Strengthening emergency contraception in Nepal

The contents are the responsibility of the FRONTIERS Program and do not necessarily reflect the views of USAID or the United States Government. Any part of this publication may be reproduced without permission for limited distribution provided it is distributed without charge and the Population Council is acknowledged as the source. The Population Council would appreciate receiving a copy of any materials in which the text is used. Emergency contraception pills (ECP) were incorporated into the National Medical Standards for Contraceptive Services and in the Clinical Protocols for Health Providers in Nepal in 2003. However, until recently, ECP was not included in actual service delivery and was not available through the government health facilities. A national workshop on emergency contraception was organized by the Family Health Division (FHD) within the Ministry of Health in 2004, and technical assistance was provided by the FRONTIERS Program of the Population Council. Among many conclusions from the workshop, one recommendation was that ECP should be introduced through the government family planning program to assist in reducing unwanted pregnancies. Based on the Population Council's past experiences with introducing and mainstreaming ECP services in Bangladesh and India, a phase-wise introduction of ECP in Nepal was recommended. In the first phase, the ECP program was implemented in three districts of Kathmandu Valley The overall objective of the program was to introduce ECP into the national family planning program and to identify any operational difficulties that the FHD may face to ensure smooth and efficient roll-out during country-wide scale-up. Introduction of the ECP in Nepal followed the model developed and tested in Bangladesh. Information education and communication (IEC) materials, as well as training and evaluation tools, were translated from Bangladeshi to Nepali. As with the Bangladesh model, project activities were implemented in three phases: i) building capacity of the national program; ii) provision of services; and iii) evaluation of the intervention's impact. Intervention activities included the following: An orientation for government officials and stakeholders; Training of trainers (TOT) and of service providers; An orientation for Female Community Health Volunteers (FCHVs); Implementation of educational activities; Provision of ECP. These interventions were evaluated through pre-and post-test comparative studies, observational studies, and in-depth interviews with clients. A three-tier training model was adopted from the Bangladesh model to train 536 service providers and 1,938 FCHVs in Nepal. The service providers were trained by 12 master trainers during the TOT sessions. Service providers …