Effect of Healthy Transitions intervention in improving family planning uptake among adolescents and young women in Western Nepal: A pre-and post-intervention study.

BACKGROUND: Contraceptive use can prevent unintended pregnancies, early childbearing, and abortion-related deaths. Despite these benefits, the use of modern contraceptives remains low among adolescent girls and young women (AGYW) in Nepal. To address this gap, the Healthy Transitions Project was implemented in Karnali Province, Nepal from February 2019 to September 2021. This study aimed at measuring the effect of Healthy Transitions' intervention on improving knowledge and use of modern family planning methods among AGYW in Nepal. METHODS: We used a pre- and post-intervention study design to assess the effect of Healthy Transitions project. A quantitative survey was conducted at baseline and after the first cohort of AGYW had completed the intervention (1 year later). The baseline survey was conducted in 2019 with a cohort of 786 married and unmarried AGYW aged 15-24 years. An end line survey was conducted in 2020 with 565 AGYW who were interviewed at baseline. Data analysis was done using STATA version 15.1. The exact McNemar significance probability value was used to decide the significance of difference between baseline and endline. RESULTS: The knowledge and uptake of modern family planning methods have increased in the endline compared to the baseline. AGYW recognised 10 out of the ten modern methods at endline, a significant increase from 7 at baseline (p<0.001). Among AGYW, 99% were aware of sources to obtain family planning methods, compared with 92% at baseline (p< 0.001). The proportion of married AGYW using modern contraceptive methods was significantly higher at the endline 33%, than baseline (26%) (p<0.001). CONCLUSION: Our results show that multilevel demand and supply-side interventions, targeting adolescents and young women, their families, community, and health system helped to improve knowledge and use of modern family planning methods among AGYW. The study suggests that these intervention approaches can be adopted to improve family planning use among adolescents and young women in other similar settings.

Findings from a mixed-methods evaluation of a multi-level adolescent and youth reproductive and maternal health intervention in Karnali Province, Nepal.

INTRODUCTION: Adolescent girls and young women (AGYW) in Nepal have disproportionately poor reproductive and maternal health outcomes. In response, Save the Children, the Nepal government, and local partners designed and implemented Healthy Transitions for Nepali Youth, a multi-level integrated intervention. The intervention aimed to improve reproductive, maternal, and newborn health knowledge, attitudes, and behaviors among AGYW, and address gender attitudes and norms in four districts of Karnali Province, Nepal. METHODS: Married and unmarried AGYW aged 15-24 were engaged in a small group, curriculum-based intervention; husbands and families received home visits, using short videos to catalyze discussion; communities were engaged through dialogue-based activities; and the health system was made more adolescent-responsive through quality assessments, training, and supervision. An external organization conducted a quantitative survey with a sample of 786 AGYW intervention participants at baseline and 565 of the same AGYW at endline. Pooled linear regressions were estimated for each indicator to assess the statistical significance of differences between baseline and endline. Focus group discussions and key informant interviews were conducted with AGYW, husbands, families, community leadership, and program implementers. Data analysis was done through STATA 14th version and NVivo. RESULTS: The percentage of AGYW currently using a modern contraceptive method increased significantly, and more AGYW believed that their family was supportive of delaying marriage and motherhood at the endline. Young women's knowledge of danger signs during labor increased, and there was a significant improvement in essential newborn care practices immediately after birth. AGYW reported shifts towards more gender equitable attitudes and behaviors, including related to decision-making about reproductive and maternal health. CONCLUSION: Positive shifts in reproductive, maternal, and newborn health and gender knowledge, attitudes, and behavior were observed among AGYW, their male partners, and families. The results can inform the design of future interventions to effectively reach this critical population. TRAIL REGISTRATION: Not applicable.

Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal.

BACKGROUND: Uptake of family planning (FP) services could prevent many unwanted pregnancies, and unsafe abortions and avert maternal deaths. However, women, especially from ethnic and religious minorities, have a low practice of contraceptives in Nepal. This study examined the knowledge and practices of modern contraceptive methods among Muslim women in Nepal. METHODS: A cross-sectional study was conducted among 400 Muslim women in the Khajura Rural Municipality of Banke district. Data were collected using face to face structured interviews. Two outcome variables included i) knowledge of and ii) practices of contraceptives. Knowledge and practice scores were estimated using the list of questions. Using median as a cut-off point, scores were categorised into two categories for each outcome variable (e.g., good knowledge and poor knowledge). Independent variables were several sociodemographic factors. The study employed logistic regression analysis, and odds ratios (OR) were reported with 95% confidence intervals (CIs) at a significance level of p<0.05 (two-tailed). RESULTS: Almost two-thirds (69.2%) of respondents had good knowledge of modern contraceptive methods, but only 47.3% practised these methods. Women of nuclear family (adjusted odds ratio (aOR) = 0.60; 95% CI: 0.38,0.95), and who work in agricultural sector (aOR = 0.38; 95% CI: 0.22, 0.64) were less likely to have good knowledge on modern contraceptives. Women with primary (aOR = 2.59; 95% CI: 1.43, 4.72), secondary and above education (aOR = 4.41; 95% CI:2.02,9.63), women with good knowledge of modern contraceptives (aOR = 2.73; 95% CI: 1.66, 4.51), who ever visited a health facility for FP counselling (aOR = 4.40; 95% CI: 2.58, 7.50) had higher odds of modern contraceptives practices. CONCLUSION: Muslim women had low use of modern contraceptive methods despite having satisfactory knowledge about them. There is a need for more equitable and focused high-quality FP practices. Targeted interventions are needed to increase the knowledge and practices of contraceptives in the Muslim community. The study highlights the need to target FP interventions among socially disadvantaged women, those living in a nuclear family, and those with poor knowledge of modern contraceptives.

Unlocking the potential for engaging men to improve reproductive, maternal, and neonatal health in Karnali Province, Nepal.

BACKGROUND: Adolescent girls and young women (AGYW) often experience early childbearing and have poor utilization of reproductive, maternal, and neonatal health (RMNH) services in Nepal. Involving men in such services has been increasingly recognized globally to improve gender-equitable reproductive health behaviour in husbands. This qualitative study assessed the implementation of Healthy Transitions' male engagement interventions in Karnali Province, Nepal which were implemented to improve gender-equitable attitudes, and supportive RMNH care-seeking behaviors among the husbands of young women. METHODS: We conducted a summative qualitative study that included in-depth interviews with 12 AGYW as primary beneficiaries and their husbands (N = 12) and in-laws (N = 8). In addition, key informant interviews were conducted with health workers (N = 8), local government representatives (N = 4), members of Health Facility Operation and Management Committee (N = 8) and project implementers (N = 12). Due to COVID-19-related travel restrictions and lockdowns, all interviews were conducted via phone calls and online consultation. Data were analyzed using multistage coding and thematic content analysis. RESULTS: AGYW, their husbands, in-laws and health workers were receptive to the Healthy transitions' male engagement initiatives. They perceived that the project contributed a momentum to facilitate men's gender-responsive behaviour. Many participants reported that male engagement interventions, including home visits, community dialogues, and social events improved husbands' support for their wives during menstruation, pregnancy, and childbirth. The activities also facilitated spousal communication and improved the couple's decision-making for family planning use. Women reported that improved support from their husbands increased their self-confidence. CONCLUSIONS: This study sheds light on the role of male engagement strategies to improve RMNH in a context where inequitable gender norms and roles are highly prevalent. Our findings highlight the potential to improve RMNH by addressing barriers to male engagement.

Association between Intimate Partner Violence and Abortion in Nepal: A Pooled Analysis of Nepal Demographic and Health Surveys (2011 and 2016).

BACKGROUND: Intimate partner violence (IPV) adversely affects female reproductive health in different ways. However, the relationship between IPV and abortion has not been adequately examined in Nepal. This study is aimed at examining the association between IPV and abortion in Nepal. METHODS: Data for this study was derived from the Nepal Demographic Health Surveys (NDHS) of 2011 and 2016. A total of 8641 women aged 15-49 years were selected for the violence module in NDHS 2011 and 2016. The analysis was restricted to 2978 women who reported at least one pregnancy five years preceding each survey. Among them, 839 women who experienced different forms of violence were included in the analysis. Various forms of IPV were taken as exposure variables while abortion as an outcome of interest. The study employed logistic regression analysis to examine the association between IPV and abortion. RESULTS: Nearly one in three (28.2%) women experienced any forms of IPV. A total of 22.2% women experienced physical violence. Almost one in five (19.5%) women were slapped. More than half (52.8%) of the women with no education experienced IPV. The logistic regression analyses showed a significant association between IPV and abortion. Women with severe physical violence had nearly two-fold higher odds (adjusted Odds Ratio (aOR) = 1.68; 95% CI: 1.06, 2.64) of having abortion. Similarly, women who reported physical violence were more likely to have abortion (aOR = 1.54; 95% CI: 1.09, 2.19) compared to those who did not experience such violence. CONCLUSION: Intimate partner violence is associated with abortion in Nepal. It is imperative that effective implementation of IPV-preventive measures through the promotion of appropriate social and policy actions can help reduce abortion in Nepal.