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SUMMARY:<br/><br/>Background: Adolescent pregnancy, which is defined as any pregnancy in a girl aged <br/>10-19 years, is a matter of concern for public health and human rights. The Chepang <br/>people are an indigenous ethnic group and are one of the most marginalized and <br/>disadvantaged communities in Nepal. Maternal conditions are among the top causes <br/>of disability-adjusted life years (DALYs) and death among girls aged 15-19. <br/><br/>Aim: This study aimed to determine the factors associated with adolescent pregnancy <br/>and its health consequences among Chepang women in selected wards of Raksirang <br/>Rural Municipality, Makwanpur District. <br/><br/>Design: Concurrent triangulation mixed method design <br/>Methods: A cross-sectional study was conducted among 231 Chepang women <br/>selected from Wards 5 and 8 of Raksirang Rural Municipality. Chepang women aged <br/>10 to 25 years who ever gave birth were included in the quantitative study. Simple <br/>random sampling was done to select the participants. A semi-structured questionnaire <br/>was used for interviewing the mothers. The data were coded, entered in Epidata <br/>Version 3.1, and analyzed using STATA MP 13 version and EZR software Version 4.0.4. <br/>Bivariate and Multivariate logistic regression using odds ratio with 95% CI was carried <br/>out. Variables with a VIF of more than 2 and a p-value of more than 0.25 were excluded <br/>from the final model. For the qualitative study, 40 participants (20 in-depth interviews <br/>and 20 key informant interviews) were recruited through judgmental sampling. An <br/>interview guide was used for interviewing the participants. All interviews were audio<br/>recorded, transcribed, translated, and analyzed using RQDA package. Braun and <br/>Clarke’s six steps thematic analysis was done for qualitative analysis. <br/><br/>Result: The study revealed that the prevalence of adolescent pregnancy among <br/>Chepang women was 71.4% [CI 65.14-77.16]. A large proportion of respondents <br/>(72.73%) were married before the age of 18 years. Early age at marriage (AOR= 236, <br/>CI: 71.46-472.67), poor knowledge of adolescent pregnancy (AOR=10.3, CI 8.42<br/>14.87), unplanned pregnancy (AOR=13.3, CI 10.76-19.2), and lack of sex education <br/>(AOR=6.57, CI 3.85-11.27) were significantly associated with adolescent pregnancy. 21.8% of adolescent mothers had an abortion and 73.3% of adolescent mothers had <br/>delivered their first child at home. 24.8% of adolescent mothers had experienced <br/>health problems during pregnancy, 29.1% had health problems during delivery and <br/>22.4% had health problems during the postpartum period. <br/>The factors affecting adolescent pregnancy from qualitative study were identified as <br/>lack of access and use of sexual and reproductive health services, programs and <br/>policies, elopement marriages, discontinuation of education, poor knowledge and <br/>understanding of marriage pregnancy and childbirth, and existing socio-cultural <br/>beliefs and norms. Likewise, adolescent mothers mostly opted for home delivery, had <br/>miscarriages, sought abortion care due to unwanted pregnancy, and feared <br/>consuming iron tablets during pregnancy. <br/>The triangulation of the data from qualitative and quantitative study validated that <br/>early marriage, unplanned pregnancy, knowledge of adolescent pregnancy, and sex <br/>education were the factors influencing adolescent pregnancy. The areas of divergence <br/>identified during triangulation were elopement marriage, education level, distance to <br/>the health facility, societal family and peer pressure, socioeconomic status, and <br/>contraceptive use, where qualitative findings contradicted quantitative findings. The <br/>areas of expansion were identified as women's position in society, the role of men in <br/>family planning, fear of not having a child later using contraception, hesitancy and fear <br/>of the service provider, programs and policies, repercussion of media and technology, <br/>immaturity and unfilled desires, schooling after marriage as a stigma, children <br/>subjected to forced labor and fear to consume iron tablets. <br/><br/>Conclusion: The prevalence of adolescent pregnancy among the Chepang community <br/>was high. Increasing awareness of the consequences of adolescent pregnancy, <br/>providing comprehensive sexuality education to adolescents, improving access to <br/>reproductive health services, and taking legal action to stop child marriage could <br/>prevent adolescent pregnancy among Chepang women. <br/><br/>Keywords: adolescent pregnancy, factors, Chepang, sexual and reproductive health, <br/>Nepal |
