Family Planning Policy and Service Utilization Trend in Nepal: A Narrative Review

Nepal's family planning (FP) program has evolved over more than six decades from a population control–oriented initiative to a rights-based public health approach aligned with global commitments such as ICPD, SDGs, and FP2030. This review examines the historical evolution of FP policies and programs in Nepal, levels of awareness and utilization, and the persistent challenges affecting equitable access to modern contraceptive services. A systematic literature search following PRISMA guidelines was conducted using the PubMed database, yielding four eligible studies for synthesis. The findings indicate substantial progress in contraceptive awareness, fertility reduction, and institutional service delivery; however, modern contraceptive use has stagnated, with increasing reliance on traditional methods and a persistent unmet need, particularly among adolescents, marginalized castes, poorer households, and geographically remote populations. Sociocultural norms, limited male involvement, misconceptions about side effects, and systemic barriers such as inadequate service readiness, decentralization-related capacity gaps, and underfunding continue to constrain program effectiveness. Evidence also highlights disparities in the benefits of community-based and financial empowerment interventions, often favoring more advantaged groups. Overall, Nepal's FP achievements remain fragile, underscoring the need for renewed, equity-focused strategies that prioritize quality of care, culturally responsive services, strengthened health systems, and inclusive engagement of both women and men to sustain progress toward FP2030 goals.