Situation Analysis: The maternal mortality rate is 515 deaths per 100,000 live births (CBS 2001). Significant proportion (18.9%) of maternal deaths occurs in adolescent age groups and there is also high prevalence of chronic energy deficiency among adolescent girls. Most of teenager mothers die due to the cause of childbirth. (Morbidity Study, 1998)

In Nepal, about 89% of all women deliver babies at homes and a nurse or doctor attends only 10.9%. The childbearing age (15-49 years) constituted 23% of the total population. (DHS 2001)

The total fertility rate for Nepalese woman age 15-49 is high (4.1 births per woman). There is a large difference in fertility by urban woman (2.1) and rural woman (4.4). There is also difference in fertility between the mountain (4.8) and other ecological regions (Terai-4.1 and Hills-4). There is a strong association between fertility and education. The TFR of women with no education (4.8) is more than double that of women with at least school leaving certificate (SLC) of education (2.1). The chances of Nepalese women suffering from pregnancy complications are very high and consequently this risk increases as these women undergo multiple pregnancies during their reproductive age (DHS 2001).

The knowledge of at least one modern method of family planning is nearly 100 percent. The total demand for family planning is 67 percent, of which 39 percent currently married women were satisfied and rest of 28 percent women still not getting family planning services. Unmet need is twice as high among women in rural areas (29%) as among women in urban areas (15.8%) (DHS 2001).

Anaemia is a serious problem throughout the lifecycle in Nepal. More than 78% of preschool children, 75% of pregnant women and 68% of non-pregnant women suffer from anaemia in rural area of Nepal. (Hellen Killer International, various reports -1998)

The doctors, nurses/paramedics are not easily available even at district level Government hospitals. Most of the hospitals are without required doctors and staff nurses in hilly and mountain regions. Doctors and nurses are not willing to go to remote districts. Rather, they are mostly concentrated in urban areas. It is ultimately difficult to get trained service providers in rural areas to provide RH, including abortion services. Another major concern is the behaviour of service provides which is not satisfactory as expected in Nepal.

Strategic Direction: Increase access to right based quality SRH services focusing on poor, marginalized & internally displaced people (refugees, youth, women, etc) by expanding gender sensitive service facilities in rural settings

Goal: All people, particularly the poor, marginalized, the socially-excluded and underserved are able to exercise their rights, to make free and informed choices about their sexual & reproductive health, and have access to SRH information, sexuality education and high quality services including family planning

Objectives: To increase availability of gender sensitive SRH information & services including family planning in rural setting of FPAN's operational areas.

Activities:

• Conduct baseline survey to maintain database on SRH related issues
• Conduct workshop/seminars with different stakeholders to disseminate information relating to SRH issues
• Organize campaign in support of sexual and reproductive health and rights of marginalized, disadvantaged and internally displaced people
• Develop IEC materials relating to SRH issues targeting to the poor, marginalized, the socially-excluded and underserved community
• Conduct orientation programmes to aware community people on various issues of SRH including men's roles and responsibilities on women's SRH rights
• Provide necessary skills to the service providers for ensuring quality services
• Establish service delivery points in rural setting of FPAN's operational areas to provide SRH services including family planning focusing on poor, marginalized & internally displaced people (refugees, youth, women, etc)
• Establish working relationship with other agencies to provide SRH services
• Conduct various income generating activities and small scale programs to uplift the socio-economic status of poor, marginalized and internally displaced people with particularly focus on women
• Review FPAN structure from gender perspective to make the Association more gender sensitive
• Document processes of successful implementation of programmes
• Undertake end line survey/studies to measure impact of the programmes Outcome Increased utilization of SRH including family planning services among underserved and marginalized people in FPAN's operational areas Increased awareness on SRH among poor and marginalized population Indicators of success Profile of clients (Age, Sex, Income etc) served by FPAN Results of survey Finding of periodic assessment.

Outcomes and Indicators: