Nepal Faces Shortage of Birth Control Shots in Health Facilities

A nationwide scramble for basic contraceptives

Across Nepal, public clinics and hospitals report that core family planning tools are missing from shelves. The injectable contraceptive Depo Provera and intrauterine devices are the hardest to find. In Bagmati Province, the Health Logistics Management Centre holds only 200 Depo Provera doses and 350 intrauterine devices in reserve for emergencies. Regular orders to health posts have stopped for months. Karnali and other provinces face the same squeeze. Facility staff are turning clients away or asking them to choose a different method that may not fit their needs.

Officials trace the shortage to long delays in government purchasing that stretch back about two years, a jump in dollar prices that raises import costs in Nepali rupees, tight public budgets, and a suspension of USAID support to private providers that has pushed more clients to state run sites. Implants and other methods have also been scarce at different points this year. The Ministry of Health and Population says procurement has restarted, and a shipment backed by the United Nations Population Fund has arrived for distribution, yet stock will take time to reach districts.

What is driving the shortage

Contraceptives procured for public facilities are mostly imported. When the Nepali rupee weakens against the dollar, the same volume costs more in local currency. Tenders issued in 2024 failed after bids came in above available ceilings. On top of that, several health programs learned in planning meetings that their budget ceilings for the coming year are lower. Agencies warned that essential services would be cut if the ceilings stand. That squeeze affects family planning commodities along with HIV services, nutrition, and maternal and newborn care.

The pause in USAID funding early in 2025 created a second shock. Some private organizations had provided free or subsidized family planning, counseling, and outreach with that support. When those activities paused, more clients turned to public health posts that already lacked stock. Store rooms at central and provincial warehouses ran down. The national system continued to promise free contraceptives, yet without timely purchasing and enough money, the promise could not be met.

The human cost of a gap in family planning

Gaps in access do not just disrupt convenience. Nepal has long struggled with unmet need for family planning. The Demographic and Health Survey (2022) reports that 21 percent of married women want to avoid or delay pregnancy but are not using a method. UNFPA estimates show that about half of pregnancies in Nepal are unintended and that close to two thirds of those end in abortion. Around 100,000 women obtain abortions each year in authorized facilities. The true figure is likely higher because some abortions are not recorded.

Abortion is legal in Nepal within a defined framework and has been progressively expanded since 2002 to improve safety. Even so, a shortage of contraception can push more women toward procedures they did not plan, some in unsafe conditions. Rural districts in the far west record low use of modern methods and regular reports of women seeking help late in pregnancy. Stigma also plays a role for unmarried youth and for women whose husbands migrate for work, which makes simple access at a local clinic even more critical.

When prevention falls short, many women seek medication abortion pills. A recent study in Eastern Nepal found that mystery clients could obtain mifepristone and misoprostol without a prescription in about two out of five community pharmacies, usually at a higher price than reported by staff. Some pharmacy workers asked helpful questions about timing and side effects, yet training was uneven. In the middle of a contraception shortage, reliance on such routes tends to rise, which makes accurate information and referral more important.

Why women ask for Depo and IUDs

Depo Provera is a progestin only injection given every three months. It often stops ovulation and thickens cervical mucus, which blocks sperm. Many women prefer it because it is private, requires no daily action, and works well when clinic visits are possible once per quarter. That is one reason stockouts hit hard. Missed repeat injections can quickly expose someone to pregnancy risk. Women whose partners work away from home also value injectables because they can plan without discussion if they fear social pressure.

Intrauterine devices are long acting reversible methods. A copper device can prevent pregnancy for up to ten years. A hormonal device can offer several years of protection. Once placed by a trained provider, the method requires little follow up. For women who want spacing or to limit births, IUDs are reliable and low cost over time. Shortages keep providers from initiating new clients. They also complicate postpartum counseling at hospitals where many women want a method before discharge.

Public versus private care after the aid pause

The suspension of United States assistance to many partners early this year had a real effect inside Nepal. Several private organizations paused free counseling and clinics. Those clients did not stop needing contraception. Many walked into government health posts, and demand rose. That shift added to a procurement gap that already existed.

Health leaders also face tighter budgets. One center under the Ministry of Health and Population reported a reduction of 55 million rupees in its ceiling for the next fiscal year and warned that essential services, including treatment and testing, would suffer. The Ministry of Finance has reportedly set an expenditure ceiling for health that is lower than the previous year by several billion rupees. Training for health workers, nutrition drives like vitamin A, and public awareness programs have been delayed or redesigned. Family planning commodities compete with many other urgent costs.

A closer look at districts

In Karnali Province, the Health Office in Jajarkot told reporters it had only about 50 Depo Provera doses left at one point, and the district hospital counted roughly a dozen. The provincial logistics center had nothing to send and asked the federal level for help. In Bagmati, the provincial warehouse kept a small reserve of 200 injectables and 350 intrauterine devices for emergency cases and stopped routine supply. Each of these numbers reflects a simple reality, facilities have been rationing or improvising for months.

Distance makes shortages more punishing. Women in mountain districts may walk for hours to reach a clinic, only to learn that the method they use is out. Some miss repeat windows because roads are blocked by rain or landslides. Health workers have tried to borrow from nearby facilities, but those sites often face the same lack. The longer the gap, the more likely a patient will switch to a method she does not prefer or stop using contraception entirely.

Stopgaps, new shipments, and what they can do

A shipment supplied through UNFPA has reached Nepal and is slated for distribution to provinces. Condoms, pills, and some implants provided through partners have helped in recent weeks. Those consignments can reduce pressure, yet they do not fully cover the missing injectables and IUDs. Managers will need to prioritize current Depo users who are due for repeat doses and women seeking immediate postpartum methods. Clear criteria can help clinics make fair choices when stock is limited.

Officials say that new government purchases are moving through the system. That process involves specifications, tendering, evaluation, and delivery, which takes time even in the best case. In the meantime, some provinces have asked facilities with any surplus to share with sites that have none. Real time reporting through the logistics information system can speed those transfers and keep small amounts from sitting on shelves in one district while a neighboring clinic runs dry.

Alternatives that could reduce pressure

Injectable options may be broadened. Sayana Press, a lower dose formulation delivered via a small device, has been introduced in some districts. It can be administered by trained health workers and, in many countries, by clients themselves after counseling. In Nepal, professionals currently provide it. Wider use would require training, supply, and clear guidance, yet it could help reach women in remote areas who struggle to return every three months.

Counseling on temporary options remains vital while injectables and IUDs are scarce. Correct and consistent use of pills prevents many pregnancies when support is available. Condoms protect against infections and pregnancy. Emergency contraception can be used after unprotected sex within a short window and should be explained without stigma. Male engagement matters. Uptake of vasectomy is low, yet it is safe and effective for couples who have completed their families.

Safe abortion access is part of the continuum of care. The pharmacy study in Eastern Nepal shows that medication abortion pills often reach clients even without prescriptions. That reality points to a need for better training for pharmacy workers on correct dosing, danger signs, and referral. It also underscores the value of accurate public information on where legal and safe services are available.

What procurement reform would look like

Nepal can reduce the risk of repeated stockouts with several practical steps. Agencies can move to multi year framework contracts for core methods, which allows periodic orders without fresh tenders each time. Tenders can include price adjustment clauses tied to currency movements so that depreciation of the rupee does not stop awards. Suppliers can be diversified so that one delay does not halt an entire method.

Buffer stocks should be rebuilt. A national target of several months of supply for each method, held at central and provincial levels, protects against transit delays and late tenders. Early warning dashboards inside the electronic logistics system can flag falling stock at facilities and trigger transfers before a gap reaches clients. Provinces can pre position extra consignments in mountain districts ahead of the monsoon season when roads are cut.

Partnerships can help. Joint procurement with United Nations agencies can speed delivery while national tenders progress. Quality assurance and regulatory checks must remain strict to protect patients. Over time, investment in local packaging or assembly could shorten lead times for some commodities, though raw materials will still come from abroad.

What people can do now

Clients who are due for a Depo repeat dose should contact the nearest health facility to ask about current stock, alternative sites, or an interim method. Health workers can provide guidance on switching methods and on the waiting period needed if a repeat injection is delayed. Those who want an IUD may be offered an implant or pills until supplies arrive.

People seeking abortion care should use legal services where trained providers can assess health status and provide counseling. Pharmacy workers often help in practice, yet clients should ask for clear instructions and information on warning signs. A return visit or phone check within a few days can improve safety.

Community leaders, youth groups, and men can support women by reducing stigma and by encouraging timely visits for family planning. Public communication that explains which methods are available each week at local clinics can save wasted trips. That transparency also builds trust as the system works to restore steady supply.

Key Points

• Public health facilities across Nepal have faced months without Depo Provera and intrauterine devices, with only small emergency reserves in some provincial warehouses.
• Causes include two years of delayed purchasing, a stronger dollar that raised import costs, tight budgets, and a pause in USAID support that shifted more clients to public clinics.
• UNFPA backed supplies have arrived and are being routed, yet distribution and fresh procurement will take time to stabilize stock.
• Unmet need for family planning among married women is 21 percent, about half of pregnancies are unintended, and close to two thirds of those end in abortion.
• Roughly 100,000 abortions occur each year in authorized facilities in Nepal, with additional cases likely going unrecorded.
• In Karnali and Bagmati, provincial stores reported minimal or no supply, prompting rationing, facility to facility sharing, and missed appointments for repeat injections.
• Temporary alternatives include pills, condoms, and implants where available. Sayana Press could help if training and supply expand.
• Short term steps include prioritizing repeat Depo users and postpartum clients, real time stock reporting, and transfers between nearby facilities.
• Longer term fixes include multi year contracts, diversified suppliers, buffer stock, and early warning tools in the logistics system.
• Clients should check with nearby facilities about current stock and use legal, safe services for abortion and counseling while the system restores supply.