Nepali families fight poverty with condoms, pills

By Terry Friel and Gopal Sharma

TILA, Nepal (Reuters) – One of the biggest-selling items in
the tiny chemists in the rebel-held Nepali hill town of Tila
are condoms — several hundred a month for a total population
of just 2,000.

In one of the world’s poorest countries, people are
starting to realize they can no longer afford the large
families once considered vital for supporting parents in old
age.

“People are generally getting increasingly aware that if
you have a big family, life becomes difficult,” says local
chemist and government community health worker Yam Bahadur
Basnet.

“So people are getting a taste for smaller families.”

Nepal’s family planning program, which began in 1959, about
the same time the hermit kingdom opened up to the outside
world, is considered a success.

Fertility rates — the average number of children a woman
bears — have come down to 4.1 in 2001 from 5.6 a decade
earlier.

“This is quite an achievement,” says Giridhari Sharma
Poudel, an official with the Family Planning Association Nepal
(FPAN), a leading group for counseling among couples.

The Himalayan country has 26 million people, the vast
majority surviving on subsistence farming, living on rice and a
few vegetables.

NO WELFARE NET

The economy, heavily dependent by foreign aid and tourism,
has been shattered by a 10-year Maoist revolt against the
world’s only Hindu monarch.

In a land with no welfare net, to have many children was
traditionally considered the best way to provide for
retirement, as in many Asian countries.

“The family planning program is a successful one,” says
Nara Bahadur Dangi, 40, another of Tila’s three community
health workers.

“Many people now think they have enough kids. People are
realizing that if they have a big family they will have
problems sending them to school, problems feeding them.”

Run by FPAN, the program involves women volunteers going
door-to-door to counsel couples in villages across Nepal.

Authorities run mobile family planning camps in remote
areas and community health posts hand out free condoms. The
Maoist rebels support the push and government health workers
are among the few public servants allowed in rebel-held areas.

FPAN’s Poudel says the proportion of couples using
contraceptives has increased to 39 percent in 2001 from 3
percent in 1976. More recent figures are not available as they
are compiled every five years.

Nepal trails behind its giant neighbor India and Bangladesh
in family planning, Poudel said, and ranked almost on a par
with Pakistan.

While condoms and birth control pills are big sellers in
Tila, in the far west, health workers say the most popular
contraceptive is Depo-Provera, injected once every three
months.

Kanchhi Tamang, a struggling domestic worker and mother of
three daughters, has been using birth control for seven years.

“I started using the family-planning methods because I did
not want to have a fourth child, raising three kids was already
a problem,” the 45-year-old Tamang says outside a Kathmandu
clinic.

In a part of the world where having a son is considered
paramount, Tamang says she does not care.

“If I can educate the three daughters, that’s okay. I don’t
mind not having a son,” she says shyly.