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Abstract:
Nepal’s fertility rate has transitioned from a high level to a replacement level over the past few decades. However, despite slow declines over the past decade, the adolescent fertility rate has remained persistently high, posing threats to the health of both young mothers and their children. Realizing this context and the importance of understanding the drivers of adolescent childbearing for adolescent health policies and strategies, we conducted a further analysis of the 2022 Nepal Demographic and Health Survey (NDHS). As most childbearing in Nepal takes places within marriage, we paid particular attention to how adolescent childbearing may be linked to adolescent marriage and early family formation.
Trends in marriage, childbirth, and unmet need for family planning (FP) among adolescents were analyzed based on data from the 2011, 2016, and 2022 NDHS surveys. Data from the 2022 NDHS was then used to explore the background variables associated with adolescent pregnancy specifically. Adolescent marriage and childbirth were analyzed using information from women age 20–24, and unmet need was analyzed using information from women age 15–19. We also analyzed differentials and determinants of adolescent marriage and childbirth using the 2022 data, with a supplemental analysis examining modern FP use, demand for FP, satisfaction of FP demand, and determinants of modern FP use and unmet need for FP. Place of residence, education, province, caste/ethnicity, and wealth quintile were among the background variables used to examine the differentials.
The results showed no statistically significant decline in adolescent childbirth between 2011 and 2022, despite a small decline in adolescent marriage. Education and wealth quintile were the major variables significantly negatively associated with adolescent marriage and childbirth. Although unmet need for FP declined significantly among married adolescents between 2011 and 2022, the decline was not significant in the most recent period (2016–2022). Number of living children and whether a woman’s husband/partner lived at home were the major variables significantly associated with modern FP use and unmet need for FP among married adolescents. Our results suggest that the slow decline in adolescent fertility in Nepal was mainly associated with a persistent pattern of early marriage followed by social pressure to have a child soon after marriage, which likely led to low demand and use of FP before adolescent childbearing and higher levels of unmet need afterward.
To notably reduce rates of adolescent childbearing, sociocultural norms and expectations about family formation must change, particularly relating to adolescent marriage. Toward this goal, health system policies should focus on delaying early marriage by implementing multisectoral interventions to reduce poverty, keep girls in school, and increase awareness about the unintended consequences of early marriage. Additionally, the postponement of first childbirth until after adolescence requires proper counseling and the use of FP. Expansion of adolescent-friendly FP services with a focus on quality may also help promote the use of modern FP methods and reduce unmet need for FP among adolescents.
Trends in and Determinants of Adolescent Marriage, Childbirth, and Unmet Need for Family Planning, 2011–2022 Nepal DHS Surveys (PDF, 3090K)