Our mothers do not tell us: A qualitative study of adolescent girls’ perspectives on sexual and reproductive health in rural Nepal
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Deeply entrenched norms around gender, sexuality, and family honor significantly limit adolescent girls’ autonomy and access to care. Girls are expected to remain silent, obedient, and sexually inactive, and those who seek SRH services risk social judgment or violence. Interventions must address these collective norms—especially the silence around sexuality and stigma around premarital sex—through family engagement, community dialogue, and gender-equitable education and healthcare practices.
Objectives This study explored the structural and socio-cultural factors that shape adolescent girls’ access to and use of sexual and reproductive health (SRH) services in a rural district of Nepal. It aimed to generate context-specific insights to inform programs targeting adolescent SRH rights in underserved regions.
Methods The study used a qualitative design and was conducted in the rural district of Achham, Nepal. Researchers conducted 21 in-depth interviews with adolescent girls aged 15–19 and three focus group discussions with community health workers (CHWs). Data were analyzed inductively and organized using the Social Ecological Model to identify barriers at individual, interpersonal, community, and systemic levels.
Results Barriers to SRH access were found at all levels. At the individual level, girls lacked knowledge, perceived no need for services, and expressed shyness and shame around SRH topics. Interpersonally, family norms restricted communication, and girls often needed permission from parents or husbands to seek care. At the community level, strict gender norms, son preference, and fear of gossip discouraged girls from using SRH services. Organizational barriers included poor sex education, lack of female providers and teachers, and long travel distances to health facilities. Stigma was a cross-cutting barrier across all levels, influencing self-perception, family dynamics, and community responses.
Conclusions Improving adolescent girls’ SRH in rural Nepal requires a multi-level approach that addresses both structural limitations and socio-cultural norms. Programs must go beyond individual education to engage families, schools, communities, and the health system in creating supportive, stigma-free environments for girls to access their SRH rights.
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