Trends and Determinants of Unmet Need for Family Planning Among Adolescent Girls and Young Women Aged 15-24 Years in Nepal: Evidence from Three Demographic and Health Surveys.

INTRODUCTION: Unmet need for family planning (UNFP) among adolescent girls and young women (AGYW) remains a major public health concern because it contributes to unintended pregnancy and adverse reproductive health outcomes. Although Nepal has expanded family planning programs over the past decade, evidence on trends and factors associated with UNFP among AGYW is limited. This study assessed trends and factors associated with UNFP among currently married AGYW aged 15-24 years using nationally representative data from the 2011, 2016, and 2022 Nepal Demographic and Health Surveys. STUDY DESIGN: Data from currently married AGYW aged 15-24 years were analyzed. UNFP was categorized as unmet need for spacing or limiting, defined as non-use of contraception despite intending to delay or stop childbearing. A binary overall UNFP variable (no unmet need vs. total unmet need) and a multinomial UNFP variable (no unmet need, unmet need for spacing and unmet need for limiting) were analyzed. In the first case, modified Poisson regression with robust standard errors was used to estimate Adjusted Prevalence Ratios (aPRs), while, in the second case, multinomial logistic regression was performed to calculate adjusted Relative Risk Ratios (RRR) for UNFP related to spacing and limiting needs, compared to no UNFP. All statistical analyses were performed using R version 4.6.1. RESULTS: Overall UNFP declined from 39.1% (95% CI: 36.5-41.7) in 2011 to 29.0% (95% CI: 26.6-31.3) in 2022. In the Poisson regression analysis, AGYW with one living child (2022: aPR = 1.67, 95% CI: 1.36-2.06) or two or more living children (2022: aPR = 1.65, 95% CI: 1.29-2.11) and those living in female-headed households (2022: aPR = 1.20, 95% CI: 1.04-1.37) had a higher prevalence of overall UNFP, whereas AGYW from rich households had a lower prevalence (2022: aPR = 0.69, 95% CI: 0.57-0.84). Multinomial regression showed that AGYW aged 20-24 years were less likely to report unmet need for spacing than those aged 15-19 years in 2016 (RRR = 0.67, 95% CI: 0.51-0.88). AGYW with one living child were more likely to report unmet need for spacing (2022: RRR = 1.86, 95% CI: 1.37-2.52), whereas those desiring three or more children were less likely to report unmet need for limiting (2022: RRR = 0.47, 95% CI: 0.24-0.93). CONCLUSION: Despite a decline in UNFP among married AGYW between 2011 and 2022, nearly three in ten still reported UNFP in 2022, indicating a persistently high burden. Reducing this gap requires youth-friendly contraceptive counselling, improved access to preferred contraceptive methods, stronger FCHV-facility referral linkages, greater male involvement and couple-based family planning counselling, and interventions that address socioeconomic barriers and support informed fertility decision-making.