The high stakes of early motherhood: insights from Nepal's teenage pregnancy crisis

Background Teenage pregnancy is a global public health burden. Motherhood during adolescence is identified as a major risk factor for adverse health outcomes for both the mother and the newborn. This paper aims to provide insights into factors associated with teenage pregnancy and adverse pregnancy outcomes in Nepal. Methods Data for this study were derived from the most recent round of the Nepal Demographic and Health Survey (NDHS) 2022. A total of 2,643 women aged 15–19 years were included in the analysis for teenage pregnancy, and 3,833 pregnant women aged 15–49 years were included for adverse pregnancy outcomes. Descriptive and multivariable analyses were performed to examine the factors associated with teenage pregnancy and adverse pregnancy outcomes. Results Out of the total adolescent girls, approximately 14% experienced teenage pregnancy. Multivariate logistic regression analysis showed that teenage pregnancy varied by different socioeconomic and demographic characteristics. Adolescents from poorest (aOR=2.87, 95% CI: 1.48–5.59), poorer (aOR=2.98, 95% CI: 1.54–5.77), and middle household wealth index (aOR=2.44, 95% CI: 1.22–4.88), those belonging to Janajati (aOR=1.96, 95% CI: 1.32–2.93), Dalit (aOR=2.01, 95% CI: 1.37–2.96), and Muslim ethnic groups (aOR=1.98, 95% CI: 1.02–3.83), and women living in Karnali Province (aOR=1.98, 95% CI: 1.24–3.17) were more likely to experience teenage pregnancy compared to their counterparts. Teenage mothers had higher rates of adverse pregnancy outcomes, such as stillbirths (p<0.001), miscarriages (p=0.013), and lower birth weights among their children (p=0.039), compared to adult mothers. Conclusion Despite its adverse health and social impacts, teenage pregnancy remains prevalent in Nepal. The implementation of targeted, multilevel interventions is required for these vulnerable populations, as well as for influencers within their families and communities. Interventions to address this issue should include tailored social behaviour change (SBC) strategies, such as comprehensive sexuality and life skills education, particularly for adolescents who are illiterate or have only basic education, belong to low-wealth households, are part of disadvantaged ethnic groups (Janajati, Dalit, and Muslim), and reside in areas with inadequate socio-economic progress (Karnali Province). Additionally, improving access to adolescent friendly sexual and reproductive health services could help reduce early motherhood and adverse pregnancy outcomes among adolescent girls in Nepal.