A Study on Family Planning Needs of Migrant Couples in Nepal

∼Terms of Reference (ToR) ∼
A <strong>Study</strong> on Family Planning Needs of Migrant Couples in Nepal
Nepal Family Health Program II (NFHP II) is soliciting proposals from consulting firms experienced in
qualitative research methods for the conduct of a study on Family Planning Needs of Migrant Couples in
Nepal. The proposal should contain a brief background, detail methodology for the study including selection
of study districts and study subjects, sample size, activity schedule, key personnel with their CVs, an
estimated budget with detailed line items, and an organization profile. A brief background, objectives of the
study and a broad idea on methodology are provided in this ToR.
1. Background
NFHP II aims to improve the delivery and use of public sector services such as family planning (FP),
maternal, newborn and child health (MNCH) with the aim of strengthening the local capacity to provide
these basic health services. Past Demographic and Health Surveys (1996, 2001 and 2006) show that there has
been almost a 2 percent increase per year in Contraceptive Prevalence Rate (CPR) in Nepal. However, the
2009 NFHP II Mid-term Survey revealed that in rural areas of Nepal, there has been a very slow increase in
CPR since 2006, accounting only for a 1 percent increase within a three-year period. This study also
documented spousal separation as one of the major contributing factor for slowing the past trend in use of
FP.
Foreign migration has, over the years, become a major feature of Nepal’s economy and society. Work
migration is highest in the rural western hills, engaging 45 percent of men. 1 Although Nepali workers
migrate to several countries in the Middle East and even Europe, the major destination for about 77% of the
migrating population is India. 2 An estimated 60,000-1.3 million Nepalese migrate to India alone, for seasonal
or long-term work, engaging in manual labor jobs in industry, construction work, agriculture, or the service
sector. 3 Nepal government statistics reports that for the period from 1993 to 2009 nearly 1.4 million Nepalese
went to countries other than India for employment. 4 It is likely that these figures underestimate the actual
volume. A paper based on analysis of NDHS 2006 data reports that at the time of the survey about 13% of
the population (~3.5 million people) had been away from home for more than 6 months 5 . Another recent
survey 6 estimated that 44% of households in Nepal have at least one member currently living either abroad
or elsewhere in Nepal.
The NFHP II mid-term survey 2009 reported that husbands of nearly one-third (32%) of the rural women
were living away from them at the time of the survey, and this trend is increasing. With regards to pattern of
migration, more than one-half (54%) of the husbands were away for less than six months, with median
duration of away being five months. The most frequent destinations for shorter durations of time have been
to Nepal and India, while migrants seem to choose other countries for longer durations of time. The survey
also reported that less than one-quarters (23%) of the separated couples used contraceptives whereas it was
nearly three-fifths (62%) among couples living together. Similarly, the use of contraception decreases as the
duration of separation increases. Furthermore, wives of migrant husbands were younger, had a smaller
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number of children, and had much higher level of unmet need than those women who were living together
with their husbands at the time of the survey.
2. Rationale
Women whose spouse has been living away from them for a considerable amount of time may have different
reproductive health and FP demands as compared to those women whose husbands usually stay with them.
Due to spouse separation, the women might not use FP methods regularly. In addition, there is less likely of
sexual relationship outside the marriage union in Nepal. As a result, when their husbands return home for a
short period of time, they are unprepared and also less likely to use FP methods. Consequently, there is a
high possibility of unplanned and unwanted pregnancies. Unwanted pregnancies expose women to additional
health risks by increasing the number of lifetime pregnancies, inadequate birth spacing, more deliveries, and
also induced abortions pushing women's life to further risks. Because of all these, there is a need of an
initiative that will help this subset of population for adoption of FP for improved maternal health, decreased
abortion rate, planned pregnancy and preparedness, spacing and child survival.
Past studies conducted by New ERA and Family Health International on population mobility and risk
behavior among migrant populations focus primarily on the transmission of STDs and HIV/AIDS because
the migrant population is of a sexually active age, thus creating conditions that may be conducive to the
transmission of HIV and STDs when the infected migrant males return home with the virus and infect their
wives. Family Planning Association of Nepal (FPAN) have reported that labor migration has made the young
population at high risk of having unwanted pregnancies in addition to STI/HIV infection, reporting this
vulnerability as partly due to limited access to youth friendly sexual and reproductive health information and
services. 7 Despite these brief references, no robust studies have been conducted to study migration of males
and use of FP. Therefore, a study to explore the perspectives of the migrant couples and other concerned
people has become necessary to meet the FP need of the migrant population in an effective way.
3. Research questions
The key questions guiding this study are:
1. What is the pattern of sex and use of FP methods when the migrant husband comes to visit their
wives?
2. Do the migrant couples discuss on FP when they meet each other? How often do they discuss? Do
they plan and prepare before having sex?
3. What is the level of knowledge and utilization of reproductive health services while their husband is
away/comes to visit?
4. What is the pattern of separation by duration of migration and destination?
5. How to improve FP practices among the migrant couples?
6. What is the chance of abortion due to lack of FP among the migrant couples?
7. What are the possible ways to avoid unwanted pregnancies when migrant couples meet each other?
8. How to meet the overall FP need of the migrant couples?
9. What barriers stopped women from using FP methods despite their interest?
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4. Objectives
The main objective of the study is to know the perspectives of the migrant couples and other key informants
to meet the overall FP needs of the migrant couples.
The specific objectives include to:
1. Assess the knowledge of migrant couples about FP methods and identify perceived FP needs along
with planning and preparedness,
2. Find out sexual behavior of migrant spouses and use of FP when the couples meet each other,
3. Identify the barriers for not using FP by the migrant couples,
4. Explore the incidence of unwanted and unplanned pregnancies, outcomes of such pregnancies, and
their knowledge about health consequences as a result of unplanned pregnancies,
5. Identify ways to reach FP information and services to married migrant population from the migrants
and key informants perspectives particularly when the couples meet each other.
5. Proposed Methodology
5.1 <strong>Study</strong> Design: This will be a qualitative study. Because of this, the design should be such that it targets
the subjects who can reliably inform about the research questions rather than represent an overall population.
The design should help programmers understand the phenomenon of FP need of migrant couples.
5.2 <strong>Study</strong> Area: A total of six districts with high out migration, both within and outside Nepal should be
proposed for the study. As the results of the study are anticipated to provide inputs in developing a national
FP strategy to address the needs of migrant populations, the districts chosen should represent geographical
zones as the destination of migration also differs by geographical region. Therefore, 3 districts from
Hill/Mountain areas and 3 districts from Plain areas should be proposed, with their distribution being in
various development regions within Nepal.
5.3 <strong>Study</strong> Subjects: The study subjects are married couples who meet at least one of the following criteria:
• Wives whose husbands are away from home at present,
• Wives of childbearing age whose husbands usually stay outside but are at home at present, and
• Husbands who have wives of reproductive age and who are currently at home but usually live away
from home.
5.4 <strong>Study</strong> Methods: In-depth Interviews (IDI), Key Informant Interviews (KII), and Focus Group Discussion
(FGD) should be used to collect information. IDI will be conducted with the migrant males and their wives.
The wives whose husbands are currently staying outside their home and the husbands who have recently
returned home from outside temporarily or permanently should be interviewed. Moreover, FGDs will be
conducted with the above categories of respondents. KIIs will be organized with District Public Health
Offices (DPHO) and supervisors, Female Community Health Volunteers (FCHVs), health workers, school
teachers, Health Facility Operation and Management Committee (HFOMC) members, and local leaders as
appropriate. The consulting firm should propose the number of IDIs, KIIs and FGDs per district with proper
justification.
5.5 Selection of <strong>Study</strong> Sites: <strong>Study</strong> subjects should be purposively selected with initial screening procedure
to recruit the different category of respondents. We propose that in each district, 2 VDCs with high out
migration is identified from secondary data sources and also in consultation with DPHOs/DDC. From each
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of the VDCs, wards or communities should be further identified, followed by identifying the respondents
themselves in consultation with FCHVs and VDC Secretary.
The duration of husband-wife separation is one of the important dimensions of this study design because it is
likely that the FP needs of the migrants vary by their duration of separation. More importantly, the risk of
pregnancy is associated with the meeting frequency between wives and husband regardless of the duration
away from each other. Because the wives of those migrant husbands who are the frequent visitors to their
homes are at higher risk of pregnancy. Therefore, the sample should include respondents who have spousal
separation for both shorter and longer durations of time, including those who are likely to meet at least once
or twice a year. Another important characteristic of the respondents to consider during their selection is
caste/ethnicity.
5.6 Analysis: The findings of the study should be analyzed according to the research question and objectives
disaggregated by key characteristics of the study subjects in relation to their caste/ethnicity, age, ecological
zone, duration of separation, reason for migration and place of migration.
6. Scope of Work
The consulting firm should work in close coordination with NFHP II Monitoring and Evaluation team to
carry out the study. NFHP II will provide necessary technical support in finalizing methodology and study
instruments and information analysis. Following will be the scope of work for the consulting firm.
• Design and develop detail methodology for the study
• Develop and finalize instruments and share with NFHP II
• Recruit capable field researchers and train them
• Conduct field work to collect information
• Outline the format for report and share it with NFHP II
• Analyze the collected information
• Prepare draft report and share it with NFHP II
• Finalize report
• Present the findings of the study in appropriate forums organized by NFHP II
The consulting firm cannot subcontract whole or any part of the above activities without the prior approval
of NFHP II.
The consulting firm including the proposed human resources should have demonstrated background and
experience in conducting qualitative research.
7. Deliverables
The selected consulting firm is liable to deliver the followings to NFHP II:
• Research instruments both in English and Nepali.
• Draft report for review and comments.
• Five hard copies of the final report and an electronic copy both in word format and pdf format.
• Electronic copy of raw data and dummies.
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8. <strong>Study</strong> Duration
The consulting firm should develop a detailed study implementation plan and share it with NFHP II. The
entire duration of the study should not exceed four months from the date of signing the contract.
9. Cost Estimation
The consulting firm should submit a realistic and competitive survey cost estimates for cost comparisons and
eventual contract negotiations. The cost estimates should be in major headings with detailed breakdown by
activities under each heading.
10. Submission of Proposal
Consulting firm is required to submit two hard copies of the proposal to NFHP II. Please also include a copy
of tax registration and clearance certificate along with the proposal. The envelop of the proposal should be
marked 'A study on FP need of migrant couples in Nepal' and reach the following address by close of
business May 23, 2011. NFHP II reserves rights to accept or not to accept the proposal. Telephone enquiries
will not be entertained.
Team Leader/Sub Agreement and Procurement
Nepal Family Health Program II
Oasis Complex, Third Floor
Patan Dhoka, Lalitpur
References
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2
3
4
5
6
7
Resilience Amidst Conflict- An Assessment of Poverty in Nepal 1995-96 and 2003-2004-Chapter 4- The Impact of
Migration and Remittance.
Addressing the Needs of Nepali Migrant Workers in Nepal and in Delhi, India, Mountain Research Development
2005.
UNGASS National Report- Nepal, 2005.
Ministry of Labor and Transport Management (MOLTM), Data Sheet. www.dofe.gov.np. Department of
Foreign Employment, Government of Nepal, Kathmandu, Nepal: MOLTM, 2009.
Thapa S, Declining Trends of Infant, Child and Under-5 Mortality in Nepal, Journal of Tropical Pediatrics, 2008,
54(4): 265-8.
Central Bureau of Statistics (CBS), Report on the Nepal Labor Force Survey 2008. National Planning Commission
Secretariat, Government of Nepal, United Nations Development Programme, and International Labor
Organization, Kathmandu, Nepal: CBS, 2009.
FPAN, Annual Work Program Budget 2010- Overall Program Summary.
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