Objectives: The unmet need for family planning is defined as the discrepancy between individual’s contraceptive behaviors and their stated fertility preferences – The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants.

Methods: Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable.

Result: The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(±3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant.

Conclusion: Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.