Behavioural determinants of child marriage and adolescent pregnancy in Nepal: A qualitative study

Research Report.

SUMMARY:

BACKGROUND: Even in the face of global achievements, progress toward ending child marriage in Nepal remains inadequate and the rate of decline has been slow. Child marriage has affected a staggering 700 million women worldwide(1) and 5 million child brides in Nepal, including 1.3 million who are married before the age of 15(2).
Also called early marriage, child marriage refers to any formal or informal union between a child under the age of 18 and an adult or another child(3). After the establishment of the global minimum marriage age of 18, and recognizing the pressing need to address this issue, Nepal raised the legal marriage age to 20 for men and women in 2017. Nepal has pledged to end child marriage by 2030 as part of its commitment to the United Nations Sustainable Development Goals and the Constitution of Nepal(4).
Despite efforts to combat the practice, Nepal has the eighth-highest rate of child marriage in the world and the third-highest rate in South Asia. The prevalence of teenage marriages and pregnancies is widespread, especially in marginalized communities across the country(5). A 2019 study revealed that 8 per cent of girls were married before the age of 15 and 33 per cent were married before the age of 18. Meanwhile, 2 per cent of men were married before age 15(6), and 9 per cent were married before they were 18(7). In some places, particularly in the southern Terai districts that border India, the figures can be even more concerning. For example, over half of marriages in Rupandehi District involve girls under the age of 12, and 89.5 per cent of females marry before they turn 18(8).Nevertheless, the prevalence throughout the country suggests a complex interrelation of caste, ethnicity, regionality and religiosity.
A study in 2012 identified that child marriage was most prevalent among those who were illiterate, from Dalit communities and indigenous ethnic groups known as Janajati(9). Women from these communities tended to be uneducated and lacked a basic understanding of reproductive and maternal health, including early marriage increasing the likelihood of early pregnancy and pregnancy-related complications(6).
The use of dowries has been known to influence early marriage, with the pressure to marry girls when they are younger attributable to dowry prices increasing as girls get older(10). Thus, a large portion of the population in some areas of Nepal believes it is better to secure their daughter’s marriage as soon as possible.
It is widely understood that economic factors and family relationships drive early marriage, with detrimental consequences linked to limited mobility and education, compromised health, rising adolescent pregnancy and heightened risk of violence(11). But what else is at play and at stake? What other behaviours are relevant, and could these be changed to eliminate early marriage? To address these and other questions, UNICEF partnered with the Nepal Health Research Council to develop a study on child marriage and early pregnancy with a focus on marginalized communities in Nepal.

METHODOLOGY: The resulting study, Behavioural Determinants on Child Marriage and Adolescent Pregnancy in Nepal: A qualitative study, employed an exploratory qualitative approach to understanding the behavioural drivers and consequences of these complex issues. Before conducting field research, an extensive literature review investigating health, education, behaviour and socioeconomic factors provided foundational insights into the situation globally and in Nepal. Integrating this knowledge, the research team aimed to identify gaps by using a unique set of exploration methods during the field research.
The qualitative research was conducted from November 2022 to April 2023 across all seven provinces, with the selection of two districts and three marginalized communities (21 in total) from each province. A balanced representation covering the mountain, hill and Terai regions aimed to represent the country's geographic diversity. A purposive sampling method was used to select participants, with secondary data on child marriage collected prior to the desk review. Thirty-six participants were selected from each province, totaling 252 participants from all seven provinces. The sampling size was determined based on the theory of information saturation, ensuring a comprehensive understanding of the subject matter through repeated thematic patterns. All interviews were conducted ethically: researchers obtained participant consent and adhered to health research requirements in Nepal.
Qualitative interviews served as one key source of data collection and occurred in selected marginalized communities in each province. In-depth interviews were conducted with early married couples, unmarried adolescents and parents, and key informant interviews were performed with community stakeholders. In total, interviews were conducted with 84 married adolescents, 42 unmarried adolescents, 42 parents, 21 female community health volunteers, 21 school teachers, 21 ward chairpersons and 14 representatives from the Department of Women and Children, an arm of the Ministry of Women, Children and Senior Citizens. Kuragraphy – an ethnographic approach that uses open dialogue and informal, unstructured and context-driven conversations with community members – was conducted with community influencers.
Field researchers and enumerators participated in a training before collecting data through interviews. Interviews were transcribed, translated and analysed thematically. Throughout the data collection process, the research team communicated and coordinated using easily accessible tools, including WhatsApp and Viber groups. The research team had letters from the Nepal Health Research Council to present to community leaders, making it easier to facilitate their work. Despite encountering challenges
related to cultural taboos and sensitivity surrounding the subject of child marriage, the researchers were able to gain a comprehensive understanding of the factors contributing to child marriage and adolescent pregnancy in Nepal.
The socio-ecological model served as a guiding framework during the analysis of qualitative data. This model considers various influences and their relationship with one another – including communication between a society, communities and individuals. Using this framework provided a way to comprehend the variety of conditions that expose or protect individuals from experiencing or committing harmful behaviours. The model also recommends that to prevent harmful behaviours, actions must be taken simultaneously at several levels of the model.

FINDINGS: By incorporating the diverse perspectives of research participants, this study offers a holistic way to understand the complex issue of child marriage and adolescent pregnancy in Nepal. The findings described in the full report and summarized here identify factors responsible for child marriage and adolescent pregnancy in selected, marginalized communities in Nepal.
Drivers of child marriage
When examining the drivers of child marriage across various Nepalese communities, participants reflected on the interplay of sociocultural, economic and family influences. Interviews with adolescents and parents, for example, revealed that child marriage primarily stems from the need to ensure a decent livelihood and is viewed as a means of survival. Preserving family honour was a significant driver, with marrying young perceived as a means to maintain a family’s reputation and approval. Others expressed that marriage is an opportunity, mentioning the potential to travel abroad after marriage.
n Young girls are considered adept at collecting Yarshagumba: a caterpillar fungus known for its medicinal properties and found in the mountain regions of Nepal. This has led some parents from the Kham Magar community in Dolpa to marry their sons at a young age so their young wives – who are thought to have excellent eyesight – can collect this delicacy and contribute to the family income.
A significant number of participants acknowledged that child marriage is a crime. Half of the participants – including from the Chhetri, Rana Tharu, Santhal and Dalit communities – reported being aware of the suitable and legally permissible age for marriage. This information is acquired through a variety of sources including schools, families, relatives, and NGOs or INGOs actively involved in the communities. In the Badi, Chaudhary, Dalit Sarki, Magar and Rana Tharu communities, teachers serve as the primary source of information regarding the legal marriage age. These educators engage in counselling sessions, offer guidance to unmarried adolescents regarding the appropriate marriage age and provide health advice to those who married early, particularly related to early pregnancy and maternal health. Teachers noted that most school-going adolescents were well-informed about the legally permissible age of marriage.
Economic conditions played a pivotal role in causing parents to compel their children into early marriage. For example, families prioritize marriage over education due to financial constraints: in the Chepang community there was a link between early marriage and a desire for better meals. Cultural norms like mama chela and fupu cheli (marriage between the daughter of a paternal aunt and the son of a maternal uncle) and a lack of awareness about the legal marriage age also persisted in certain communities, influencing parental decisions.
n In Muslim communities, a parent’s reputation can suffer when their child elopes. Protecting their family’s prestige and reputation is especially important if their child’s safety is compromised. These concerns prompt many parents to arrange early marriages for their children.
Some people, such as those from the Chhetri, Chamaar and Dalit communities, were able to explain their reasons for choosing child marriage. The influence of family dynamics was evident, with adolescents whose fathers worked abroad feeling pressured to wed early. Instances of stepmothers pressuring stepdaughters into marriage, and marriage as a consequence of a parent eloping with someone else, were prevalent across various communities. Unmarried adolescents from the Chhetri and Rana Tharu communities said that their family members provoked their children to elope into marriage, due in part to financial constraints or because family members wanted to be free from the responsibility of providing for a child.
Participants from the Muslim, Musahar and Chamaar communities reported that specific beauty standards influence the marriage prospects of girls. These communities declared a preference for taller, fair-skinned and slim girls, compared to those who are short, dark-skinned or heavier. In marginalized communities like the Muslim community in Dhanusha, some individuals agreed that if a marriage does not occur before the age of 20, societal perceptions change significantly. They expressed more grievances about this issue within the Muslim community, particularly concerning how society views individuals based on their marital status.
My mother expired [passed away] when I was nine years old, and I have a stepmom at home. I was fat at the time. She told me I looked huge due to my body and I might get even more fat, so she married me off.”
– 15-year-old married girl from the Chamaar community, Dhanusha, Madhesh ProvinceUnmarried adolescents from marginalized communities like the Gharti Magar, Santhal and Gangai communities have shared concerns about parental bias favoring sons' education over daughters’ education. In these communities, a clear pattern emerged where daughters are typically sent to government schools while sons receive education in boarding schools. As families prioritize sons' education, daughters are assigned to household roles, such as goat-grazing, with fewer opportunities for academic advancement. Entrenched traditional beliefs within a community drive these trends and reflect a pervasive gender bias. Teachers have noted significant dropout rates among students after they have married, with very few continuing their education. One teacher from the Badi community raised a worrying issue where school administration often restricts individuals who marry early from pursuing further education. While this approach was aimed at discouraging early marriage in favor of children receiving an education, using this punitive tactic ends up restricting a child’s rights.
In certain communities like the Gurung community in Illam and the Santhal community, parental insistence on child marriage stems from astrological suggestions claiming compatibility between birthdates. This belief leads parents to arrange girls' and boys' marriages at a young age, as they perceive it to secure a prosperous future for their children. Meanwhile, in Raute communities, the leader of the group holds authority in making marriage decisions, which are then agreed upon by the adolescents and their parents. One participant explained, "Every group has a leader, whose decisions, especially in the Kalyal (a Raute clan), are highly respected."
While elopement is on the rise, a decline in arranged marriages was noted around all provinces of Nepal except the Terai, where there is an increase in arranged marriages in part due to parental influence, pressure and cultural norms. The rise in the use of mobile phones and the internet, however, has significantly impacted early marriages. Findings indicate that adolescents between ages 14 and 18 in Badi, Bote, Chaudhary and Santhal communities exhibit a high dependency on mobile phones, primarily utilizing social media platforms like Facebook, TikTok and WhatsApp. Study participants reported the use of mobile phones to exchange numbers, engage in conversations and subsequently enter into marriage, often with strangers outside of the community. Despite strict school rules, children also carry their phones to school, engage in extraneous conversations and view inappropriate content instead of focusing on their studies.
I am a poor guy. The later you marry your daughter, the more dowry you have to give. The earlier you marry them, the better it will be. I am a poor guy, so I gave nothing in dowry.”
– A father from the Chamar community, Mahottari, Madhesh Province
Regrettably, many youth perceive marriage as a form of entertainment, lacking an understanding of its true meaning and responsibilities. Hastily entering into marriage without comprehending its significance has become a result of this skewed understanding among some adolescents.Additionally, participants shared that children from the Chepang and Raute communities often imitate their parents' behaviours, particularly when they witness their parents engaging in intimate activities due to their open living environment. Adolescents, filled with curiosity, tend to be eager to explore and sometimes participate in similar intimate activities themselves.
I was excited about getting married – wearing a new dress, looking beautiful and getting pampered by my friends and relatives.”
– 13-year-old married girl from the Raute community, Karnali Province
Consequences of child marriage
The consequences of early marriage manifest across multiple domains, significantly impacting education, health and family dynamics. To avoid legal consequences, child marriages are often not registered. The repercussions of early marriage can affect career prospects and girls encounter substantial hurdles in returning to school after marriage.
My in-laws insisted me not to join the school. She said, ‘We earn and your husband earns. Why study? You have to study just to earn and everyone earns here. Don’t go to school, instead make the food at home and learn other kitchen activities.’”
– 19-year-old married woman from the Dalit community, Achham, Sudurpashchim Province
In the Baram, Chepang, Dalit Sarki and Rana Tharu communities, dropout rates due to child marriage are considerably high. A participant from the Dalit Sarki community mentioned that almost 20 per cent of students expected to be in Grades 9 and 10 in Tripurasundari Municipality, Karnali Province, have left school due to marriage. Moreover, in the Muslim and Musahar communities, adolescent girls expressed discomfort attending school in traditional marriage attire, like bangles and kurthas, while their classmates wore school uniforms. These cultural aspects introduce an added complexity to adolescents’ educational experiences, highlighting the intersection of cultural norms and educational access.
Girls reported feeling shy or uncomfortable due to changes in their appearance and increased responsibilities after childbirth. Certain participants from the Baram community highlighted that the onset of puberty brings about physical changes in girls, making them uncomfortable in public spaces. This discomfort becomes a significant factor leading to school dropout, as attending school becomes discouraging for them. Additionally, women tend to hide their pregnancy, fearing potential bullying from peers at school. This leads to girls discontinuing their studies as they feel unsafe or unwelcome in that environment. In specific Muslim communities, cultural norms impose restrictions on daughters-in-law, prohibiting them from pursuing education outside the home due to conservative values. Instead, these young women are confined indoors and lack the freedom to attend school.
In the Dalit Sarki community of Dolpa, early marriage is nearly universal, with an almost 100 per cent prevalence rate, often leading to early pregnancies. Building rapport and discussing the topic of child marriage within this community was challenging and presented significant barriers for researchers. Participants noted severe consequences of child marriage including adolescent pregnancy, malnutrition, uterine prolapse, infant mortality and mental health issues.
I thought that I could never be a mother at a young age, but my mother-inlaw didn’t agree. She told me, ‘I had a baby when I was 16, so what will happen to you?’ I wanted to have a child after reaching the appropriate age but she didn’t agree. The neighbours used to tell my mother-in-law, ‘She doesn’t have a baby. Why would you let her stay there? You should kick her out.’ So to maintain prestige in society, I had to have a baby.”
– 16-year-old married girl from the Chettri community, Achham, Sudurpashchim Province
In the Kham Magar community of Karnali Province, couples are expected to conceive soon after marriage; otherwise, the daughter-in-law is labeled infertile. Female community health volunteers reported that the lack of knowledge about contraception leads to early childbirth. In the Terai, among the Chamaar, Musahar and Muslim communities, teachers highlighted how child marriage results in uterine prolapse and maternal malnutrition due to close spacing between births. They also urged improved health education in school curricula to better address these issues. Community mobilizers, including female community health volunteers from the Gangai community, also recognized the challenges of young pregnancy including childbirth, health risks and uterine prolapse. Many adolescents lacking family support were uninformed about prenatal and newborn care, exacerbating health risks for both mother and child.
Some parents from the Dalit and Tharu communities held different views on early marriage and pregnancy. Contrarily, they expressed concerns about increased financial burdens when their sons marry early, potentially leading to early pregnancies and larger family sizes. Similarly, in the Musahar community, early pregnancies and childbirth were known to escalate expenses for maternal and child health care.
If you have a child at a young age, you can face difficulties in continuing your education. Having a child at a young age can bring personal hardships as you have to take care of the child, and also continue your studies. You won't have your own income. People say that if you don't achieve such things at a young age, you can only attain them after having a child.” Child marriage also tragically leads to suicide. In the Gurung and Santhal communities, a few early-married couples reportedly ended their lives due to their parents’ refusal to accept their marriage. In a Santhal community in Jhapa, for example, a teacher recounted a young couple's suicide in a tea garden after their family pressured them to separate to preserve the family’s honour. Key persons in the Gurung and Kham Magar communities highlighted issues arising from miscommunication when a spouse works abroad. Instances of extramarital affairs or remarriage while away can also lead to family conflicts, occasionally resulting in suicides.
Almost all participants were well-informed about the legal implications of marrying before 20 years of age, but adherence lags. In the Gharti Magar community, a female community health volunteer faced repercussions and endured beatings from locals after attempting to file a case against an early marriage arranged by an adolescent’s parents. After multiple warnings from the adolescent’s relatives, she opted not to proceed with the complaint. Ward chairpersons and representatives from the Department of Women and Children noted a minimal number of cases filed regarding child marriage, often settling disputes privately and without legal interventions due to mutual agreements between the parties involved. As a result of government regulations prohibiting the registration of marriages before the age of 20, many people do not register their children’s births, creating obstacles for their children.
These community-specific issues emphasize the intricate interplay of cultural, social and biological elements that impact the life paths of adolescents, underscoring the necessity for tailored interventions to tackle these challenges effectively.


Findings: Kuragraphy is a term used to describe an ethnographic method for data generation. Researchers collect information through unstructured, unscheduled conversations with people in their natural settings. Conversations are based on a theme, in this case, child marriage and early pregnancy. Kuragraphic interviews were conducted in automobiles, tea stalls, chautari (a rest stop/gathering place around big trees), temples, police stations and more. Community influencers were engaged in these conversations, including astrologers, faith leaders, police, senior citizens (i.e., grandmothers and grandfathers), traditional healers and village chiefs. The Kuragraphy findings consistently supported the key informant interviews and in-depth interviews, echoing concerns voiced by parents and grandparents regarding the escalating rate of child marriages.
In the Santhal community, church leaders expressed their efforts in advising young adolescents against dropping out of school and marrying early. However, some adolescents, citing financial constraints, chose to leave school to seek employment due to family poverty. A few determined adolescents, adhering to the church's guidance, were resolute in not marrying before 20. The church leader highlighted that couples who elope and marry early are not permitted to wed inside the church, since it is considered sinful. To rectify this, they are expected to follow church regulations diligently as a means of salvation. Discipline measures for child marriage include six months of isolation from friends and relatives and regular visits to the church alone to seek forgiveness. These punitive actions influenced some adolescents in the Santhal community to delay marriage until after turning 20.
One significant example illustrates the value of respecting a girl's voice. A senior citizen from the Chepang community in Bagmati Province described a ritual called ‘khoji khane’ among the Chepang community. A ceremony performed during the marriage includes sacrificing a goat and calling the name of the girl's parents. The girl is then called forward and asked if girl she is participating willingly or under force. If the girl is brought against her will or expresses unhappiness, she is returned to her parents.
Most senior citizens across the provinces expressed no objection to child marriage and cited elopement or parental marriage as common. Another prevalent and traditional belief, this time in Karnali Province, suggests that dhamis (traditional healers) refrain from intervening in early marriages. This is due to the belief that the dhamis will be punished by god or a higher power if they try to put a stop to child marriage. Many community members advocated against providing phones at a young age, attributing the rise in child and elopement marriages to the widespread availability and usage of mobile phones and internet access.
Kuragraphy with police personnel showcased a consistent trend across provinces to avoid registering child marriage, leading to an underreporting of child marriages. In Gandaki, Karnali, Lumbini, Madhesh and Sudurpashchim provinces, police expressed a shared sentiment that child marriage cases often go unreported or are settled privately within the communities and between the families involved. They emphasized that child marriages are rarely disclosed to law enforcement unless they are linked to significant incidents like suicides, disputes or missing person cases. This is indicative of the indirect involvement or acceptance of parents and the community in these marriages.
Police personnel also stressed the importance of community concern and reporting, underscoring their inability to intervene without cases being reported. They acknowledge the absence of specific awareness programmes on child marriage, highlighting the need for broader societal involvement and better reporting mechanisms to address this concerning issue. Police personnel from Achham in Sudurpashchim Province also highlighted that girls' protection stems from historical gender inequalities, but there is a need for recognition that boys can also fall victim to child marriage and its detrimental outcomes.
In the Bote community, also in Bagmati Province, a female traditional healer, referred to as jhakri, used rituals with rice grains and lights to repel evil during childbirth. She cited incidents where these practices and the births attended by traditional healers have led to fatalities of the mother and baby, despite a 101 per cent rise in institutional deliveries in Bagmati Province.

CONCLUSIONS: The behavioural drivers of child marriage and adolescent pregnancy in Nepal are multifaceted and deeply intertwined with societal norms, economic conditions and cultural expectations. Poverty, discriminatory practices and limited agency of adolescents, especially girls and in certain communities, contribute to early marriages. The influence of family decisions, perceptions of physical attractiveness and the desire for independence also play a pivotal role. Additionally, the lack of comprehensive education and awareness, coupled with societal pressures and traditional beliefs, contribute to the perpetuation of these practices.
Child marriage and adolescent pregnancy have far-reaching and detrimental consequences for individuals, families and communities. These practices perpetuate cycles of poverty and underdevelopment, limiting the potential of young girls and hindering societal progress.
The impact on the health of young brides and their children is severe, with increased risks of pregnancy-related complications, malnutrition, infant mortality rates, uterine prolapse and long-term health consequences. Child marriage diminishes educational opportunities, leading to school dropout and restricting the empowerment of young girls. Furthermore, the financial implications extend to the families involved, exacerbating economic challenges.
Efforts to address these issues must encompass comprehensive strategies, including education, awareness and legal reforms, to break the cycle of child marriage and promote the well-being of adolescents. It is crucial to foster an environment that supports the education and empowerment of young girls and boys, ensuring their rights, health and opportunities for a better future.
Schools can stop child marriage. When I was in Grade 5, ‘Child marriage is a serious crime’, was written on the school wall. I left school at the age of 12.”

RECOMMENDATIONS: The findings in this study underscore the pressing need for immediate, concerted action and targeted interventions to address early marriage and pregnancy. Combining comprehensive awareness efforts with policy support can empower communities to take proactive steps in reporting child marriage cases and protecting vulnerable children from harm. Including adolescents in decision-making processes and programme development can lead to a better understanding of their needs and concerns. Indeed, their perspectives can aid in the development of effective interventions and policies aimed at preventing child marriage and promoting children's overall well-being. By implementing these recommendations, Nepal can make substantial strides in eradicating child marriage and ensure a brighter, more equitable future for young girls and boys.  
Educational campaign on the consequences of social media  Empower young individuals to navigate social media responsibly and avoid situations that may lead to early marriage or other harmful outcomes. An educational campaign focusing on digital literacy, critical thinking skills and safe online behaviours should emphasize the importance of exercising caution and discernment when interacting with strangers on social media platforms. Addressing the legal, social and emotional ramifications of eloping and marrying at a young age is also important. Collaborating with educators, parents, community leaders and online safety experts, the campaign can deliver tailored messages across various mediums to effectively reach children and adolescents.  
Engagement of family members Effectively engage family members to prevent child marriage. Deploy educational campaigns and social mobilizers to conduct family counselling sessions targeting all family members, including children, adolescents, grandparents and decision-makers. Sessions should focus on challenging harmful gender norms, emphasizing the negative consequences of early marriage, and promoting the value of delaying marriage. By involving all members and encouraging open dialogue, communities can empower individuals to make informed decisions and create a supportive environment conducive to preventing child marriage and promoting healthier relationships. 
Safeguarding child rights  Use awareness campaigns to address the hesitations and fears associated with reporting child marriage cases, provide clarity on reporting procedures and highlight the significance of safeguarding children's rights. Additionally, broader policy formation should facilitate the implementation of existing laws, providing frameworks and resources to effectively support reporting mechanisms. School health programmes Integrate comprehensive training into school health programmes, specifically targeting teachers, to enhance awareness and prevention efforts regarding early marriage, early pregnancy and reproductive health. Teachers serve as primary sources of information reaching children and their families, thus empowering them with accurate knowledge and resources is pivotal. It is also imperative to identify other influencers within communities who can reach and provide positive guidance to children. This may include school nurses, community leaders, local health workers, peer educators and religious leaders, among others. Incorporate child marriage, reproductive health and adolescent pregnancy as a mandatory element in school curriculum starting from Grade 6.    
Vocational training Incorporate vocational training initiatives into intervention programmes to address poverty-driven aspirations, develop employment skills and opportunities, and improve economic factors. Providing adolescents and their families with access to appropriate money-generating skills and vocational training equips them with the tools necessary to secure stable incomes and financially support their families. Challenge misconceptions about child marriage and promote alternative pathways to sustainable livelihoods by incorporating key messages that emphasize its negative consequences, including limiting educational and economic possibilities.
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