National 5 (Spotlight Weekly)

Young Issue

A nation-wide survey of the reproductive health needs of young adults could prove crucial to formulate policies to manage the adolescent population

By SANJAYA DHAKAL

In order to present the findings of the Nepal Adolescents and Young Adult (NAYA) study, a program was organized on Tuesday (March 19, 2002) by the Family Health International.

Dr. Thapa : New and useful findings

With the objective of collecting information relevant to the reproductive and sexual health needs of representative adolescent and youth adults (ages 14 through 22 years) population for the development of appropriate policies, strategies and programs, Family Health International (FHI) with the support from USAID, had initiated Nepal Adolescents and Young Adult (NAYA) research in 1998 in one dozen districts covering rural and urban as well as married and unmarried segment of the population. The Valley Research Group and BP Memorial Health Foundation, too, had assisted in the survey.

The research was divided into qualitative (focus group discussions) and quantitative (survey) studies. The NAYA focus group discussions conducted in 1999 covered 11 districts. On the other hand, the survey covered 13 districts including Kathmandu, Lalitpur, Pokhara, Biratnagar and Birgunj representing urban area and Ilam, Kavre, Argakhanchi, Dailekh, Rupandehi, Mahottari, Saptari and Banke representing rural area. The total number of respondents covered was 7977 (2824 in urban and 5153 in rural area).

"The NAYA study was undertaken to find out the sexual and reproductive health needs of adolescents. We hope the findings would be helpful in formulating specific programs and policies catering to this section of population," said Dr. Shyam Thapa, senior scientist at FHI.

Among the total population of Nepal, approximately 45 percent is under the age of 15, and an additional 19 percent between the ages of 15 and 24. Youths between the ages of 10 and 24 comprise approximately 30 percent of the total population of nearly 24 million. In view of the size of the population segment and the implications of its age structure for future population growth, several initiatives focusing on the reproductive health of adolescents and young adults have been undertaken in Nepal in the recent years. However, virtually no systematic studies have been conducted to develop an understanding of their current situation and the future needs.

Being the first population-based household survey, NAYA findings will provide baseline date relevant to adolescent reproductive health needs, including the prevention of unwanted pregnancy and sexually transmitted infections (STIs) and the provision of prenatal care. "No other countries in Asia has done a national level survey of adolescents like NAYA. We are pleased to be a part of this effort," said Rebecca Rohrer, chief, Office of Health, USAID Mission, speaking at the study dissemination program. During the program, experts presented their findings on eight different aspects of the survey.

A total of 11 districts -- including both from hills and terai region; urban and rural settings; and five development regions -- were purposively selected for conducting the focus-group discussion. The selected districts represent diverse ethnic groups and varied levels of development. All focus groups were stratified by gender and marital status. Rural and urban groups were further stratified by literacy or level of education. Fourteen young men and 15 young women trained as moderators and note-takers conducted the discussion between February and May, 1999.

The findings from the focus-group discussions are presented under several themes: transition to adulthood; school, work and leisure; love and marriage; and pregnancy and child-bearing.

Likewise, the NAYA survey collected information about the reproductive health knowledge, practices, and behavior of a representative sample of Nepalese in the same 14-22 age category. Its objective is to provide better guidance for the development of effective policies, strategies, and programs aimed at improving the reproductive health of this age group. The field staffs posed queries on puberty, sexual behavior, risk-taking behavior (smoking, drinking), mass media exposure, STIs and HIV/AIDs etc and came up with startling findings.

According to the survey, in general, the level of education, marital status and rural-urban divide was found to play a crucial role in their awareness and response to particular questions. For instance, in the study of knowledge and beliefs among urban youths regarding STIs and HIV/AIDS, awareness of such diseases, precautionary measures and modes of transmission was found to depend considerably on the level of education. Interestingly, unmarried male and female alike were more knowledgeable about these subjects than their married counterparts possibly because of the information they get from their peers in schools/colleges. While TV remained the media they were most exposed to, they preferred getting information on related topics from newspapers.

Similarly, the findings of smoking behavior of Nepalese adolescents indicated that both the youth groups from upper-class urban area and lower-class rural area were more involved in smoking behavior. Though some were found to have initiated the smoking since 10 years, the volume of smokers was found to take-off sharply after 15 years — both in case of male and female. The smoking behavior among adolescents was more prevalent in hilly region than terai — more so in case of females.