Nepal's Contraceptive Shortage Leaves Clinics Rationing Birth Control Shots and IUDs

Small reserves leave women without their usual contraception

Bagmati Province's Health Logistics Management Centre has just 200 doses of Depo Provera and 350 intrauterine devices reserved for emergencies, while routine supplies to health posts have stopped for months. In Karnali, Jajarkot's Health Office reported about 50 doses of the injectable contraceptive remaining at one point, and the district hospital had roughly a dozen. The provincial logistics centre had nothing to send.

As of November 7, 2025, public clinics and hospitals across Nepal are struggling to provide basic family planning methods. Depo Provera and intrauterine devices, commonly called IUDs, are among the hardest to find. Implants and other contraceptives have also been scarce at different points this year. Staff have been turning clients away or asking them to accept another method that may not suit their needs.

Officials trace the shortage to purchasing delays stretching back about two years, higher import costs as the Nepali rupee weakens against the dollar, and tight public budgets. The suspension of USAID support to private providers early in 2025 added pressure by sending more people to government facilities whose supplies were already running low.

The Ministry of Health and Population says procurement has restarted. A shipment supported by the United Nations Population Fund, or UNFPA, has also reached Nepal for distribution to provinces. Supplies will take time to reach districts, however, and no date has been given for restoring a steady supply nationwide.

For women who depend on a repeat injection every three months, the shortage interrupts an established routine. For those seeking an IUD, it closes off a method that can provide years of protection. Nepal continues to promise free contraception through public facilities, but delayed purchasing and insufficient funding have left many clinics unable to deliver it.

Why government purchases stalled

Nepal imports most contraceptives bought for public facilities. When the rupee weakens against the dollar, purchasing the same quantity requires more money in local currency. A budget that previously covered an order may therefore fall short even when the number of doses stays unchanged.

Tenders issued in 2024 failed because suppliers submitted bids above the available spending ceilings. A tender is the process through which the government asks suppliers to compete for a contract. If their prices exceed the money available, the purchase can stall before any supplies are ordered.

Several health programmes also learned during planning meetings that their budget ceilings for the coming year would be lower. Agencies warned that essential services would have to be cut if those limits stood. Family planning commodities face this pressure alongside HIV services, nutrition programmes, and care for mothers and newborns.

Central and provincial warehouses have gradually run down their stores. Restarting procurement involves preparing specifications, inviting bids, evaluating them and arranging delivery. Each stage takes time, leaving facilities dependent on limited reserves, transfers and partner support while government purchases move forward.

The aid pause brought more clients to public clinics

The suspension of United States assistance to many partners early in 2025 created a second shock. Some private organisations had used USAID support to provide free or subsidised contraception, counselling and outreach. Several paused free counselling and clinics when that support stopped.

People who had used those services still needed contraception. Many turned to government health posts, increasing demand in a system already affected by delayed procurement. The aid pause added to an existing shortage rather than starting it.

One centre under the Ministry of Health and Population reported a reduction of 55 million rupees in its budget ceiling for the next fiscal year. It warned that essential services, including treatment and testing, would suffer. The Ministry of Finance has reportedly set a health expenditure ceiling several billion rupees below the previous year's level.

Training for health workers, nutrition activities such as vitamin A programmes, and public awareness work have been delayed or redesigned. Family planning supplies must compete with these and other urgent health costs, making it harder to rebuild stocks while serving the additional clients arriving from private services.

What the shortage looks like in districts

Jajarkot's remaining stock illustrates how little room some facilities have to manage demand. About 50 Depo Provera doses at the Health Office and roughly a dozen at the district hospital offered only a limited supply. With no stock available at Karnali's provincial logistics centre, officials asked the federal level for help.

Bagmati's warehouse has retained its 200 injectable doses and 350 IUDs for emergencies while stopping routine distribution. These reserves are therefore unavailable for the regular flow of orders that health posts need to maintain appointments and start new clients on their chosen methods.

Health workers have tried borrowing supplies from nearby facilities. Those facilities often face the same shortage. Some provinces have asked sites with any surplus to share with those that have none, but transfers depend on there being stock somewhere within reach.

Women in mountain districts may walk for hours to reach a clinic and discover that their usual method is unavailable. Rain and landslides can block roads, causing some women to miss the window for repeat injections. A prolonged gap can lead someone to switch to a less preferred method or stop using contraception entirely.

Rationing and improvised transfers have continued for months. Distance makes those disruptions especially difficult: a wasted visit may mean another long journey, while a delayed appointment leaves a woman needing advice about how to prevent pregnancy until her preferred method becomes available.

Why Depo Provera and IUDs matter

Depo Provera is an injection containing only progestin, a hormone, given every three months. It often stops ovulation, the release of an egg, and thickens cervical mucus, making it harder for sperm to pass through. Many women choose it because it is private and requires no daily action.

A quarterly clinic visit can be easier to manage than remembering a pill every day. Missed repeat injections can quickly expose a woman to pregnancy risk, however. Women whose partners work away from home may also value an injectable method because it lets them plan without discussion when they fear social pressure.

IUDs are devices placed inside the uterus by a trained provider. They are long acting and reversible, meaning they can prevent pregnancy for an extended period and can be removed. A copper IUD can work for up to ten years, while a hormonal IUD can provide protection for several years.

Once inserted, an IUD requires little follow up and offers reliable contraception at a low cost over time. It can suit women who want to space births or avoid further pregnancies. Shortages prevent providers from offering it to new clients and complicate counselling after childbirth, when many women want a method before leaving hospital.

A gap in prevention carries a human cost

Nepal's Demographic and Health Survey of 2022 found that 21 percent of married women wanted to delay or avoid pregnancy but were not using a contraceptive method. This is known as unmet need for family planning. A shortage makes it harder to meet that need even when a woman reaches a health facility and asks for help.

UNFPA estimates indicate that about half of pregnancies in Nepal are unintended and close to two thirds of those pregnancies end in abortion. Around 100,000 women obtain abortions each year at authorised facilities. The true number is likely higher because some abortions are not recorded.

Nepal has progressively expanded legal abortion access since 2002 within a defined framework intended to improve safety. A contraceptive shortage can nevertheless push more women towards procedures they had not planned, including some carried out in unsafe conditions.

Rural districts in the far west have low use of modern contraceptive methods and regular reports of women seeking help late in pregnancy. Stigma adds another barrier, particularly for unmarried young people and women whose husbands migrate for work. Reliable access at a nearby clinic is especially valuable for people facing these pressures.

The dates behind the current situation show how an existing need has met a growing supply problem:

• Since 2002, Nepal has progressively expanded legal abortion access to improve safety.
• In 2022, the Demographic and Health Survey recorded unmet family planning need among 21 percent of married women.
• Government purchasing delays stretch back about two years, and tenders issued in 2024 failed when bids exceeded spending ceilings.
• Early in 2025, the pause in USAID support disrupted services at some private organisations and increased demand at public facilities.
• By November 7, 2025, routine supply remained interrupted in affected areas, while procurement had restarted and a UNFPA supported shipment had arrived.

Pharmacies become another route to abortion care

A recent study in Eastern Nepal found that mystery clients could obtain mifepristone and misoprostol without a prescription at about two out of five community pharmacies. The medicines are used for medication abortion. Mystery clients are people who approach a service as customers so researchers can assess what happens in practice.

The prices charged were usually higher than pharmacy staff had reported. Some workers asked useful questions about the timing of pregnancy and possible side effects, but training was uneven. Clients therefore encountered differences in both cost and the information they received.

When contraception becomes harder to obtain, reliance on routes such as pharmacies tends to rise. The study points to a need for better training on correct dosing, danger signs and referral, alongside accurate public information about where legal and safe abortion services are available.

New supplies offer relief while distribution continues

A shipment supplied through UNFPA has reached Nepal and is intended for distribution to provinces. Condoms, pills and some implants provided through partners have also helped in recent weeks. These deliveries can reduce pressure, but they do not fully cover the missing injectables and IUDs.

Managers will need to prioritise current Depo Provera users whose repeat doses are due and women seeking contraception immediately after childbirth. Clear criteria can help facilities allocate limited supplies fairly rather than leaving each clinic to make decisions without a consistent approach.

Government purchases are moving through the procurement system, according to officials. Until those orders arrive, transfers between facilities remain a practical option where surplus stock exists. Accurate reporting through the logistics information system can help staff identify supplies and move them to clinics with none.

Reporting stock levels in real time can also reduce the chance that a small quantity sits unused in one district while a neighbouring clinic runs dry. Receiving a shipment nationally is only one stage of recovery; supplies must then reach provincial stores, districts and the facilities where clients seek care.

Which alternatives could reduce pressure?

Sayana Press, a lower dose injectable formulation delivered through a small device, has been introduced in some districts. Trained health workers can administer it. In many countries, clients can also give themselves the injection after counselling, while professionals currently provide it in Nepal.

Wider use would require supplies, training and clear guidance. It could help reach women in remote areas who struggle to return for an injection every three months. Any expansion would still depend on dependable purchasing and delivery.

Pills, condoms and implants, where available, offer other choices during the shortage. Correct and consistent pill use prevents many pregnancies when support is available. Condoms protect against both pregnancy and infections. Emergency contraception can be used within a short window after unprotected sex and should be explained without stigma.

Men also have a role in family planning. Vasectomy uptake is low, although the method is safe and effective for couples who have completed their families. Counselling should help people consider available options without pushing them towards a method that does not fit their preferences or circumstances.

Safe abortion services remain part of reproductive care. Better information and referral are needed alongside efforts to restore contraception, especially where people already obtain medication abortion pills through pharmacies.

Changes that could prevent repeated shortages

Contracts covering several years could allow Nepal to place periodic orders for core contraceptives without starting a fresh tender each time. Price adjustment clauses tied to currency movements could help prevent a weakening rupee from stopping contract awards. Using several suppliers could also reduce dependence on a single delivery.

Rebuilding buffer stocks would provide protection against late tenders and transport delays. A national target of several months of supply for each method, held at central and provincial levels, would give managers more time to respond before clinics run out.

Early warning dashboards within the electronic logistics system could flag falling stock and trigger transfers before clients encounter a gap. Provinces could place additional supplies in mountain districts before the monsoon, when blocked roads make replenishment harder.

Joint procurement with United Nations agencies could help bring in supplies while national tenders progress. Quality checks and regulatory controls would remain necessary to protect patients. Investment in local packaging or assembly could shorten delivery times for some commodities over time, although raw materials would still come from abroad.

These are practical options for reducing repeated interruptions. The immediate task remains getting available supplies to facilities and completing purchases, while longer contracts, reserves and better stock information could make future shortages less likely.

What clients and communities can do now

Women due for a repeat Depo Provera injection should contact their nearest health facility to ask about stock, other sites or an interim method. Health workers can advise on switching methods and any waiting period needed when an injection is delayed. Someone seeking 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 their health and provide counselling. Pharmacy workers often help in practice, but clients should ask for clear instructions and information about warning signs. A return visit or telephone check within a few days can improve safety.

Community leaders, youth groups and men can support women by reducing stigma and encouraging timely family planning visits. Public updates explaining which methods are available at local clinics each week could save wasted journeys and help maintain trust while steady supply is restored.

Key Points

• Public facilities across Nepal face shortages of Depo Provera, IUDs and, at different points this year, other contraceptives.
• Bagmati holds 200 injectable doses and 350 IUDs for emergencies; routine supplies have stopped for months.
• Purchasing delays, higher import costs, tighter budgets and increased demand after the USAID aid pause have strained stocks.
• Government procurement has restarted, and a UNFPA supported shipment has arrived for distribution.
• The 2022 survey found unmet family planning need among 21 percent of married women.
• UNFPA estimates about half of pregnancies are unintended, with close to two thirds of those ending in abortion.
• Temporary options require counselling and available stock; repeat injection users should contact facilities for advice.
• Proposed responses include transfers, stronger stock reporting, buffer supplies and contracts covering several years.