Title: Addressing the knowledge gaps and SHRH needs and challenges in

Nepal

Background

Globally, there has been a substantial progress in addressing the needs of services
for adolescent sexual and reproductive health (ASRH). Two major global strategies
have been very important for the year 2016 as ASRH has become a global agenda
for sustainable development goals and United Nations endorsed the Global
Strategy for Womens children and Adolescents health.

Adolescent birth rates have decreased globally even the courtiers are experiencing
the unmet needs of , modern contraception. For instance, in Sub-Saharan countries,
adolescent birth rate has declined from 150 per 1000 adolescent women in 1960 to
108.8 in 2013 (Michelle, 2016). At the same time, in the countries, where abortion is
more accessible, the adolescent birth rate is lower. In the meantime, reported
decline in global adolescent birth rates is not fully explained by the decline in
adolescent pregnancy. Without accounting abortion, we can not capture the
adolescent preganacy rate.

In order to address the challenges, estimation of adolescent pregnancies is needed

to provide the evidence about the rate of sexual activity and contraceptive
coverage from the population based surveys. This evidence is highly underreported.
Therefore, there are undocumented needs and challenges of adolescent needs in a
global scale and in Nepal also.

Context of Nepal

Nepal has observed a substantial progress in the area of SRH in last 20 years. For
instance total fertility rate has been reduced from 5.2 in 1991 to 2.3 in 2011,
maternal mortality rate has been declined from 539 in 1996 to 258 per 100000 live
births in 2014. In the progressive line, safe abortion has been legalized in 2002 and
more than 750,000 women receive safe abortion services till now. Despite these
improvements, the country has not been made into progress to address SRH needs
among adolescent, especially among poor, marginalized, and vulnerable segment of
the society. The cross cutting motivators will change the behavior of adolescents.

Rationale for high impact intervention research project in Nepal

The country has limited data sources and evidence about the needs, resources, and
the capacities of ASRH issues. Additionally, existing evidence does not provide the
information about the reproductive health services indicators, contraceptive rates.
Moreover, the rate of sexual activity and contraceptive coverage in the various
segments of the population is not identified mostly targeting the most vulnerable to
the adolescent population with marginalized group of the society. Furthermore,
there is a need to a serious understanding of improving the paradigm of approaches
in identifying the needs and services of ASRH in the country such as identifying the
background, exposure, and access to the services.

Objective

To identify the needs of ASRH in adolescent Nepal

To evaluate the effectiveness of intervention in improving needs and service
seeking of adolescents

Methodology

Design of the study:

The intervention research will be designed as mixed method approach. First

qualitative approach will be gathered to assess the formative background of the
target people, resources and the capacities in the communities. Second quantitative
baseline survey will be done to identify the coverage, gaps, knowledge, attitude,
and practices. The intervention and control group will be identified from the various
segments of the adolescent population. Intervention group will receive the services
and control group will be receiving the regular services. A cluster randomized design
will be adopted to select the intervention and control participants. Follow up will be
done for six months.

Intervention

The intervention include the following approaches but not limited to:

Addressing biological changes,

Involving peers and family and friends to build their capacity in understanding and
managing ASRH problems

Empowering and educating community

Ensuring access to economic and information opportunities to the adolescents

Involving adolescent in life skills and economic opportunities

Participants and sampling strategy

Sampling will be done and participants will be selected based on the population
proportionate to size method considering marginalized, vulnerable, lower caste,
education level etc. Adolescent of age 15-19 will be included in the study. The
district will be chosen based on the criteria of available indicators.

Tools and measurements

Focus group discussions (FGD) and in-depth interview (IDI)will be conducted to
identify the information about the services, their reach, attitudes, expectations of
services needs. For evaluation, knowledge, practice, coverage and effectiveness of
addressing needs will be measured using quantitative tools.

Ethical consideration

Participants will be ensured about the voluntary participation and confidentiality of

information. Further ethical approval will be taken from the Nepal Health Research
Council.

Expected output

Impact: Improved adolescent and sexual and reproductive health

Outcome: Increased access to services and increased capacity of

adolescents in addressing their ASRH problems

Output

% of adolescents involving in peer groups sessions

% of adolescents adopting their safe ASRH practices

% of adolescent seeking ASRH services

% of adolescents access to economic and other opportunities.