Findings from a mixed-methods evaluation of a multi-level adolescent and youth reproductive and maternal health intervention in Karnali Province, Nepal
Outcomes: Child, Early, and Forced Marriage, Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways The Healthy Transitions intervention demonstrated that gender-transformative programming at multiple socio-ecological levels can shift deeply rooted norms around early marriage, fertility, and gender roles. While notable progress was made in improving AGYW’s gender-equitable attitudes and family support for delaying marriage and childbearing, persistent social norms—such as son preference and stigma around contraception use—continue to limit reproductive autonomy. Long-term norm change will require more intensive, sustained engagement at household and community levels.
Objectives To evaluate the effects of the Healthy Transitions for Nepali Youth Project on adolescent girls’ and young women’s (AGYW) reproductive, maternal, and newborn health (RMNH) knowledge, attitudes, and behaviors, as well as related gender norms in Karnali Province, Nepal.
Methods A mixed-methods pre-post evaluation design was used. Quantitative surveys were conducted with 786 AGYW at baseline and 565 at endline. Qualitative data included 31 baseline and 24 endline focus group discussions (FGDs), as well as key informant interviews with project implementers, local leaders, and health workers. Data were analyzed using STATA and NVivo, with triangulation across methods to assess changes over time.
Intervention Details Healthy Transitions (2018–2021) was a multi-level, gender-transformative intervention targeting AGYW aged 15–24 across four districts. Activities included: safe space group sessions using a custom curriculum; home visits with tablet-based job aids for families and spouses; community dialogues and events to promote equitable norms; and adolescent-responsive health system strengthening, including provider training and facility quality improvements. Over 15,000 AGYW participated across two cohorts.
Results The intervention led to statistically significant increases in AGYW’s RMNH knowledge, modern contraceptive use (up from 26% to 33%), and support for delaying marriage and motherhood. Knowledge of danger signs during pregnancy and labor also improved. Gender attitude shifts included reduced agreement with statements justifying violence, son preference, and unequal household roles. However, limitations in home visit reach and persistent male migration patterns constrained deeper change. Families still expected AGYW to bear sons quickly after marriage, limiting birth spacing options.
Conclusions Healthy Transitions shows promise as a scalable model for improving adolescent health and transforming gender norms. Multi-sectoral, gender-synchronized approaches that engage families and communities are essential, especially in contexts where traditional expectations around fertility, marriage, and gender roles persist.
Norms Addressed
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