals make informed choices for their reproductive health.

Education on proper use, potential side effects, and considerations based on age and health conditions is vital for maximizing the benefits of family planning.

However, despite the perception that the educated class is responsible and sensitive to family matters, studies indicate that family planning tools are less utilized in these social strata.

Narplant offers a long-term family planning solution, lasting for a period of 7 years.

Despite its effectiveness, it is a more expensive option compared to other means, making it less readily available.

Proper maintenance requires a trained individual, as Narplant is implanted inside the body.

Notably, Narplant does not have any adverse effects on the body despite its internal placement.

It is essential for individuals to be well-informed about these family planning options, understanding both their benefits and potential side effects.

Clear communication with healthcare providers ensures that women can make informed choices based on their individual needs and preferences.

Information is available, but its utility remains limited.

Over time, society has become more educated; however, despite widespread awareness of family planning tools from urban centers to rural areas, their usage has stagnated over the past decade.

A predominant concern among women is the fear of permanent infertility after utilizing family planning methods.

Some worry about potential disruptions to menstruation, impacts on the uterus, and even the risk of cancer.

Many couples in our society experience stress due to uncertainty about family planning methods, often avoiding expert consultation.

Health workers note that a significant number of women desire to avoid conception but hesitate to use family planning tools and avoid seeking counseling.

Education plays a crucial role in family planning. Educated families tend to marry later, have fewer children, and maintain a favorable birth rate.

Dr. Upadhyaya observes that some women experience issues like irregular periods and heavy bleeding due to the use of temporary devices.

However, despite the perception that the educated class is responsible and sensitive to family matters, studies indicate that family planning tools are less utilized in these social strata.

Medical officer Upadhyaya highlights the rising number of abortions in urban areas and draws attention to the increased prevalence of abortions compared to the use of family planning tools in rural Dolpa.

He emphasizes the importance of educating women seeking abortions about permanent sterilization options and providing support for hospital visits through convenient means.

Family planning is recognized as a reproductive health right for women by the Constitution of Nepal.

Dr. Upadhyaya stresses the importance of careful and informed use of family planning tools, as their improper usage can lead to various effects.

He advises individuals to choose tools they are comfortable with and consult experts for guidance.

Dr. Upadhyaya observes that some women experience issues like irregular periods and heavy bleeding due to the use of temporary devices.

Therefore, he emphasizes the importance of seeking advice on the right family planning tool at the appropriate time to ensure a well-informed decision.