Mapping the consumer journeys of Nepalese youth to access voluntary family planning & contraception* Dr. Lhamo Yangchen Sherpa, Senior Manager Strategic Evidence and Research, Population Services International– Nepal; Mahesh Paudel, Regional Researcher, Population Services International; Sushma Rajbanshi, Research Specialist Population Services International—Nepal; and Rebecca Husband, Technical Advisor, Population Services International *Please note: in Nepali all FP methods are referred to as “Pariwar Niyojan.” “Pariwar” translates to “family” and “Niyojan” most closely translates to “control” or “stop,” but not “planning.” We use both terms in the title – voluntary family planning and contraception – to reflect the ways in which women and men talk about family planning, respectively. To simplify, we use “family planning” to represent both terms below. FIG 1. Journey Map: Newly Married Female BACKGROUND Family Planning (FP) is one of Nepal’s Ministry of Health’s priority programs. The existing program aims to foster equitable access and utilization of quality FP services throughout the country. Between 1996 and 2006, Nepal showed progress in improving the modern Contraceptive Prevalence Rate (mCPR) from 26%  to 43% (DHS 1996 & 2016), but this momentum has not been maintained. Between 2011 and 2016 use of modern methods has remained stagnant, as has the percentage of young women aged 15-19 who have given birth. It is clear that Nepal's FP market is failing sub-regions and certain market segments. FIG 2. Journey Map: Unmarried Female METHODS A qualitative field survey using 47 in-depth interviews and 9 focus group discussions (14th October to 7th November 2017) Three major geographical areas covering urban, urban slum and rural areas in demographically diverse districts Three populations: primary respondents: unmarried males and females aged 15-24 years  primary respondents: females, newly married aged 20-24 years secondary respondents: female community health volunteers, mother's groups, youth groups, husbands of married women and service providers To align with the research objective of measuring the key influencers and barriers to voluntary FP method use, the study recruited primary respondents who stated they were sexually active or who did not engage in frequent sex but had experienced a sexual encounter at least once at the time of the interview Consumer journey maps were created for the three populations FIG 3. Journey Map: Unmarried Male CONCLUSION Our market analysis of these consumer journeys pinpointed the weakest areas in consumers’ experience, and what market failures exist at those points, including: Both married and unmarried young women expressed a lack of agency in making decisions about accessing voluntary FP services and products. Young married females’ FP method choices were heavily influenced by parents, in-laws, and providers themselves. While there was relatively more communication and partner involvement among young unmarried females, they were largely dependent on partners to acquire voluntary FP methods. These groups need differently tailored messages of empowerment regarding access to voluntary FP. Unmarried youth viewed public providers as unfriendly and biased toward married clientele, and accordingly private outlets are an important source of voluntary FP for unmarried youth in Nepal. This is also demonstrated by the method choices these youth felt are most accessible, such as emergency contraceptive pills, which are principally available in private medical outlets. These findings correlate with the DHS 2011 showing the public sector as a decreasing source of contraceptives for youth since 1996. Also, while school curricula includes discussion of FP and life skills, some teachers are reluctant to teach this content, and many youths from rural and urban slum areas drop out of school before this subject is taught. Our data also show that privacy and counseling for youth in the private sector can be greatly improved, which is supported by findings in the 2016 DHS. Addressing these barriers will require scale up and reinforcement of youth friendly service approaches in both the public and private sector, and provision of information in non-school settings. RESULTS Young married and unmarried females in Nepal perceive and use voluntary FP methods differently Unmarried youth often feel they have limited FP method choices and often describe the only options available as condoms, emergency contraceptive pills (ECPs) and withdrawal Unmarried youth are unlikely to visit public providers due to lack of privacy and a perception that providers have a negative opinion towards them. However, privacy and counselling in the private sector are also weak Young married couples often seek FP only after the birth of their first child due to misconceptions about FP and infertility, as well as social and parental pressure Youth report relatively easy geographic access to short-acting FP products in the private sector, with cost not being a critical issue population-services-international PSIhealthylives Lhamosherpa@psi.org.np @PSIimpact