Reproductive Health Research on Adolescents to exemplify Nepal’s efforts in reducing Teenage Pregnancies

Although the law mandates both men and women in Nepal to be 20 years at the time of marriage, teenage marriages and pregnancies are still prevalent in Nepal. According to the Nepal Demographic and Health Survey (NDHS), published recently in June, 2023, the median age at first marriage is 18.3 years among women aged 25 to 49. One in five adolescent girls who are between the ages of 15 and 19 are currently married or in a union in Nepal.

However, the data reveals that less than 10 percent of adolescent girls who are married between the ages of 15 and 19 have registered their marriage. The percentage of marriage registration is significantly higher among women aged 20 and above. Furthermore, due to the social development disparity that exists between different parts of Nepal, Karnali province has the lowest rate of marriage registration in contrast to Bagmati Province which has the highest rate.

The data obtained from the Nepal Demographic and Health Survey reveals that, 14 percent of adolescent girls aged between 15 and 19 have been pregnant while 10 percent have had a live birth, and 2 percent have had a pregnancy loss. Teenage pregnancies also reflect the disparity in Nepalese society created by socio-economic and geographical factors. Teenage pregnancies mostly occur in Karnali Province of Nepal while it has the lowest rate of occurrence in Bagmati Province. Similarly, increasing levels of education and wealth also become a significant factor in decreasing the rate of teenage pregnancies in communities.

Adolescent fertility rate is in a decreasing trend in Nepal, along with adolescent female marriages that have consistently decreased from 43 percent in 1996 to 21 percent in 2022. Despite many challenges, Nepal has made noteworthy progress over the years in improving adolescents’ reproductive health.

Successful reduction of adolescent fertility rate among adolescent girls between the ages of 15 and 19 years, has enabled Nepal to make a place among the six exemplar countries selected for the Exemplars in Global Health (EGH), Adolescent Sexual and Reproductive Health and Rights research project along with India, Rwanda, Cameroon, Malawi and Ghana. The research project was formally launched in the Women Deliver Conference 2023, in Kigali, Rwanda.

Exemplars in Global Health aims to guide public health decision makers around the world through research that identifies the drivers of success in the positive outlier or successful countries so that other countries with similar challenges and comparable settings can adopt and implement the strategies, policies and programs that brought success in the exemplar countries.

The Exemplars in Global Health’s Adolescent Health research project is being conducted under the leadership of cross country research institution, African Institute for Development Policy (AFIDEP) by the Center for Research on Environment, Health and Population Activities (CREPHA) in Nepal. Dr. Mahesh Puri, Co-Director of CREHPA says, “To our knowledge, no systematic and rigorous study has been carried out to document what made Nepal successful in reducing adolescent fertility rate, and perform better in other adolescent health outcomes possible in Nepal. Our research initiative in Nepal, aims to meticulously investigate the policies and programs that have facilitated the progress of adolescents’ reproductive health, compared to other similar countries.”

 “The exploration of such determinants or catalysts for progress in adolescents’ reproductive health, not only equips Nepal with insights to amplify the most impactful interventions but also furnishes other countries facing similar challenges with the knowledge to emulate and expand upon the lessons derived from Nepal.” he adds. On the importance of conducting health research in Nepal, Dr. Puri says, “Generating evidence on health through a rigorous research approach is vital to assist policymakers, program designers, implementers, and other decision-makers in making informed choices, and it is also valuable for health and social care professionals who aim to provide the best treatments and options to their patients, service users, and communities. It aids decision-makers in understanding what works, what doesn't, and why.”

On the necessity of addressing the reproductive health needs of adolescents, Youth Activist Urja Humagain says, “Despite commitments from the government and the presence of policies and legal framework that support sexual and reproductive health and rights (SRHR), many young people continue to face obstacles in their realization of SRHR. Adolescents and young people, especially women and girls face unique vulnerabilities because of their age, gender and cultural context, enforcing negative sanctions on their right to make choices over their bodies, lives and futures. Association of SRHR with stigma, immediate dismissal of SRHR curiosities from parents and teachers, judgmental behaviors from health service centers and lack of proper mechanisms that help adolescents have access to credible information sources have resulted in decisions that lead to adverse health outcomes in adolescents which adversely impact their overall well-being.”

Adolescence (10-19 years of age), is a phase of both physical and emotional growth in a person’s lifetime. More than 20 percent of Nepal’s population is currently in the age group of 10 to 19 years which makes it crucial for Nepal to prioritize adolescent wellbeing and health. Kabita Aryal, Adolescent Health Section Chief from Family Welfare Division, Ministry of Health and Population Nepal, deems parent and teacher education as important to deal with preadolescents and adolescents in order to improve adolescent wellbeing.