PT  - JOURNAL ARTICLE
AU  - Kazutaka Sekine
AU  - Nirajan Khadka
AU  - Rogie Royce Carandang
AU  - Ken Ing Cherng Ong
AU  - Anand Tamang
AU  - Masamine Jimba
TI  - Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model
AID  - 10.1136/bmjopen-2020-046156
DP  - 2021 Oct 01
TA  - BMJ Open
PG  - e046156
VI  - 11
IP  - 10
4099  - http://bmjopen.bmj.com/content/11/10/e046156.short
4100  - http://bmjopen.bmj.com/content/11/10/e046156.full
SO  - BMJ Open2021 Oct 01; 11
AB  - Objectives This study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors.Design The study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results.Setting An urban municipality and a rural municipality in Bara district, Nepal.Participants We recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15–19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs.Results Married adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women’s autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples’ decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy.Conclusions The convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.Data are available on reasonable request. The data generated during the current study are not publicly available due to restrictions (e.g., their containing information that could compromise the privacy of research participants) but are available from the corresponding author on reasonable request.