Access to critical family planning choices continued to widen in 2024 with UNFPA support. On a policy level the government delivered on its commitment to increase national budgetary allocations as part of the compact agreement with UNFPA.

Family planning commodities were supplied through the UNFPA Global Supplies Partnership Programme to health centres and mobile clinics. These included 97,000 implants, 738,000 vials for injectables, 922,320 oral contraceptive pills, 2,000 intrauterine contraceptive devices and 1,800 emergency contraceptives. A further 12.7 million condoms were supplied that are available free to users.

The increase in the availability of Sayana Press to 20 districts across all seven provinces of Nepal was a major milestone in 2024, widening choice for women and their families and how they plan their families. Within a 12-month period, 80,000 vials were administered, benefiting over 38,000 new users.

In 2024 a community conversation model of outreach called ‘guftagu’ was introduced to encourage men to more actively engage in sexual and reproductive health and rights. The attitudes of participants in this scheme towards family planning and maternal health issues showed marked improvement following participation in the sessions, with a 19 percent rise in willingness to use family planning services, a 34 percent increase in support for cervical cancer checks, and a 44 percent rise in HPV vaccination support. Practices improved too, with a 14 percent increase in family planning use.

A nationwide assessment of 115 hospitals offering comprehensive emergency obstetric and newborn care facilities was completed in 2024.

With technical assistance from UNFPA, the Ministry of Health and Population has adopted a standard light assessment tool for assessing the capacity of emergency obstetric and newborn care services and the efficiency in the allocation of resources.

Using the assessment’s findings, UNFPA facilitated the first prioritization and optimization exercise using GIS/AccessMod in Gandaki province, which identified inefficiencies in the current maternal health service delivery system. The evidence-based prioritization exercise revealed that the emergency obstetric and newborn needs of the province could be met by 29 facilities, which is far fewer than the existing 52 hospitals that provide these services.

This initiative, which will be expanded nationwide, provides the foundation for expanding the light assessment tool and prioritization nationally for improved decision-making and future planning for quality maternal health services and more efficient use of resources allocated to safer births.

Essential equipment was also provided to 76 health facilities in 16 municipalities to bridge critical gaps and enhance sexual and reproductive health and rights, especially in emergency obstetric care, integrated family planning services, and the management of reproductive morbidities including cervical cancer.

During UNFPA-supported mobile camps, 4,604 women were screened for pelvic organ prolapse, which resulted in the identification of 565 cases requiring treatment. These women were all referred for treatment. In 2024, 80 had completed surgery, 166 ring pessaries were inserted, 162 received thermocoagulation treatment and the remaining 157 women were referred for surgery.

An obstetric fistula door-to-door campaign that was conducted by 239 female community health volunteers was also conducted this year with UNFPA support. A total of 22,244 households were visited that facilitated the screening of 43,167 women aged 15 and above. A total of 115 suspected cases of stool and urine leakage were identified. Following further examination, three confirmed fistula cases were discovered, which resulted in surgical repairs.

In 2024, to further improve the availability of cancer screening, a number of outreach and training initiatives were supported. In the targeted areas there is an increase in both the numbers of women being screened and the detection of cancer.

In partnership with national training centres, cervical cancer screening and prevention training was conducted for 40 healthcare professionals. Orientation classes were organized for 567 female community health volunteers in screening and referrals. Following the sessions, these reached 14,000 women in home visits and community group meetings with critical information and advice.

Three municipalities also conducted visual inspections with acetic acid camps that 413 women attended. Of the total, 4.8 percent of these women were subsequently referred to the provincial hospital for further investigation following results suggesting signs of cancer. Eight doctors were also trained on colposcopy and loop electrosurgical excision procedures that have improved service quality and expanded access to essential cervical cancer care.

In 2024 gender-based violence survivors were able to access a range of critical services through our support to survivor-centred services in four provinces.

A total of 5,080 gender-based violence survivors received critical support at 18 one-stop crisis management centres. Supported by UNFPA, the case workers in the centres provided survivor-centred case management and psychosocial counselling services and referrals for survivors to access a comprehensive set of support services in the referral pathway.

In 17 shelter homes and safe houses, 2,313 gender-based violence survivors received specialized support. Secure accommodation for 1,348 vulnerable women was also provided that included a wide range of support services.

These services were supported by a pool of 169 community psychosocial workers who are mandated to make home visits and engage communities to identify vulnerable women and girls, counsel survivors and advise on referrals. During the year they directly engaged with 8,649 gender-based violence survivors, providing psychosocial first aid and referrals to support services.

These community psychosocial workers also reached 172,901 people in their community awareness campaigns going door-to-door and holding regular sessions with communities with a focus on high-risk groups.

To encourage closer community and family understanding of gender-based violence, a number of outreach schemes reached out to communities in 2024.

A total of 440 couples and 2,133 family members participated in gender-transformative couple discussions or family dialogue sessions to promote gender-equitable norms and understanding. These aim to prevent gender-based violence by fostering mutual understanding and shared responsibilities between partners and empathy within families. 4,814 individuals also participated in intergenerational dialogues to foster positive behavioural change across generations by engaging both men and boys, as well as women and girls, in meaningful discussions on gender roles, rights, and responsibilities.

At the leadership level, training for 109 leaders and public officials to strengthen gender-responsive planning and budgeting ensured the inclusion of gender-based violence prevention and responses, as well as sexual and reproductive health services in regular budgeting processes. 640 key leaders and civil society organizations also participated in gender-transformative discussions to increase understanding of gender-based violence and referral systems.

Local government authorities are increasingly taking over full responsibility for the sustainability and financing of these services provided to gender-based violence survivors. Supported by UNFPA advocacy and coordination efforts in 2024, key outputs are increasingly being transferred to local authority ownership.

Gender-responsive budgeting allocations in the 19 municipalities targeted in Koshi and Sudurpaschim demonstrated significant increases from 51 percent in the fiscal year ending 2023 to 63 percent in 2024.

As part of this increased commitment to funding a percent of the costs of case managers in one-stop crisis management centres, local authorities have increased their budget for these resources, from 25 percent in 2022 to 43 percent in 2024.

Of the 169 community psychosocial workers deployed as part of outreach to vulnerable households, 15 percent are fully funded by local authorities. The costs of a further 85 percent are now being shared. Overall, local authorities are now contributing 37 percent of the budget for these key workers, an increase from 21 percent in 2022.

In 2024, 10,296 adolescents, including 7,758 girls participated in the UNFPA supported ‘Rupantaran’ life skills programmes empowering them to make informed decisions about education, health, and marriage while fostering a gender-supportive environment.

The 260 UNFPA trained facilitators led sessions that provided a safe environment for girls to participate in a range of extra curriculum activities targeting the gender-based violence and harmful practices they are exposed to including child marriage and underage pregnancy. Further support to the network was added with the training of 77 additional facilitators to deliver training packages. Awareness training was also introduced to equip 161 facilitators with increased understanding of mental health issues.

To strengthen wider community support for young people 2,587 parents were involved in parenting packages, enhancing their awareness and commitment to delaying child marriage and supporting adolescent development. Intergenerational dialogues with 510 participants also acted to bridge traditional and modern perspectives, effectively challenging harmful gender norms.

Five ending child marriage strategies were endorsed by municipal authorities to prevent and work to eliminate child marriage providing for long-term sustainability through increased commitment at local level. To strengthen this, 446 local government officials, attended orientation sessions on these strategies, increasing their understanding of the root causes and consequences of harmful practices.

A total of 25, 378 adolescents accessed comprehensive sexuality education and their sexual and reproductive health and rights in adolescent friendly spaces in one of the 64 community schools supported by UNFPA. A further 72,580 school students received integrated sexual and reproductive health and family planning advice in UNFPA supported adolescent friendly health centres.

To strengthen teaching practices 341 teachers and 150 peer educators participated in comprehensive sexuality education capacity-building training programmes. A total of 83 health service providers from five districts also completed a five-day training on adolescent-friendly services using modern learning methods to improve access to services at healthcare facility level for young people.

Outreach schemes promoting awareness of sexual and reproductive health and rights reached 12,142 adolescent girls and boys in 2024. This included programmes to raise awareness of HIV/AIDS and the prevention of sexually transmitted diseases, and harmful practices.

Thematic analysis of the 2021 population and housing census data was completed in 2024 with the technical assistance of UNFPA. This year, four of the key thematic reports were published, and a further 12 are completed and awaiting publication. This year’s reports covered crucial issues for Nepal, including household dynamics and rapid urbanization providing planners and policymakers crucial evidence to base decision-making upon.

An analysis and review of further analyzes of the demographic health survey was carried out focused on determinants of gender-based violence and harmful practices and trends and determinants of adolescent marriage, childbirth, and unmet need for family planning.

A census visualization platform specifically designed to showcase data from the census was upgraded in 2024 with a wider range of data and functions, including a cross-tabulation module, local-level demographic profiles, population projections and an e-learning module introduced. The platform now has more than 325,000 users, with more than 100,000 repeat users.

To support evidence-based planning and government resource allocations, for the first time in Nepal, population projections until 2051 were developed, offering detailed annual estimates by age and sex at the ward level with technical assistance from UNFPA.

High-resolution small-area population estimates were created using small-area techniques, offering data by age and sex at a detailed 100m x 100m resolution. Municipality-level estimates for key indicators like family planning and domestic violence were also developed.

To improve understanding of how population dynamics influence wider trends including economic growth and public finances, a system of National Transfer Accounts was also introduced for the first time in Nepal, analyzing resource consumption, production, and sharing across age groups to inform age-responsive policies amid demographic change.

In 2024 UNFPA in Nepal and partners developed an artificial intelligence-powered system called ‘SITA’ to pilot test the potential for the acceleration of data analysis of big data surveys. The team developed a domain-aware artificial intelligence system that understands and interprets natural language queries using natural language processing and machine learning classifiers that instantly produce analytical outputs and reports from complex datasets.

To pilot the tool, data and analysis of the Nepal Demographic and Health Survey, which was conducted in 2022, was selected for the test with access granted to the database and the published analytical report. This allowed the pilot to assess the reproducibility of the artificial intelligence and analysis and the human-coded analysis. The results demonstrated wide-ranging cost and efficiency savings and 100 percent accurate reproducibility of human-coded analysis in tests.

The SITA has the potential to significantly reduce timelines in Nepal for data analysis and reporting for large-scale population surveys. Although still in its early stages of development, the integration of SITA into national platforms, research centres and the private sector can lead to sustainable and long-term efficiencies in translating data into actionable decision-making.

During 2024 areas of Nepal have witnessed severe impacts of earthquakes and river flooding as well as localized fires throughout the year.

The most significant of these events occurred in Karnali province. In this remote area, a 6.4 magnitude earthquake impacted an area of 1.3 million people, with 10,000s displaced and 250,000 vulnerable people directly impacted with major damage to infrastructure, services and buildings.

A second major disaster occurred in the low-lying areas of the Terai. As a result of heavy rain, riverbanks burst, causing extensive loss of life and damage across 21 districts of Nepal.

Partners together with UNFPA responded to these disasters as part of a joint response for humanitarian action to secure the rights of women and girls by providing support to essential sexual and reproductive health and gender-based violence response services in the areas most impacted.

Emergency responses included the rapid distribution of 7,850 winter kits and 17,144 dignity kits to women and girls in the most affected municipalities to ensure they were able to maintain hygiene and dignity.

Essential inter-agency emergency health kits were also dispatched to 26 health centres. These included vital commodities for safe births, miscarriage management, post-rape care, and family planning, reaching an estimated 106,284 women and adolescents of reproductive age.

To reach remote communities 28 mobile sexual and reproductive health camps were established with UNFPA support to provide critical services for 10,957 women. Cash assistance also supported 1,367 pregnant and postnatal women, improving timely access to safe delivery and health facilities and averting potential harm to mothers and newborns.

To ensure gender-based violence survivors continued to have access to critical support services UNFPA supported two one-stop crisis management centres, seven women-friendly spaces and two safe houses during emergency and post-disaster periods, providing survivor-centred case management, psychosocial support, and referrals. A total of 14,083 women were supported by these services in 2024, with 43 accessing safe houses.

Community outreach included 157 community awareness sessions and 692 door-to-door visits that provided information and services to 8,277 vulnerable individuals. 281 female community health volunteers and specialist counsellors also reached out to 3,781 women. Key awareness messages were supported by public service announcements which were broadcast across six local radio stations highlighting key protection messages.

We will support maternal health services, especially in pockets of the country that are lagging behind national trends related to the targets of SDG 3.1 and lack adequate emergency obstetric and newborn care. In our response we plan to roll out a comprehensive maternal healthcare programme in Madhesh province, where the maternal mortality ratio is 140 per 100,000, with large differences compared to somewhere like Kathmandu, where it is 98 per 100,000.

A major focus of this initiative will be strengthening the availability of quality maternal and newborn services with a focus on basic and comprehensive emergency obstetric and newborn care and referrals. We will also work to improve prevention, screening and management of key maternal morbidities and target increased community engagement.

In 2025 we will start to implement our new programme in youth empowerment targeting harmful practices and gender-based violence experienced by adolescent girls and young women in three provinces of Nepal where levels of gender-based violence and harmful practices are high.

Our approach is to empower young women and adolescent girls in safe spaces to build their support networks that promote knowledge and skills. Through learning, mentoring, and peer-based discussions in physical and digital spaces, these girls will be equipped with the social capital to make independent decisions about their lives, including their sexual and reproductive health and rights. These will also create digital platforms for young adolescent girls and vulnerable communities supporting them to participate in meaningful ways in the public sphere that shapes their futures.

In 2025 we will scale up our initiative to support artificial intelligence and data analysis. Building on our experience, we will expand artificial intelligence into new areas where it can be employed to strengthen existing data systems and analysis for the benefit of policymakers and planners.

Supporting SDG 13 in 2025, a new partnership will strengthen the adaptive capacity of maternal healthcare services to manage climate-related and natural disaster shocks. Facilities in two districts most exposed to disasters will be equipped to absorb these shocks and ensure continuity of care of maternal health services during emergencies and crises.