Factors associated with adolescent pregnancy and its health consequences among Chepang women in selected wards of Raksirang rural municipality, Makwanpur district: A mixed method study.

Thesis Report.

SUMMARY:

Background: Adolescent pregnancy, which is defined as any pregnancy in a girl aged
10-19 years, is a matter of concern for public health and human rights. The Chepang
people are an indigenous ethnic group and are one of the most marginalized and
disadvantaged communities in Nepal. Maternal conditions are among the top causes
of disability-adjusted life years (DALYs) and death among girls aged 15-19.

Aim: This study aimed to determine the factors associated with adolescent pregnancy
and its health consequences among Chepang women in selected wards of Raksirang
Rural Municipality, Makwanpur District.

Design: Concurrent triangulation mixed method design
Methods: A cross-sectional study was conducted among 231 Chepang women
selected from Wards 5 and 8 of Raksirang Rural Municipality. Chepang women aged
10 to 25 years who ever gave birth were included in the quantitative study. Simple
random sampling was done to select the participants. A semi-structured questionnaire
was used for interviewing the mothers. The data were coded, entered in Epidata
Version 3.1, and analyzed using STATA MP 13 version and EZR software Version 4.0.4.
Bivariate and Multivariate logistic regression using odds ratio with 95% CI was carried
out. Variables with a VIF of more than 2 and a p-value of more than 0.25 were excluded
from the final model. For the qualitative study, 40 participants (20 in-depth interviews
and 20 key informant interviews) were recruited through judgmental sampling. An
interview guide was used for interviewing the participants. All interviews were audio
recorded, transcribed, translated, and analyzed using RQDA package. Braun and
Clarke’s six steps thematic analysis was done for qualitative analysis.

Result: The study revealed that the prevalence of adolescent pregnancy among
Chepang women was 71.4% [CI 65.14-77.16]. A large proportion of respondents
(72.73%) were married before the age of 18 years. Early age at marriage (AOR= 236,
CI: 71.46-472.67), poor knowledge of adolescent pregnancy (AOR=10.3, CI 8.42
14.87), unplanned pregnancy (AOR=13.3, CI 10.76-19.2), and lack of sex education
(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
delivered their first child at home. 24.8% of adolescent mothers had experienced
health problems during pregnancy, 29.1% had health problems during delivery and
22.4% had health problems during the postpartum period.
The factors affecting adolescent pregnancy from qualitative study were identified as
lack of access and use of sexual and reproductive health services, programs and
policies, elopement marriages, discontinuation of education, poor knowledge and
understanding of marriage pregnancy and childbirth, and existing socio-cultural
beliefs and norms. Likewise, adolescent mothers mostly opted for home delivery, had
miscarriages, sought abortion care due to unwanted pregnancy, and feared
consuming iron tablets during pregnancy.
The triangulation of the data from qualitative and quantitative study validated that
early marriage, unplanned pregnancy, knowledge of adolescent pregnancy, and sex
education were the factors influencing adolescent pregnancy. The areas of divergence
identified during triangulation were elopement marriage, education level, distance to
the health facility, societal family and peer pressure, socioeconomic status, and
contraceptive use, where qualitative findings contradicted quantitative findings. The
areas of expansion were identified as women's position in society, the role of men in
family planning, fear of not having a child later using contraception, hesitancy and fear
of the service provider, programs and policies, repercussion of media and technology,
immaturity and unfilled desires, schooling after marriage as a stigma, children
subjected to forced labor and fear to consume iron tablets.

Conclusion: The prevalence of adolescent pregnancy among the Chepang community
was high. Increasing awareness of the consequences of adolescent pregnancy,
providing comprehensive sexuality education to adolescents, improving access to
reproductive health services, and taking legal action to stop child marriage could
prevent adolescent pregnancy among Chepang women.

Keywords: adolescent pregnancy, factors, Chepang, sexual and reproductive health,
Nepal