Identification of key bottlenecks in human rights-based approach to family planning among HIV-infected women in a resource-restricted setting of Nepal

• Date: 26 March 2024
• Pages: 75-91
• DOI: https://doi.org/10.1108/IJHRH-03-2023-0017
• Published date: 26 March 2024
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Govinda Prasad Dhungana,Dwij Raj Bhatta,Wei-Hong Zhang

Identif‌ication of key bottlenecks in human

rights-based approach to family planning

among HIV-infected women in a resource-

restricted setting of Nepal

Govinda Prasad Dhungana, Dwij Raj Bhatta and Wei-Hong Zhang

Abstract

Purpose –Family planning (FP) services through the lens of human rights are not well known in Nepal. This

study aims to assess Family Planning 2020: Rights and Empowerment Principles for Family Planning and

identify factors affecting contraceptive use among HIV-infected women living in rural Far Western Nepal.

Design/methodology/approach –This study conducted a cross-sectionalsurvey using self-designed

proforma. To assess the association between contraceptive use and independent variables,this study

calculatedadjusted odd ratio (AOR) with 95% confidenceinterval (CI) using statistical package for social

sciences(SPSS) V.20.

Findings –Only 37.8% of participants had access to full range of contraceptive methods, and only 57.5%

of participants received proper counseling. Agency/autonomy, transparency/accountability and voice/

participation were practiced by 43.7%, 23.4% and 19.7% of participants, respectively. Husband’s support

(AOR ¼4.263; 95% CI: 1.640–11.086), availability of FP services in their locality (AOR ¼2.497; 95% CI:

1.311–4.754), employment (AOR ¼3.499; 95% CI: 1.186–10.328) and postpartum period (AOR ¼0.103;

95% CI: 0.023–0.475) were significantly associated with contraceptive use.

Research limitations/implications –Health-care providers’ and program managers’ perspe ctives

were not examined.

Practical implications –Findings of this study willbe useful for making strategicplan on human rights-

based approachto FP.

Social implications –Expanding access to contraceptiveinformation and services and strengthening

autonomy,accountability and participationare key to human rights-based approach to FP.

Originality/value –This study identified that inadequate counselling, nonavailability of full range of

contraceptive methods, lowlevel of autonomy, accountability and participation were key bottlenecks in

fulfillinghuman rights-based approach to FP.

Keywords Family planning, Human rights-basedapproach to family planning, Nepal,

Socio-economically disadvantaged women

Paper type Research paper

Introduction

Family planning (FP) is central to Sexual and Reproductive Health and Rights, gender

equity and women empowerment [United Nations Population Fund (UNFPA), 2019a]. It is

also one of the important indicators of Sustainable Development Goals (SDGs). The SDG’s

indicator 3.7.1 (proportion of women aged 15–49years who have their need for FP satisfied

with modern methods) ensures universal access to FP services and its integration into

national strategies and programs (United Nations, 2020). As universal access to safe and

voluntary FP is a human right, states have obligation to respect, protect and fulfill human

Govinda Prasad Dhungana

is based at the Department

of General Science, Far

Western University,

Mahendranagar, Nepal.

Dwij Raj Bhatta is based at

the Central Department of

Microbiology, Tribhuvan

University, Kathmandu,

Nepal.

Wei-Hong Zhang is based

at the Department of Public

Health and Primary Care,

Ghent University, Ghent,

Belgium.

Received 3 March 2023

Revised 14 November 2023

27 February 2024

Accepted 5 March 2024

This study was financially

supported by AIDS Health

Care Foundation (USA).

DOI 10.1108/IJHRH-03-2023-0017 VOL. 18 NO. 1 2025, pp. 75-91, ©Emerald Publishing Limited, ISSN 2056-4902 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 75

rights related to FP (The Office of the High Commissioner for Human Rights, 2020). Human

rights-based approach to FP is one of the key agendas of various international

organizations working in FP including, but not limited to, Family Planning 2030, United

Nations Population Fund (UNFPA) and International Planned Parenthood Federation (IPPF).

In 2014, the World Health Organization (WHO) published a document to provide guidance

for policymakers, managers, providers and other stakeholders on the programmatic

integration of different human rights dimensions into the provision of contraceptive

information and services (Worldhealth Organization, 2014).

In context to Nepal, the government had made a promising commitments at the national and

international forums to bolster human rights-based approach to FP. At the global level, one of

the recent overarching commitments made by the Government of Nepal was to achieve three

zeros on violence against women, preventable maternal death and unmet need for FP during

Nairobi Summit on International Conference on Population and Development-25 (2019) [United

Nations Population Fund (UNFPA), 2019b]. At the national level, the government had endorsed

sufficient policies, service-related action plan and logistics (including financing and resource

management) and recommended Ministry of Health and Population for full implementation of

such commitments. For instance, the Constitution of Nepal 2015 has provisioned the “Rights

Relating to Health” (article 35) and “Rights of Women” (article 38) as “Fundamental Rights”

(Nepal Law commission, 2020). Similarly, “Rights to Safe Motherhood and Reproductive Health

Act” (2075) ensures that every person shall have the right to get information regarding

contraceptive and use them (Chapter 2, Number 4) (Nepal Law Commission, 2018a).

Furthermore, Public Health Service Act (2075) ensures FP services as Primary Health Service

and should be provided free of cost (Nepal Law Commission, 2018b). Various organizations

including, but not limited to, FP 2030, UNFPA, IPPF, WHO, Bill Gates and Melinda Foundation,

the United States Agency for International Development (USAID) are providing technical and

financial support to Nepal Government (the Ministry of Health and Population, Nepal) for full

implementation of human rights-based approach to FP at the program level.

FP is one of the priority programs of Ministry of Health and Population, Nepal. One of the widely

used indicators of FP is the “contraceptive prevalence rate” which ca n be defined as the

percentage of women of reproductive age (15–49 years), either married or in a union, who are

currently using at least one contraceptive method (Center for Global Development, 2006).

Modern contraceptives include hormonal methods as well as nonhormonal methods all of which

are medical procedures or products that interfere with reproduction following sexual intercourse

(Hubacher and Trussel, 2015). In an effort to support United Na tions’ SDG (related to indicator

3.7.1: proportion of women of aged 15–49 years who have the ir need for FP satisfied with

modern methods) (United Nations, 2020), the Ministry of Health and Population, Nepal had set

a target that use of modern methods of contraception by women of reproductive age (15–49)

will reach 60% by 2030 (Ministry of Health and Population, 2022a) . However, Nepal

Demographic Health Survey-2022 reported that only 43% of w omen of reproductive age

(15–49) were using modern contraceptive methods (Ministry of Health and Population, 2022b).

This value represents the overall situation of FP across the nation and may not reflect t he actual

FP situations of special populations (for e.g. HIV-infected women of rural areas). One of the key

drawbacks in health service delivery system in Nepal is the existence of unequal distribution of

health services. As a result, FP services available in urban ar eas may not be available to rural

areas. Furthermore, HIV-infected women living rura l and remote villages face several

challenges in terms of health, educational and socio-e conomic status (Joint United Nations

Programme on HIV/AIDS, 2015,2017). Furthermore, social norms and values, stig ma and

discrimination and high gender inequality are major barriers to uptake of FP services among

HIV-infected (or socio-economically disadvantaged) women [In ternational Center for Research

on Women, 2005;World Health Organization, 2013;Joint United Nations Programme on HIV/

AIDS (UNAIDS), 2019]. Several research studies reported that use of contracept ion among

HIV-infected women in rural areas was relatively lower than th eir urban counterparts (Abhijeet

et al., 2009;Ashore et al.,2022).

PAGE 76 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jVOL. 18 NO. 1 2025