Key Social Norms Take-aways The study highlights how entrenched social norms—such as son preference, expectations to avoid contraception before the first child, and misconceptions about side effects—shape contraceptive use in Nepal. These norms are reinforced by family pressures, particularly from husbands and mothers-in-law, and by community-wide surveillance of women’s reproductive choices. The discussion emphasizes that addressing these deep-rooted social expectations is essential for increasing uptake and sustained use of modern contraceptive methods. Without confronting social pressures and myths, even accessible services and supplies may be underutilized.
Objectives This study aimed to understand the barriers to family planning use among underserved groups in Nepal, with a specific focus on how side effects, fertility awareness, social and cultural factors, and structural challenges influence contraceptive behavior.
Methods A qualitative study was conducted in five districts of Nepal using 36 focus group discussions, 18 participatory group discussions, and 144 in-depth interviews with married women, men, and health care providers. The data were transcribed, translated, and analyzed using thematic coding in ATLAS.ti to identify key patterns related to family planning perceptions and behaviors.
Results The study identified four main themes: (1) limited fertility awareness, especially about ovulation and safe timing for pregnancy; (2) strong religious and cultural norms, including son preference and the belief that contraceptives should not be used before the first child; (3) fear of side effects, driven by misinformation and community stories; and (4) structural barriers, such as limited method options, lack of privacy, and lack of same gender providers. These factors combined to reduce uptake of modern contraceptives, particularly among younger and newly married women.
Conclusions Efforts to increase contraceptive use in Nepal must address more than just access to methods. Programs need to directly tackle harmful social norms, improve fertility education, correct misinformation about side effects, and ensure method mix and service availability. Engaging both women and influential family members, including men and mothers-in-law, is crucial for shifting community expectations and reducing resistance to contraceptive use.