Understanding the Determinants of Adolescent Pregnancy among an Indigenous Community in Rural Nepal: A Qualitative Exploration.

Introduction: Adolescent pregnancy is a global concern, with a higher occurrence among more disadvantaged groups. Within Nepal's highly marginalized Chepang community, adolescent pregnancies are notably more prevalent. This study aimed to understand the determinants of adolescent pregnancy among Chepang community in Raksirang Rural Municipality, Makwanpur District of Nepal using qualitative methods.

Methods: The study was conducted from September 2022 to April 2023. Twenty participants (10 in-depth interviews and 10 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 R-based Qualitative Data Analysis package. Braun and Clarke's six-step thematic analysis was used to perform analysis.

Results: Six key themes were identified as determinants of adolescent pregnancy among Chepang community: (i) inadequate access to and use of sexual and reproductive health services, (ii) gaps in programmatic implementation, (iii) elopement marriage as a form of escape, (iv) discontinuation of education, (v) limited knowledge and understanding of marriage, pregnancy, and childbirth, and (vi) early pregnancy as a sign of prosperity. Challenges such as difficult geographical terrain, limited access to adolescent-friendly healthcare, gender inequality, child labor, weak enforcement of child marriage laws, and societal stigma exacerbated these determinants.

Conclusion: A multifaceted approach, including improved access to adolescent-friendly healthcare, enforcement of child marriage laws, access to secondary education, efforts to raise awareness of sexual and reproductive health, and a shift in sociocultural norms, should be implemented to reduce adolescent pregnancy in the Chepang community.