Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model
Outcomes: Sexual and Reproductive Health
View SourceObjectives This study aimed to identify and examine the multilevel factors influencing contraceptive use and childbearing decisions among married adolescent girls in Bara district, Nepal, using the socioecological model to understand how individual, relational, community, and structural influences interact.
Methods A qualitative study design was used, incorporating in-depth interviews (IDIs) with 60 participants—20 married adolescent girls (aged 15–19), 20 of their husbands, and 20 mothers-in-law—alongside key informant interviews (KIIs) with 10 health professionals and community health volunteers. Data collection was guided by the socioecological model, and analysis followed a directed content analysis approach using both predefined and emergent codes. Findings were triangulated across respondent groups and data sources.
Results Multiple, interrelated barriers to contraceptive use emerged across levels. At the intrapersonal level, misinformation about contraceptive side effects, low awareness of adolescent pregnancy risks, and limited autonomy hindered use. Girls often lacked access to information and felt shy or embarrassed to discuss family planning. Interpersonally, husbands and mothers-in-law held significant decision-making power, with patriarchal norms reinforcing women’s dependence. Community-level factors included strong social pressure to prove fertility early in marriage and stigma around infertility, abandonment, or delayed childbirth. Religious beliefs, particularly in Muslim communities, further discouraged contraceptive use. Organizational barriers—such as lack of privacy in healthcare facilities and unwelcoming attitudes from providers—also contributed to low uptake.
Conclusions The findings highlight that decisions around contraceptive use and childbearing are not individual but shaped by family and community expectations, norms, and power dynamics. Social norms—particularly those reinforcing male dominance, early childbearing, and fertility as a measure of worth—are central barriers to contraceptive use. Programs aiming to improve adolescent reproductive health must go beyond individual education and address these sociocultural norms by involving families and communities. Culturally sensitive, rights-based interventions that promote gender equality and empower girls to make informed reproductive choices are essential for improving contraceptive uptake and delaying early childbearing.
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