The high stakes of early motherhood: insights from Nepal's teenage pregnancy crisis

The high stakes of early motherhood: insights from Nepal's teenage pregnancy crisis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The high stakes of early motherhood: insights from Nepal's teenage pregnancy crisis Dipendra Singh Thakuri, Resham B Khatri, Barun K Singh, Patricia Lee, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6462941/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Teenage pregnancy is a global public health burden. Motherhood during adolescence is identified as a major risk factor for adverse health outcomes for both the mother and the newborn. This paper aims to provide insights into factors associated with teenage pregnancy and adverse pregnancy outcomes in Nepal. Methods Data for this study were derived from the most recent round of the Nepal Demographic and Health Survey (NDHS) 2022. A total of 2,643 women aged 15–19 years were included in the analysis for teenage pregnancy, and 3,833 pregnant women aged 15–49 years were included for adverse pregnancy outcomes. Descriptive and multivariable analyses were performed to examine the factors associated with teenage pregnancy and adverse pregnancy outcomes. Results Out of the total adolescent girls, approximately 14% experienced teenage pregnancy. Multivariate logistic regression analysis showed that teenage pregnancy varied by different socioeconomic and demographic characteristics. Adolescents from poorest (aOR=2.87, 95% CI: 1.48–5.59), poorer (aOR=2.98, 95% CI: 1.54–5.77), and middle household wealth index (aOR=2.44, 95% CI: 1.22–4.88), those belonging to Janajati (aOR=1.96, 95% CI: 1.32–2.93), Dalit (aOR=2.01, 95% CI: 1.37–2.96), and Muslim ethnic groups (aOR=1.98, 95% CI: 1.02–3.83), and women living in Karnali Province (aOR=1.98, 95% CI: 1.24–3.17) were more likely to experience teenage pregnancy compared to their counterparts. Teenage mothers had higher rates of adverse pregnancy outcomes, such as stillbirths (p<0.001), miscarriages (p=0.013), and lower birth weights among their children (p=0.039), compared to adult mothers. Conclusion Despite its adverse health and social impacts, teenage pregnancy remains prevalent in Nepal. The implementation of targeted, multilevel interventions is required for these vulnerable populations, as well as for influencers within their families and communities. Interventions to address this issue should include tailored social behaviour change (SBC) strategies, such as comprehensive sexuality and life skills education, particularly for adolescents who are illiterate or have only basic education, belong to low-wealth households, are part of disadvantaged ethnic groups (Janajati, Dalit, and Muslim), and reside in areas with inadequate socio-economic progress (Karnali Province). Additionally, improving access to adolescent friendly sexual and reproductive health services could help reduce early motherhood and adverse pregnancy outcomes among adolescent girls in Nepal. Figures Figure 1 Introduction Pregnancy in adolescence and early motherhood remain a global public health challenge with broad health, economic, and social consequences ( 1 – 3 ). Teenage pregnancy is defined as pregnancy in women aged 10 to 19 years ( 3 , 4 ). It is recognized as a health risk, often leading to devastating health consequences ( 5 ). Teenage pregnancy contributes significantly to the global burden of maternal and child health-related morbidities and mortalities, with a substantially high proportion occurring in low and middle-income countries (LMICs) ( 5 ). Early childbearing can have negative health consequences for teenage mothers and their infants. In LMICs, babies born to adolescent mothers face increased risks of complications such as pre-term delivery, obstructed labor, infections, stillbirths, premature and low birth weight, and severe neonatal health complications ( 6 – 9 ). These complications are the leading causes of death among girls aged 15–19 years worldwide, with LMIC countries accounting for 99% of these deaths ( 10 ). Globally, around 13% of women below 18 years gave birth in 2015–2020, with over 90% of teenage pregnancies occurring in LMICs, such as Nepal ( 11 ). As of 2019, an estimated 21 million girls aged 15–19 years in LMICs become pregnant each year, resulting in approximately 12 million births ( 4 ). Around half of these pregnancies were unplanned ( 4 ). This produces significant immediate and long-term impacts on maternal and child health outcomes ( 12 ). Teenage pregnancy can also generate social stigma, rejection or violence by partners, parents and peers ( 13 ), as well as reduce access to future education and employment opportunities ( 13 – 15 ). The World Health Organization (WHO) estimates that 5–33% of adolescents and young women who abandon school do so because of early pregnancy and marriage ( 16 ). Past evidence revealed that South Asia has the second highest rate of teenage pregnancy, with Nepal having one of the highest rates in the region at 21% ( 12 ). The high burden of teenage pregnancy in Nepal is reportedly due to various factors related to low socioeconomic status, high child marriage, and lack of comprehensive sexuality education (CSE) ( 17 , 18 ). Other factors identified globally include family income, family size, educational level, wealth status, perceptions of the appropriate age of marriage, and exposure to mass or social media ( 1 , 11 , 12 , 19 ) Nepal has made various efforts to reduce teenage pregnancy. As a signatory to the International Convention on Population and Development (ICPD) Program of Action ( 20 ), The Government of Nepal (GoN) has adopted various laws, policies, and strategies focused on adolescent sexual and reproductive health, including tackling teenage pregnancy as a priority. For instance, Nepal's National Reproductive Health Strategy, developed in 1998 as the country's first Strategy of its kind, was a pioneering effort that included Adolescent Sexual and Reproductive Health as a key component ( 20 ). The Strategy was mandated to promote adolescents' health and socioeconomic status through various measures, including raising the legal age of marriage and reducing teenage pregnancy rates. In 2000, the GoN also developed the National Adolescent Health and Development strategy ( 21 ). Following the Strategy, in 2010, Nepal introduced adolescent-friendly sexual and reproductive health services under its five-year health sector plan ( 22 ). The constitution of Nepal (2015) ( 23 ) ensured reproductive health rights, and the National Civil Code (2017) set the minimum marriage age at 20, with penalties for violations ( 24 ). The Safe Motherhood and Reproductive Health Act (2018) reinforced these commitments ( 25 ). The Adolescent Health and Development Strategy was revised in 2018 to address emerging health issues and align with Sustainable Development Goals ( 21 ). Nepal's Health Sector Strategy (2016–2021, 2022–2030) targets fertility rate reduction and universal access to reproductive health services ( 26 , 27 ) (Supplementary Fig. 1 and Table 1). Despite these efforts, progress remains slow ( 28 ). Adolescent marriage and fertility rates remain high (72/1000 in 2022), and teenage pregnancy contributes to adverse health outcomes and unsafe abortion, posing a challenge to achieving Nepal's 2030 health and development goals. In 2017, 120,000 teenage pregnancies were recorded [ 30,31]. Although teenage pregnancy is a significant public health concern in Nepal, there is limited research on the determinants of teenage pregnancy and the adverse pregnancy outcomes ( 17 ). Preventing pregnancy among adolescents and pregnancy-related mortality and morbidity are foundational to achieving positive health outcomes across the life course and imperative for achieving the Sustainable Development Goals (SDGs) related to maternal and newborn health ( 31 ). Identifying key determinants of teenage pregnancy and adverse pregnancy outcomes is essential for evidence-based programs. Hence, this study aimed to examine these factors in Nepal using the latest nationally representative data from the Nepal Demographic and Health Survey (2022). The findings provide evidence-based insights to help policymakers and program managers strengthen policies and program interventions to reduce teenage pregnancy and its adverse outcomes. Methodology Study Design and Sampling Procedure This study is based on secondary data analysis of the existing national-level data from the recent round of the Nepal Demographic and Health Survey (NDHS) 2022 (available from https://dhsprogram.com/data/datasetadmin/index.cfm#). The NDHS is a nationally representative household survey conducted by New Educational Reform Associates (New ERA) under the guidance of the Ministry of Health and Population (MoHP), Government of Nepal, with support from global partners, including USAID and ICF International. We extracted all relevant variables from the women's data files (individual recode) in the NDHS 2022 data set for this study. A detailed description of the methodology is provided elsewhere (28). Briefly, the NDHS 2022 adopted a multistage cluster sampling design and collected data to periodically estimate several sociodemographic and health indicators, including information about reproductive health issues such as teenage pregnancy and childbirth. Women aged 15-49 years of selected households who had agreed to participate in the study were also enrolled to participate in the survey. Data on pregnancy and childbirth history were collected from 14,845 women aged 15-49 years, yielding a response rate of 97%. For this study, we restricted our analyses to 2,643 adolescent girls aged 15-19 years and 3,833 pregnant women aged 15-49 years (Fig 2). Study Variables Dependent Variable The primary outcome variable of interest in this study was "teenage pregnancy", defined as women aged 15-19 years who were pregnant or reported live birth at the time of the interview, regardless of the outcome of the pregnancy preceding the three years of the survey period. Women aged 15-49 years were asked to report past pregnancy outcomes as well as their current pregnancy status at the time of the interview. The dependent variable was binary and coded as "1" for adolescents who either had started childbearing or were pregnant for the first time and coded as "0" if otherwise. The secondary outcome variable was an adverse pregnancy outcome, which included several factors such as whether the individual had ever experienced pregnancy that ended in stillbirth (yes/no), whether they had ever had a pregnancy that ended in miscarriage (yes/no), and whether their child was born with a low birth weight (yes/no). The response to the above is coded as 1, which means "yes", and coded as "0" if otherwise. Exploratory variables The exploratory variables were selected based on the review of past studies on teenage pregnancy and adverse outcomes conducted in developing countries, including Nepal (1,12,17), as well as information available in the NDHS 2022 dataset. This included variables such as place of residence, wealth status, ethnicity, religion, maternal education, and exposure to family planning (FP) messages on social media. Variables such as wealth status, maternal education, ethnicity, religion, maternal smoking status, and exposure to FP messages were further categorised for this study, as shown in Table 2 (32). Table 2. Definitions of study variables and their utilization in models formulated. Variable Definition Utilized in model/ Type Adolescent motherhood Adolescents who have ever given birth Dependent/Binary Teenage Pregnancy Adolescents who have even been pregnant Dependent/Binary Place of residence Place of residence (Urban; Rural) Independent/ categorical Ethnicity Ethnicity was classified into five categories: Brahmin/ Chhetri, Janajati, Dalit, Madhesi, and Muslim. In Nepal, Brahmin/Chettri is considered as an advantaged ethnic group due to their comparative privilege, whereas Dalit, Janajati, Madhesi and Muslim are relatively disadvantaged and socioeconomically marginalized groups (28). Independent/ categorical Religion Religion was categorised into four groups: Hindu, Buddhist, Muslim, and others. Independent/ categorical Province The seven provinces of Nepal are Koshi, Madhesh, Bagmati, Gandaki, Lumbini, Karnali, and Sudurpaschim. Independent/ categorical Maternal Education Maternal education was categorised into four groups: none (no education), basic (1-8 grades), secondary, and higher (9-12 grades or above). Independent/ categorical Household Wealth Status The NDHS applied an asset-based approach to estimate household wealth quintiles, and household wealth status was categorized as poorest, poorer middle, richer, and richest. Independent/ categorical Maternal smoking status Maternal smoking status is grouped as Yes; No. Binary Exposure to FP messages on social media Women's access to social media at least once a week is grouped as Yes; No. Binary Data analysis Data were analysed using STATA (version 18.0) (Stata Crop, Texas, USA). In the descriptive analyses, the characteristics of the study participants were presented in the form of frequency and proportion (%) with 95% confidence intervals (CI). Univariate logistic regression examined the unadjusted association between exploratory variables and study outcome. This was followed by multivariable logistic regression modelling to identify determinants of teenage pregnancy. According to the adjusted regression model, variables with p<0.05 were considered to be significantly associated with teenage pregnancy. We presented the adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs). Research Ethics This study used secondary data derived from the recent round of NDHS 2022. These surveys were approved by an ethical review board of ICF Marco International, Maryland, USA, and the Nepal Health Research Council. The first author submitted a formal request to the DHS program through their website (www.dhsprogram.com) to obtain permission to use those datasets for this study, and approval was granted on February 15, 2024. The DHS data are available and accessible at https://dhsprogram.com/data/dataset_admin/index.cfm# upon online request. Results Table 3 depicts the sociodemographic profile and prevalence of teenage pregnancy in Nepal. Out of the total adolescent girls (N=2,643) in the sample, around 14% had teenage pregnancy. The rates of teenage pregnancy varied between sub-populations with different sociodemographic backgrounds: with socioeconomically better off having lower teenage pregnancy. Teenage pregnancy was highest among adolescents who belonged to poor households (poorer and poorest), adolescents with no education, and those who were from Dalit and Muslim castes (disadvantaged caste group). Similarly, teenage pregnancy was high among adolescents from the Muslim religion, those who resided in certain areas with inadequate socioeconomic progress (Karnali and Madesh province), and those who did not have exposure to any Family Planning (FP) -related media messages (Table 3). Table 3. Distribution of teenage pregnancy by background characteristics, 2022 DHS, Nepal (N=2643). Variables Categories Total Adolescents (N) % Teenage Pregnancy (n) % (CI) P-value Community level factors Place of residence Urban 1,758 66.5 227 12.9 (10.8,15.3) 0.206 Rural 885 33.5 132 14.9 (12.8,17.3) Provinces Koshi 409 15..5 52 12.8 (9.5,17.0) <0.001 Madhesh 619 23.4 122 19.8 (15.5,24.9) Bagmati 489 18.5 38 7.8 (5.2,11.5) Gandaki 238 9.0 31 12.9 (8.9,18.4) Lumbini 435 16.4 43 9.8 (7.1,13.4) Karnali 203 7.7 42 20.5 (16.8,24.8) Sudurpaschim 250 9.5 31 12.5 (8.7,17.6) Household and Individual factors Household Wealth Index Poorest 535 20.2 93 17.4 (14.8,20.4) <0.001 Poorer 568 21.5 105 18.5 (15.2,22.3) Middle 533 20.2 74 13.9 (10.8,17.7) Richer 571 21.6 69 12.1 (9.0,16.1) Richest 436 16.5 18 4.0 (2.3,7.0) Women's Education Secondary and Higher 1575 59.6 129 8.2 (6.8,9.9) <0.001 Basic 928 35.1 184 19.8 (16.8,23.2) No education 140 5.3 46 32.7 (25.7,40.6) Ethnicity Brahmin/Chettri 724 27.4 57 7.8 (6.2, 9.8) <0.001 Janajati 839 31.7 108 12.9 (10.3, 16.0) Dalits 471 17.8 98 20.7 (16.8, 25.3) Madheshi 438 16.6 59 13.4 (10.1, 17.7) Muslim 171 6.5 38 22.2 (15.1, 31.4) Religion Hindu 167 82 285 13.1 (11.5,14.9) <0.05 Buddhist 156 5.9 14 9.4 (5.3,16.2) Muslim 174 6.6 40 22.8 (15.7,31.9) Others 146 5.5 20 13.5 (7.8,22.3) Individual Behavior and Social Condition Smoking status Yes 20 0.7 1 5.3 (1.4,18.1) 0.122 No 623 99.3 358 13.6 (12.1,15.4) Exposure to media FP messages At least one media 695 27.3 67 9.7 (7.3, 12.8) 0.004 No 1948 73.7 292 15.0 (13.1, 16.9) The p-value was obtained from the chi-squared association test. † Significant at p < 0.05. Table 4 presents the adjusted association between sociodemographic characteristics and teenage pregnancy. In the multivariable logistic regression analyses, three-stage modelling was used. In the first stage, community-level factors (place of residence and province) were entered into the first-stage model (Model I), and a manually executed elimination method was used to determine factors associated with teenage pregnancy at p < 0.05. The significant factors in the first stage model were then added to household and individual level factors (household wealth index, women's education, and ethnicity), which was the second stage model (Model II); this was then followed by a manually executed elimination procedure. The significant factors for both Models I and II were added to individual behaviour and social condition (smoking, exposure to media FP messages) in the third model (Model III). We used a similar approach for individual behaviour and social conditions in Model III. Model III, the fully adjusted model, included all relevant factors, including behavioural and social conditions (smoking status, exposure to family planning messages). The findings of the final model showed that teenage pregnancy was significantly associated with household wealth index (poorest or poor or middle household wealth index), ethnic disadvantaged groups (Janajati, Dalit and Muslim), education (no or basic education) and those who lived in the province with inadequate socioeconomic progress (Karnali province). Adolescents having the poorest (aOR= 2.87, 95% CI: 1.48, 5.59), poorer (aOR=2.98, 95% CI: 1.54, 5.77) and middle household wealth (aOR=2.44, 95% CI:1.22, 4.88) were more likely to experience teenage pregnancy compared to those with the highest household wealth. Teenage mothers belonged to Janajati caste (aOR=1.96, 95% CI: 1.32, 2.93), Dalit (aOR=2.01, 95% CI:1.37, 2.96), and Muslim ethnicity groups (aOR=1.98, 95% CI: 1.02, 3.83) had higher odds of teenage pregnancy compared to Brahmin/Chettri (relatively advantaged ethnic group). Similarly, women who lived in Karnali had nearly two-fold higher odds of having teenage pregnancy (aOR=1.98, 95% CI: 1.24, 3.17). (Table 4) Table 4. Factors associated with teenage pregnancy in Nepal, DHS 2022, (N=2643). Variables Categories Unadjusted Model Model 1 Model 2 Model 3 OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Community level factors Place of residence Urban 1.0 1.0 Rural 1.18 (0.91, 1.54) 1.19 90.91, 1.54) Koshi 1.0 1.0 1.0 1.0 Provinces Madhesh 1.68 (1.08, 2.63) * 1.68 (1.08, 2.63) * 1.23 (0.72, 2.09) 1.32 (0.77, 2.25) Bagmati 0.58 (0.33, 1.00) 0.58 (0.33, 1.00) 0.79 (0.46, 1.34) 0.77 (0.45, 1.31) Gandaki 1.02 (0.60, 1.73) 1.02 (0.60, 1.73) 1.29 (0.77, 2.17) 1.27 (0.75, 2.13) Lumbini 0.75 (0.46, 1.21) 0.75 (0.46, 1.21) 0.76 (0.47, 1.23) 0.72 (0.45, 1.17) Karnali 1.77 (1.16, 2.68) ** 1.77 (1.16, 2.68) ** 2.10 (1.31, 3.36) ** 1.98 (1.24, 3.17) ** Sudurpaschim 0.98 (0.58, 1.65) *** 0.98 (0.58, 1.65) *** 1.18 (0.68, 2.04) 1.09 (0.63, 1.87) Household and Individual factors Household Wealth Index Richest 1.0 1.0 1.0 Richer 3.28 (1.66, 6.48) ** 2.41 (1.18, 4.93) * 2.42 (1.19, 4.95) Middle 3.84 (1.99, 7.39) *** 2.33 (1.15, 4.70) * 2.44 (1.22, 4.88) * Poorer 5.40 (2.91, 9.99) *** 2.87 (1.47, 5.61) ** 2.98 (1.54, 5.77) ** Poorest 5.02 (2.69, 9.36) *** 2.70 (1.37, 5.33) ** 2.87 (1.48, 5.59) ** Women's Education Secondary or above 1.0 1.0 1.0 Basic 2.76 (2.09, 3.65) *** 2.08 (1.53, 2.82) *** 2.37 (1.73, 3.25) *** No education 5.44 (3.66, 8.09) *** 3.49 (2.03, 5.98) *** 4.62 (2.71, 7.90) *** Ethnicity Brahmin/Chettri 1.0 1.0 1.0 Janajati 1.74 (1.21, 2.50) ** 1.93 (1.30, 2.86) ** 1.96 (1.32, 2.93) *** Dalits 3.08 (2.16, 4.40) *** 1.95 (1.33, 2.86) *** 2.01 (1.37, 2.96) *** Madhesi 1.82 (1.21, 2.76) ** 1.42 (0.83, 2.42) 1.50 (0.87, 2.60) Muslim 3.37 (1.97, 5.76) *** 1.93 (0.99, 3.75) 1.98 (1.02, 3.83) * Individual Behavior and Social Condition Smoking status Yes 1.0 1.0 No 2.81 (0.71, 11.08) 2.77 (0.74, 10.37) Exposure to media FP messages No 1.0 1.0 At least one 0.93 (0.72, 1.20) 1.94 (1.46, 2.57) *** p<0.001, ** p<0.01, * p<0.05 Table 5 shows the results for adverse pregnancy outcomes. Adolescent mothers had higher rates of stillbirths (p<0.001) and miscarriage (p=0.013) than those women who were adults. Similarly, children born to teenage mothers weighed less (p=0.0397). However, adult mothers had higher rates of abortion than teenage mothers (p<0.001). Table 5. Adverse Pregnancy Outcomes Variable Total N 15-19 Years n (%) Total N 20-49 years n (%) P-value Stillbirth 697 6 (0.93) 3136 27 (0.86) < 0.001 Miscarriage 697 83 (11.84) 3136 278 (8.86) 0.013 Low birth weight 697 47 (7.96) 3136 16 (2.74) 0.0397 Very Low birth weight 697 16 (2.74) 3136 7 (1.23) 0.0387 Discussion The present study highlighted the prevalence of teenage pregnancy and adverse pregnancy outcomes in Nepal. Despite longstanding programmatic efforts from the Government, the teenage pregnancy rate remains high, with 14% of teenage women experiencing pregnancy before the age of 20 in Nepal. This finding is higher than the study finding reported in the majority of South Asian countries, such as India (6.8%) ( 33 ), Maldives (5%), and Srilanka (3.8%) ( 34 ). The plausible reason for the higher teenage pregnancy may be attributed to the high prevalence of early marriage in Nepal ( 35 ) and the belief that early girl marriage for social acceptance is still common in many parts of Nepal ( 17 ). The current situation is marked by the highest incidence of self-initiated marriages due to social perception against adolescent relationships, unsafe use of social media practices, peer influence, and a desire to engage in sexual activity ( 36 ). The social behavior change intervention around the negative health impact of early marriage, targeting adolescents, parents, and those who are involved in marriage decisions, can help increase the marital age and reduce teenage pregnancy ( 37 , 38 ). Our findings indicate a high prevalence of teenage pregnancy, especially among adolescents from economically disadvantaged households, marginalized ethnic groups (Janajati, Dalit, and Muslim), those with no or basic education, and residents with limited socioeconomic development, such as Karnali. Economic status significantly influences the teenage pregnancy, with adolescents from lower-income households experiencing higher rates of pregnancy compared to their counterparts from more affluent background. This finding is in agreement with the study conducted by Samikshya et al. ( 17 ) and Lenny et al. ( 39 ). Low family income is linked with failure to obtain daily basic needs such as clothing, food, and entertainment. This can lead to dropping out of school and leaving home for work; some girls find it easy to get married in hopes of getting support from their husbands and reducing their family's economic burden, ultimately fostering early sexual practices and pregnancy. Also, teenage mothers from poor households may have poor access to health services because they can't afford the cost of reproductive health services and contraceptives. This is also substantiated by the previous findings ( 40 – 42 ). Integrating income-generating activities into health programs for adolescent and their families could provide essential vocational training and skills, enabling them to secure stable income and financial independence. This would help address immediate financial needs and empower adolescents to make informed decisions, reducing the rates of child marriage and teenage pregnancy ( 38 ). Adolescent mothers with a high level of education were less likely to experience teenage pregnancy, a trend consistent with previous studies conducted in India ( 1 ), Bangladesh ( 43 ) and Ghana ( 44 ). This may be because adolescents with higher education are likely to be more empowered and better informed about their fundamental and legal rights, enabling them to make informed decisions about their health, including the ability to deny early marriage and early pregnancy ( 17 ). Education further enhances girls' autonomy, decision-making power, and economic independence, contributing to delayed marriage and reduced fertility ( 45 ). In contrast, uneducated adolescents have limited access to sexual and reproductive health information and essential services needed to prevent pregnancy. Teenage girls who are not doing well in school may perceive marriage and motherhood as attractive ( 8 ). Ethnicity and regional disparities also play a significant role in teenage pregnancy in Nepal. Findings indicate that women from the disadvantaged ethnic group (Janajati, Dalit, and Muslim) face a higher likelihood of pregnancy during adolescence compared to their counterparts from advantaged ethnic groups (Brahmin and Chettri), aligning with previous studies in Nepal and other low- and middle-income countries ( 12 , 46 ). The study also highlights regional differences in teenage pregnancy, with Karnali province reporting the highest prevalence. The possible pathway of this influence could be understood through an intersectional lens, where teenage mothers from the disadvantaged ethnic group (Janajati, Dalit, and Muslim) living in Karnali province experience multiple, overlapping forms of disadvantage-economic, social, and educational marginalization ( 47 , 48 ) -that collectively limit their access to various facilities, including reproductive health services. The intersection of these multiple structural barriers may have predisposed them to early marriage and teenage pregnancy ( 47 , 48 ). The practice of early marriage in this area may have been driven by firmly established traditional beliefs widely practised in this province of Nepal ( 35 ). Socioeconomic determinants, including access to education, occupation, and income-generating programs, are essential to ensure adolescent girls' health and well-being. This could assist girls with avoiding early pregnancy or make them better equipped to manage if they do become pregnant ( 49 ). Further, the effective implementation of comprehensive sexuality and life skills education would provide adolescents with awareness of the adverse outcomes of early marriage and equip them with the skills to navigate early marriage and sexual relationships. Our study also found that teenage mothers experience a higher burden of adverse pregnancy outcomes compared to adult mothers. This is largely attributed to the biological and social vulnerabilities of adolescence, which entail considerable risks during pregnancy. Adolescent bodies are often not fully developed and ready for pregnancy, increasing the likelihood of health complications ( 5 ). Teen mothers are also less likely to receive adequate prenatal care, resulting in undetected and untreated complications. Socioeconomic disadvantages, such as lower income and education levels, further limit teen mothers’ access to healthcare and essential resources, consistent with previous evidence ( 8 , 13 , 29 ). Social barriers also discourage adolescent girls from seeking reproductive health services, including contraception ( 50 ). In Nepal, it is stigmatizing for a female to carry a condom or contraceptives. If a girl requests protective sex, she may be blamed for infidelity( 18 ). Cultural preferences for virgin brides are also cited as a reason for teenage marriages and subsequent adverse pregnancy outcomes ( 18 ). Inadequate sexual and reproductive health knowledge, along with poor access to contraception, often leads to unplanned pregnancies and negative pregnancy outcomes. Stigma-reducing sexual health literacy can help to empower adolescents to challenge stigma and discriminatory norms, advocate for their rights and support others in a respectful and informed manner. Additionally, improving Adolescent mothers' access to adolescent-friendly sexual and reproductive health services through expanding such services would improve access to quality care, increase the uptake of contraceptive services among marginalized and disadvantaged adolescent girls, and help prevent teenage pregnancy and its adverse health outcomes. These efforts must adopt equity-focused and contextually relevant strategies that emphasize the inclusion of adolescents and families facing multiple forms of marginalization, with a particularly those who are deprived and hard-to-reach. Lastly, effective implementation, monitoring, and evaluation of existing policies and programs related to adolescent sexual and reproductive health are crucial for reducing teenage pregnancy and fostering positive changes on adolescent health. Strength and limitations The strength of this study included the analysis based on the data derived from nationally representative surveys conducted in Nepal, which maximized the sample size and improved the generalizability of the results to the wider population. Furthermore, the NDHS used a pretested and well-designed questionnaire and trained interviewers for data collection with good reliability. However, the following limitations should be considered while interpreting the study findings. First, it was a survey design that didn't provide us with inferences regarding causality, and the information provided by the respondents was based on self-reports that may be subject to recall bias. Conclusion Findings suggest the high prevalence of teenage pregnancy and high adverse pregnancy outcomes. Teenage pregnancies differ by socioeconomic demographic characteristics and other factors such as wealth status, ethnicity, education, and residence. Implementing multilevel interventions targeting adolescents, their families, and communities is imperative. These interventions should be tailored, particularly for women with poor socioeconomic status, including those who are poor, have basic or no education, and belong to disadvantaged ethnic groups (Dalit, Janajati, or Muslim caste) and residing in areas with poor socio-economic progress (Karnali province). Additionally, effective implementation of Social and Behavioral Change interventions, including comprehensive sexuality and life skills education covering schools and the community, would empower adolescent girls by providing them with accurate information, fostering healthy attitudes, and equipping them with skills to decide to delay sexual activity and early marriage. Likewise, ensuring access to adolescent-friendly sexual and reproductive health services could prevent early motherhood and adverse pregnancy outcomes. Moreover, provincial and national efforts to prevent early marriage and empower women and girls can benefit. Abbreviations CSE -Comprehensive Sexuality Education FP -Family Planning GoN -Government of Nepal ICPD- ICPD -International Conference on Population and Development LMIC -Low- and Middle-Income Countries MoHP- Ministry of Health and Population NDHS -Nepal Demographic and Health Survey SBC -Social Behavior Change SDGs -Sustainable Development Goals Declarations Conflict of interest The authors declare that they have no competing interests, and the research was conducted without any commercial or financial relationships that could potentially create a conflict of interest. Availability of data and material The data supporting our findings can be made publicly available. Competing interests The authors declared that they have no competing interests. Funding No funding was received for this manuscript. Authors' contributions DST conceptualized the manuscript; BKS performed the data analysis; DST prepared the first draft; DST, RB, BS, PL, and RH reviewed and edited the manuscript. 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The Effect of Adolescent Pregnancy on Child Mortality in 46 Low- and Middle- ­ Income Countries. BMJ Glob Heal. 2022;1–12. de la Calle M, Bartha JL, Lopez CM, Turiel M, Martinez N, Arribas SM, et al. Younger age in adolescent pregnancies is associated with higher risk of adverse outcomes. Int J Environ Res Public Health. 2021;18(16). Theresa O. Scholl PhD a, Mary L. Hediger PhD a, Jianping Huang MA b, Francis E. Johnson PhD b, Woollcott Smith PhD c IGAM a. Young maternal age and parity influences on pregnancy outcome. Ann Epidemiol. 1992; Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ. Adolescent Pregnancy Outcomes and Risk Factors. Int J Environ Res Public Health. 2023;20(5):0–9. Mutea L, Were V, Ontiri S, Michielsen K, Gichangi P. Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003–2014. BMC Womens Health. 2022;22(1):1–11. Anaba EA, Alor SK, Badzi CD. Utilization of antenatal care among adolescent and young mothers in Ghana ; analysis of the 2017 / 2018 multiple indicator cluster survey. BMC Pregnancy Childbirth. 2022;1–8. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121 Suppl:40–8. Poudel S, Razee H, Dobbins T, Akombi-Inyang B. Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies. Int J Environ Res Public Health. 2022;19(22). WHO. Adolescent pregnancy: Adolescence is a time of opportunity during which a range of actions can be taken to set the stage for healthy adulthood : fact sheet [Internet]. Adolescent Pregnancy Fact Sheet. 2014. 1–4 p. Available from: http://apps.who.int/iris/bitstream/10665/112320/1/WHO_RHR_14.08_eng.pdf%0Awww.who.int/reproductivehealth Edilberto L, Mengjia L. Adolescent Pregnancy : A Review of the Evidence. Unfpa [Internet]. 2013; Available from: https://gsdrc.org/document-library/adolescent-pregnancy-a-review-of-the-evidence/ Tom Merrick. Making the Case for Investing in Adolescent Reproductive Health. 2015;(December). Available from: http://poppov.org/Publications-and-Multimedia/2015/Adolescent-Repro-Health.aspx Bahamondes L. Long term social consequences of adolescent pregnancy. Vol. 126, BJOG: An International Journal of Obstetrics and Gynaecology. 2019. p. 368. Poudel S, Upadhaya N, Khatri RB, Ghimire PR. Trends and factors associated with pregnancies among adolescent women in Nepal: Pooled analysis of Nepal Demographic and Health Surveys (2006, 2011 and 2016). PLoS One. 2018; Poudel I. Teenage pregnancies in Nepal - the problem status and socio-legal concerns - Letter to the editor. Vol. 57, Journal of the Nepal Medical Association. 2019. p. 285. Poudel S, Upadhaya N, Khatri RB, Ghimire PR. Trends and factors associated with pregnancies among adolescent women in Nepal: Pooled analysis of Nepal Demographic and Health Surveys (2006, 2011 and 2016). PLoS One. 2018;13(8). Government of Nepal, Ministry of Health D of HS. Adolescent Sexual and Reproductive Health Programme to Address Equity, Social Determinants, Gender and Human Rights in Nepal, Report of the Pilot Project [Internet]. 2017. Available from: https://un.org.np/resource/adolescent-sexual-and-reproductive-health-programme-address-equity-social-determinants Department of Health Services. National Adolescent Health and Development Strategy (Unofficial Translation) [Internet]. Vol. 2057. 2018. Available from: https://fwd.gov.np/asrh/ Sugawara E, Nikaido H. Properties of AdeABC and AdeIJK efflux systems of Acinetobacter baumannii compared with those of the AcrAB-TolC system of Escherichia coli. Antimicrob Agents Chemother [Internet]. 2014;58(12):7250–7. Available from: https://fwd.gov.np/asrh/ GoN 2015. The Constitution of Nepal [Internet]. Nepal Gazette 2015 p. 1–226. Available from: https://lawcommission.gov.np/en/?s=constitutional+of+Nepal Statements P, Authority P. The National Civil ( Code ) Act , 2017 ( 2074 ) [Internet]. Vol. 2017. 2017. Available from: https://lawcommission.gov.np Nepal Law Commission. The Right to Safe Motherhood and Reproductive Health Act, 2018 [Internet]. 9–2075 Nepal; 2018. Available from: https://lawcommission.gov.np Governement of Nepal. Nepal Health Sector Strategy.Ministry of Health and Population, Kathmandu [Internet]. 2015. Available from: https://nepal.unfpa.org/en/publications/nepal-health-sector-strategy-2015-2020 Ministry of Health and Population. Nepal Health Sector Strategy. Nepal Heal Sect Strateg [Internet]. 2015;1–26. Available from: http://nhrc.gov.np/wp-content/uploads/2017/03/Health-Research-Areas-of-Nepal-2019.pdf Ministry of Health and Population (MOHP). Nepal Demographic and Health Survey [Internet]. 2022. Available from: https://dhsprogram.com Gurung R, Målqvist M, Hong Z, Poudel PG, Sunny AK, Sharma S, et al. The burden of adolescent motherhood and health consequences in Nepal. BMC Pregnancy Childbirth. 2020;20(1):1–7. Khatri RB, Poudel S, Ghimire PR. Factors associated with unsafe abortion practices in Nepal: Pooled analysis of the 2011 and 2016 Nepal Demographic and Health Surveys. Vol. 14, PLoS ONE. 2019. p. 1–15. World Health Organization. Adolescent pregnancy [Internet]. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy Khatri RB, Karkee R. Social determinants of health affecting utilisation of routine maternity services in Nepal: a narrative review of the evidence. Vol. 26, Reproductive Health Matters. Taylor & Francis; 2018. p. 32–46. National Family Health Survey (NFHS-5). National Family Health Survey (NFHS-5) India 2019-21. NFHS-5 Rep [Internet]. 2019;15:2019–21. Available from: http://rchiips.org/nfhs/factsheet_nfhs-5.shtml%0Ahttp://rchiips.org/nfhs/factsheet_NFHS-5.shtml Chatzistratidi F, Papakitsos EC, Mavridaki A. A Systems Methodology Approach to the Designing and Evaluation of Websites. Am J Oper Manag Inf Syst [Internet]. 2016;1(1):7–16. Available from: http://www.sciencepublishinggroup.com/j/ajomis Bhattarai PC, Paudel DR, Poudel T, Gautam S, Paudel PK, Shrestha M, et al. Prevalence of Early Marriage and Its Underlying Causes in Nepal: A Mixed Methods Study. Soc Sci. 2022;11(4). National Child Rights Council. The Status of Child Marriage And Impact Upon Girls [Internet]. 2021. Available from: https://plan-international.org/nepal/publications/status-child-marriage-impact-upon-girls/ Siddiqi M, Greene ME, Stoppel A, Allegar C. Interventions to Address the Health and Well-Being of Married Adolescents: A Systematic Review. Glob Heal Sci Pract. 2024;12(4):1–19. NHRC, UNICEF. Behavioural Determinants of Child Marriage and Adolescent Pregnancy in Nepal: A qualitative study [Internet]. 2024. Available from: https://www.unicef.org/nepal/media/21151/file/ECM - Main Report.pdf Mushwana L, Monareng L, Richter S, Muller H. International Journal of Africa Nursing Sciences Factors influencing the adolescent pregnancy rate in the Greater Giyani Municipality , Limpopo Province – South Africa. Int J AFRICA Nurs Sci. 2015;2:10–8. Pannilage U. Impact of Family on Children’s Wellbeing. J Sociol Soc Work. 2017;5(1):149–58. Diniz E, Koller SH. Factors Associated with Pregnancy among Low-Income Brazilian Adolescent. Paideia. 2012;22(53):305–14. Jonas K, Crutzen R, Borne B Van Den, Sewpaul R, Reddy P. Teenage pregnancy rates and associations with other health risk behaviours : a three- wave cross-sectional study among South African school-going adolescents. Reprod Health. 2016; Nahar Q, Min H. Trends and determinants of adolescent childbearing in Bangladesh [Internet]. DHS Working Papers No. 48. 2008. Available from: http://dhsprogram.com/pubs/pdf/WP48/WP48.pdf Senkyire EK, Boateng D, Boakye FO, Logo DD, Ohaja M. Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey. PLoS One. 2022;17(12 December):1–16. Worku MG, Tessema ZT, Teshale AB, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15–19 years) in East Africa: a multilevel analysis. BMC Pregnancy Childbirth. 2021;21(1):1–8. Maharjan RK, Karki KB, Shakya TM, Aryal B. Child marriage in Nepal [Internet]. Save the Children, Plan Nepal and World Vision. 2012. 76 p. Available from: https://www.wvi.org/sites/default/files/Child Marriage in Nepal- Report.pdf Project and Planning Commission. Sustainable Development Goals Baseline Report of Gandaki Province - DocsLib. 2019;(September). Available from: https://docslib.org/doc/9850610/sustainable-development-goals-baseline-report-of-gandaki-province Save the Children, Nepal Country Office, Kathamndu N. Advancing SDGs and Realizing Children’s Rights in Nepal: Child-Informed SDGs review report, [Internet]. 2024. Available from: https://resourcecentre.savethechildren.net/document/advancing-sdgs-and-realizing-childrens-rights-in-nepal-child-informed-sdgs-review-report/ Williamson N. Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy. State World Popul 2013. 2013;132. Yang C, Tang D. Patient-Specific Carotid Plaque Progression Simulation. C Model Eng Sci. 2000;1(2):119–31. Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences : a scoping review. Health Psychol Rev. 2015;0(0):1–22. Additional Declarations No competing interests reported. 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Teenage pregnancy is defined as pregnancy in women aged 10 to 19 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is recognized as a health risk, often leading to devastating health consequences (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Teenage pregnancy contributes significantly to the global burden of maternal and child health-related morbidities and mortalities, with a substantially high proportion occurring in low and middle-income countries (LMICs) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly childbearing can have negative health consequences for teenage mothers and their infants. In LMICs, babies born to adolescent mothers face increased risks of complications such as pre-term delivery, obstructed labor, infections, stillbirths, premature and low birth weight, and severe neonatal health complications (\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These complications are the leading causes of death among girls aged 15\u0026ndash;19 years worldwide, with LMIC countries accounting for 99% of these deaths (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, around 13% of women below 18 years gave birth in 2015\u0026ndash;2020, with over 90% of teenage pregnancies occurring in LMICs, such as Nepal (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). As of 2019, an estimated 21\u0026nbsp;million girls aged 15\u0026ndash;19 years in LMICs become pregnant each year, resulting in approximately 12\u0026nbsp;million births (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Around half of these pregnancies were unplanned (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This produces significant immediate and long-term impacts on maternal and child health outcomes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTeenage pregnancy can also generate social stigma, rejection or violence by partners, parents and peers (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), as well as reduce access to future education and employment opportunities (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The World Health Organization (WHO) estimates that 5\u0026ndash;33% of adolescents and young women who abandon school do so because of early pregnancy and marriage (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePast evidence revealed that South Asia has the second highest rate of teenage pregnancy, with Nepal having one of the highest rates in the region at 21% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The high burden of teenage pregnancy in Nepal is reportedly due to various factors related to low socioeconomic status, high child marriage, and lack of comprehensive sexuality education (CSE) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Other factors identified globally include family income, family size, educational level, wealth status, perceptions of the appropriate age of marriage, and exposure to mass or social media (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNepal has made various efforts to reduce teenage pregnancy. As a signatory to the International Convention on Population and Development (ICPD) Program of Action (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), The Government of Nepal (GoN) has adopted various laws, policies, and strategies focused on adolescent sexual and reproductive health, including tackling teenage pregnancy as a priority. For instance, Nepal's National Reproductive Health Strategy, developed in 1998 as the country's first Strategy of its kind, was a pioneering effort that included Adolescent Sexual and Reproductive Health as a key component (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The Strategy was mandated to promote adolescents' health and socioeconomic status through various measures, including raising the legal age of marriage and reducing teenage pregnancy rates. In 2000, the GoN also developed the National Adolescent Health and Development strategy (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFollowing the Strategy, in 2010, Nepal introduced adolescent-friendly sexual and reproductive health services under its five-year health sector plan (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The constitution of Nepal (2015) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) ensured reproductive health rights, and the National Civil Code (2017) set the minimum marriage age at 20, with penalties for violations (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The Safe Motherhood and Reproductive Health Act (2018) reinforced these commitments (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The Adolescent Health and Development Strategy was revised in 2018 to address emerging health issues and align with Sustainable Development Goals (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Nepal's Health Sector Strategy (2016\u0026ndash;2021, 2022\u0026ndash;2030) targets fertility rate reduction and universal access to reproductive health services (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (Supplementary Fig.\u0026nbsp;1 and Table\u0026nbsp;1). Despite these efforts, progress remains slow (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Adolescent marriage and fertility rates remain high (72/1000 in 2022), and teenage pregnancy contributes to adverse health outcomes and unsafe abortion, posing a challenge to achieving Nepal's 2030 health and development goals. In 2017, 120,000 teenage pregnancies were recorded [ 30,31]. Although teenage pregnancy is a significant public health concern in Nepal, there is limited research on the determinants of teenage pregnancy and the adverse pregnancy outcomes (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePreventing pregnancy among adolescents and pregnancy-related mortality and morbidity are foundational to achieving positive health outcomes across the life course and imperative for achieving the Sustainable Development Goals (SDGs) related to maternal and newborn health (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Identifying key determinants of teenage pregnancy and adverse pregnancy outcomes is essential for evidence-based programs. Hence, this study aimed to examine these factors in Nepal using the latest nationally representative data from the Nepal Demographic and Health Survey (2022). The findings provide evidence-based insights to help policymakers and program managers strengthen policies and program interventions to reduce teenage pregnancy and its adverse outcomes.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Sampling Procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is based on secondary data analysis of the existing national-level data from the recent round of the Nepal Demographic and Health Survey (NDHS) 2022 (available from https://dhsprogram.com/data/datasetadmin/index.cfm#). The NDHS is a nationally representative household survey conducted by New Educational Reform Associates (New ERA) under the guidance of the Ministry of Health and Population (MoHP), Government of Nepal, with support from global partners, including USAID and ICF International. We extracted all relevant variables from the women\u0026apos;s data files (individual recode) in the NDHS 2022 data set for this study. A detailed description of the methodology is provided elsewhere (28).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBriefly, the NDHS 2022 adopted a multistage cluster sampling design and collected data to periodically estimate several sociodemographic and health indicators, including information about reproductive health issues such as teenage pregnancy and childbirth. Women aged 15-49 years of selected households who had agreed to participate in the study were also enrolled to participate in the survey. Data on pregnancy and childbirth history were collected from 14,845 women aged 15-49 years, yielding a response rate of 97%. For this study, we restricted our analyses to 2,643 adolescent girls aged 15-19 years and 3,833 pregnant women aged 15-49 years (Fig 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Variables\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome variable of interest in this study was \u0026quot;teenage pregnancy\u0026quot;, defined as women aged 15-19 years who were pregnant or reported live birth at the time of the interview, regardless of the outcome of the pregnancy preceding the three years of the survey period. Women aged 15-49 years were asked to report past pregnancy outcomes as well as their current pregnancy status at the time of the interview. The dependent variable was binary and coded as \u0026quot;1\u0026quot; for adolescents who either had started childbearing or were pregnant for the first time and coded as \u0026quot;0\u0026quot; if otherwise. The secondary outcome variable was an adverse pregnancy outcome, which included several factors such as whether the individual had ever experienced pregnancy that ended in stillbirth (yes/no), whether they had ever had a pregnancy that ended in miscarriage (yes/no), and whether their child was born with a low birth weight (yes/no). The response to the above is coded as 1, which means \u0026quot;yes\u0026quot;, and coded as \u0026quot;0\u0026quot; if otherwise.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe exploratory variables were selected based on the review of past studies on teenage pregnancy and adverse outcomes conducted in developing countries, including Nepal (1,12,17), as well as information available in the NDHS 2022 dataset. This included variables such as place of residence, wealth status, ethnicity, religion, maternal education, and exposure to family planning (FP) messages on social media. Variables such as wealth status, maternal education, ethnicity, religion, maternal smoking status, and exposure to FP messages were further categorised for this study, as shown in Table 2 (32). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Definitions of study variables and their utilization in models formulated.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUtilized in model/ Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdolescent motherhood\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eAdolescents who have ever given birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDependent/Binary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeenage Pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eAdolescents who have even been pregnant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDependent/Binary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003ePlace of residence (Urban; Rural)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eEthnicity was classified into five categories: Brahmin/ Chhetri, Janajati, Dalit, Madhesi, and Muslim. In Nepal, Brahmin/Chettri is considered as an advantaged ethnic group due to their comparative privilege, whereas Dalit, Janajati, Madhesi and Muslim are relatively disadvantaged and socioeconomically marginalized groups (28).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eReligion was categorised into four groups: Hindu, Buddhist, Muslim, and others.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProvince\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eThe seven provinces of Nepal are Koshi, Madhesh, Bagmati, Gandaki, Lumbini, Karnali, and Sudurpaschim.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eMaternal education was categorised into four groups: none (no education), basic (1-8 grades), secondary, and higher (9-12 grades or above).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Wealth Status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eThe NDHS applied an asset-based approach to estimate household wealth quintiles, and household wealth status was categorized as poorest, poorer middle, richer, and richest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eIndependent/ categorical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal smoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eMaternal smoking status is grouped as Yes; No.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBinary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to FP messages on social media\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eWomen\u0026apos;s access to social media at least once a week is grouped as Yes; No.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBinary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analysed using STATA (version 18.0) (Stata Crop, Texas, USA). In the descriptive analyses, the characteristics of the study participants were presented in the form of frequency and proportion (%) with 95% confidence intervals (CI). Univariate logistic regression examined the unadjusted association between exploratory variables and study outcome. This was followed by multivariable logistic regression modelling to identify determinants of teenage pregnancy. According to the adjusted regression model, variables with p\u0026lt;0.05 were considered to be significantly associated with teenage pregnancy. We presented the adjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used secondary data derived from the recent round of NDHS 2022. These surveys were approved by an ethical review board of ICF Marco International, Maryland, USA, and the Nepal Health Research Council. The first author submitted a formal request to the DHS program through their website (www.dhsprogram.com) to obtain permission to use those datasets for this study, and approval was granted on February 15, 2024. The DHS data are available and accessible at https://dhsprogram.com/data/dataset_admin/index.cfm# upon online request.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 3 depicts the sociodemographic profile and prevalence of teenage pregnancy in Nepal. Out of the total adolescent girls (N=2,643) in the sample, around 14% had teenage pregnancy. The rates of teenage pregnancy varied between sub-populations with different sociodemographic backgrounds: with socioeconomically better off having lower teenage pregnancy. Teenage pregnancy was highest among adolescents who belonged to poor households (poorer and poorest), adolescents with no education, and those who were from Dalit and Muslim castes (disadvantaged caste group). Similarly, teenage pregnancy was high among adolescents from the Muslim religion, those who resided in certain areas with inadequate socioeconomic progress (Karnali and Madesh province), and those who did not have exposure to any Family Planning (FP) -related media messages (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Distribution of teenage pregnancy by background characteristics, 2022 DHS, Nepal (N=2643).\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Adolescents (N)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeenage Pregnancy (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% (CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 652px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity level factors\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1,758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e66.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e12.9 (10.8,15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e14.9 (12.8,17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProvinces\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eKoshi\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e15..5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e12.8 (9.5,17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMadhesh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e19.8 (15.5,24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBagmati\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e7.8 (5.2,11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eGandaki\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e12.9 (8.9,18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eLumbini\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e9.8 (7.1,13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eKarnali\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e20.5 (16.8,24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSudurpaschim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e12.5 (8.7,17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 652px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold and Individual factors\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Wealth Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e17.4 (14.8,20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003ePoorer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e18.5 (15.2,22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMiddle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13.9 (10.8,17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eRicher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e12.1 (9.0,16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eRichest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4.0 (2.3,7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026apos;s Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSecondary and Higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e59.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8.2 (6.8,9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e19.8 (16.8,23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e32.7 (25.7,40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBrahmin/Chettri\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e7.8 (6.2, 9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eJanajati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e12.9 (10.3, 16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eDalits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e20.7 (16.8, 25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMadheshi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e13.4 (10.1, 17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e22.2 (15.1, 31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13.1 (11.5,14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBuddhist\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e9.4 (5.3,16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e22.8 (15.7,31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13.5 (7.8,22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 652px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual Behavior and Social Condition\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e5.3 (1.4,18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e99.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003e13.6 (12.1,15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to media FP messages\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAt least one media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e9.7 (7.3, 12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e15.0 (13.1, 16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eThe p-value was obtained from the chi-squared association test.\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026dagger;\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eSignificant at p \u0026lt; 0.05.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 presents the adjusted association between sociodemographic characteristics and teenage pregnancy. In the multivariable logistic regression analyses, three-stage modelling was used. In the first stage, community-level factors (place of residence and province) were entered into the first-stage model (Model I), and a manually executed elimination method was used to determine factors associated with teenage pregnancy at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05. The significant factors in the first stage model were then added to household and individual level factors (household wealth index, women\u0026apos;s education, and ethnicity), which was the second stage model (Model II); this was then followed by a manually executed elimination procedure. The significant factors for both Models I and II were added to individual behaviour and social condition (smoking, exposure to media FP messages) in the third model (Model III). We used a similar approach for individual behaviour and social conditions in Model III. Model III, the fully adjusted model, included all relevant factors, including behavioural and social conditions (smoking status, exposure to family planning messages).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe findings of the final model showed that teenage pregnancy was significantly associated with household wealth index (poorest or poor or middle household wealth index), ethnic disadvantaged groups (Janajati, Dalit and Muslim), education (no or basic education) and those who lived in the province with inadequate socioeconomic progress (Karnali province). Adolescents having the poorest (aOR= 2.87, 95% CI: 1.48, 5.59), poorer (aOR=2.98, 95% CI: 1.54, 5.77) and middle household wealth (aOR=2.44, 95% CI:1.22, 4.88) were more likely to experience teenage pregnancy compared to those with the highest household wealth. Teenage mothers belonged to Janajati caste (aOR=1.96, 95% CI: 1.32, 2.93), Dalit (aOR=2.01, 95% CI:1.37, 2.96), and Muslim ethnicity groups (aOR=1.98, 95% CI: 1.02, 3.83) had higher odds of teenage pregnancy compared to Brahmin/Chettri (relatively advantaged ethnic group). Similarly, women who lived in Karnali had nearly two-fold higher odds of having teenage pregnancy (aOR=1.98, 95% CI: 1.24, 3.17). (Table 4)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Factors associated with teenage pregnancy in Nepal, DHS 2022, (N=2643).\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Unadjusted Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity level factors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.18 (0.91, 1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.19 90.91, 1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eKoshi\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eProvinces\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eMadhesh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.68 (1.08, 2.63) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.68 (1.08, 2.63) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.23 (0.72, 2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.32 (0.77, 2.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eBagmati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.58 (0.33, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.58 (0.33, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.79 (0.46, 1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.77 (0.45, 1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eGandaki\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.02 (0.60, 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.02 (0.60, 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.29 (0.77, 2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.27 (0.75, 2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eLumbini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.75 (0.46, 1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.75 (0.46, 1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.76 (0.47, 1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.72 (0.45, 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eKarnali\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.77 (1.16, 2.68) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.77 (1.16, 2.68) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.10 (1.31, 3.36) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.98 (1.24, 3.17) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eSudurpaschim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.98 (0.58, 1.65) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.98 (0.58, 1.65) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.18 (0.68, 2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.09 (0.63, 1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold and Individual factors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Wealth Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eRichest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eRicher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3.28 (1.66, 6.48) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.41 (1.18, 4.93) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.42 (1.19, 4.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eMiddle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3.84 (1.99, 7.39) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.33 (1.15, 4.70) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.44 (1.22, 4.88) *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ePoorer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5.40 (2.91, 9.99) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.87 (1.47, 5.61) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.98 (1.54, 5.77) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ePoorest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5.02 (2.69, 9.36) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.70 (1.37, 5.33) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.87 (1.48, 5.59) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026apos;s Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eSecondary or above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e2.76 (2.09, 3.65) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.08 (1.53, 2.82) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.37 (1.73, 3.25) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5.44 (3.66, 8.09) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e3.49 (2.03, 5.98) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4.62 (2.71, 7.90) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eBrahmin/Chettri\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eJanajati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.74 (1.21, 2.50) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.93 (1.30, 2.86) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.96 (1.32, 2.93) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eDalits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3.08 (2.16, 4.40) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.95 (1.33, 2.86) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.01 (1.37, 2.96) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eMadhesi\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1.82 (1.21, 2.76) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.42 (0.83, 2.42)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.50 (0.87, 2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3.37 (1.97, 5.76) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.93 (0.99, 3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.98 (1.02, 3.83) *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual Behavior and Social Condition\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e2.81 (0.71, 11.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.77 (0.74, 10.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to media FP messages\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eAt least one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.93 (0.72, 1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.94 (1.46, 2.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*** p\u0026lt;0.001, ** p\u0026lt;0.01, * p\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eTable 5 shows the results for adverse pregnancy outcomes. Adolescent mothers had higher rates of stillbirths (p\u0026lt;0.001) and miscarriage (p=0.013) than those women who were adults. Similarly, children born to teenage mothers weighed less (p=0.0397). However, adult mothers had higher rates of abortion than teenage mothers (p\u0026lt;0.001). \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Adverse Pregnancy Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal N\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15-19 Years n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal N\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20-49 years n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStillbirth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6 (0.93)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e27 (0.86)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMiscarriage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e83 (11.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e278 (8.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow birth weight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e47 (7.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.0397\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Low birth weight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.0387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study highlighted the prevalence of teenage pregnancy and adverse pregnancy outcomes in Nepal. Despite longstanding programmatic efforts from the Government, the teenage pregnancy rate remains high, with 14% of teenage women experiencing pregnancy before the age of 20 in Nepal. This finding is higher than the study finding reported in the majority of South Asian countries, such as India (6.8%) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), Maldives (5%), and Srilanka (3.8%) (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe plausible reason for the higher teenage pregnancy may be attributed to the high prevalence of early marriage in Nepal (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) and the belief that early girl marriage for social acceptance is still common in many parts of Nepal (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The current situation is marked by the highest incidence of self-initiated marriages due to social perception against adolescent relationships, unsafe use of social media practices, peer influence, and a desire to engage in sexual activity (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The social behavior change intervention around the negative health impact of early marriage, targeting adolescents, parents, and those who are involved in marriage decisions, can help increase the marital age and reduce teenage pregnancy (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings indicate a high prevalence of teenage pregnancy, especially among adolescents from economically disadvantaged households, marginalized ethnic groups (Janajati, Dalit, and Muslim), those with no or basic education, and residents with limited socioeconomic development, such as Karnali.\u003c/p\u003e \u003cp\u003eEconomic status significantly influences the teenage pregnancy, with adolescents from lower-income households experiencing higher rates of pregnancy compared to their counterparts from more affluent background. This finding is in agreement with the study conducted by Samikshya et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Lenny et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Low family income is linked with failure to obtain daily basic needs such as clothing, food, and entertainment. This can lead to dropping out of school and leaving home for work; some girls find it easy to get married in hopes of getting support from their husbands and reducing their family's economic burden, ultimately fostering early sexual practices and pregnancy. Also, teenage mothers from poor households may have poor access to health services because they can't afford the cost of reproductive health services and contraceptives. This is also substantiated by the previous findings (\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Integrating income-generating activities into health programs for adolescent and their families could provide essential vocational training and skills, enabling them to secure stable income and financial independence. This would help address immediate financial needs and empower adolescents to make informed decisions, reducing the rates of child marriage and teenage pregnancy (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdolescent mothers with a high level of education were less likely to experience teenage pregnancy, a trend consistent with previous studies conducted in India (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), Bangladesh (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and Ghana (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). This may be because adolescents with higher education are likely to be more empowered and better informed about their fundamental and legal rights, enabling them to make informed decisions about their health, including the ability to deny early marriage and early pregnancy (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Education further enhances girls' autonomy, decision-making power, and economic independence, contributing to delayed marriage and reduced fertility (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). In contrast, uneducated adolescents have limited access to sexual and reproductive health information and essential services needed to prevent pregnancy. Teenage girls who are not doing well in school may perceive marriage and motherhood as attractive (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthnicity and regional disparities also play a significant role in teenage pregnancy in Nepal. Findings indicate that women from the disadvantaged ethnic group (Janajati, Dalit, and Muslim) face a higher likelihood of pregnancy during adolescence compared to their counterparts from advantaged ethnic groups (Brahmin and Chettri), aligning with previous studies in Nepal and other low- and middle-income countries (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study also highlights regional differences in teenage pregnancy, with Karnali province reporting the highest prevalence. The possible pathway of this influence could be understood through an intersectional lens, where teenage mothers from the disadvantaged ethnic group (Janajati, Dalit, and Muslim) living in Karnali province experience multiple, overlapping forms of disadvantage-economic, social, and educational marginalization (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) -that collectively limit their access to various facilities, including reproductive health services. The intersection of these multiple structural barriers may have predisposed them to early marriage and teenage pregnancy (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). The practice of early marriage in this area may have been driven by firmly established traditional beliefs widely practised in this province of Nepal (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Socioeconomic determinants, including access to education, occupation, and income-generating programs, are essential to ensure adolescent girls' health and well-being. This could assist girls with avoiding early pregnancy or make them better equipped to manage if they do become pregnant (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Further, the effective implementation of comprehensive sexuality and life skills education would provide adolescents with awareness of the adverse outcomes of early marriage and equip them with the skills to navigate early marriage and sexual relationships.\u003c/p\u003e \u003cp\u003eOur study also found that teenage mothers experience a higher burden of adverse pregnancy outcomes compared to adult mothers. This is largely attributed to the biological and social vulnerabilities of adolescence, which entail considerable risks during pregnancy. Adolescent bodies are often not fully developed and ready for pregnancy, increasing the likelihood of health complications (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Teen mothers are also less likely to receive adequate prenatal care, resulting in undetected and untreated complications.\u003c/p\u003e \u003cp\u003eSocioeconomic disadvantages, such as lower income and education levels, further limit teen mothers\u0026rsquo; access to healthcare and essential resources, consistent with previous evidence (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Social barriers also discourage adolescent girls from seeking reproductive health services, including contraception (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). In Nepal, it is stigmatizing for a female to carry a condom or contraceptives. If a girl requests protective sex, she may be blamed for infidelity(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Cultural preferences for virgin brides are also cited as a reason for teenage marriages and subsequent adverse pregnancy outcomes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Inadequate sexual and reproductive health knowledge, along with poor access to contraception, often leads to unplanned pregnancies and negative pregnancy outcomes. Stigma-reducing sexual health literacy can help to empower adolescents to challenge stigma and discriminatory norms, advocate for their rights and support others in a respectful and informed manner. Additionally, improving Adolescent mothers' access to adolescent-friendly sexual and reproductive health services through expanding such services would improve access to quality care, increase the uptake of contraceptive services among marginalized and disadvantaged adolescent girls, and help prevent teenage pregnancy and its adverse health outcomes.\u003c/p\u003e \u003cp\u003eThese efforts must adopt equity-focused and contextually relevant strategies that emphasize the inclusion of adolescents and families facing multiple forms of marginalization, with a particularly those who are deprived and hard-to-reach. Lastly, effective implementation, monitoring, and evaluation of existing policies and programs related to adolescent sexual and reproductive health are crucial for reducing teenage pregnancy and fostering positive changes on adolescent health.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eThe strength of this study included the analysis based on the data derived from nationally representative surveys conducted in Nepal, which maximized the sample size and improved the generalizability of the results to the wider population. Furthermore, the NDHS used a pretested and well-designed questionnaire and trained interviewers for data collection with good reliability. However, the following limitations should be considered while interpreting the study findings. First, it was a survey design that didn't provide us with inferences regarding causality, and the information provided by the respondents was based on self-reports that may be subject to recall bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFindings suggest the high prevalence of teenage pregnancy and high adverse pregnancy outcomes. Teenage pregnancies differ by socioeconomic demographic characteristics and other factors such as wealth status, ethnicity, education, and residence. Implementing multilevel interventions targeting adolescents, their families, and communities is imperative. These interventions should be tailored, particularly for women with poor socioeconomic status, including those who are poor, have basic or no education, and belong to disadvantaged ethnic groups (Dalit, Janajati, or Muslim caste) and residing in areas with poor socio-economic progress (Karnali province).\u003c/p\u003e \u003cp\u003eAdditionally, effective implementation of Social and Behavioral Change interventions, including comprehensive sexuality and life skills education covering schools and the community, would empower adolescent girls by providing them with accurate information, fostering healthy attitudes, and equipping them with skills to decide to delay sexual activity and early marriage. Likewise, ensuring access to adolescent-friendly sexual and reproductive health services could prevent early motherhood and adverse pregnancy outcomes. Moreover, provincial and national efforts to prevent early marriage and empower women and girls can benefit.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCSE\u003c/strong\u003e-Comprehensive Sexuality Education\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFP\u003c/strong\u003e-Family Planning\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGoN\u003c/strong\u003e-Government of Nepal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICPD- ICPD\u003c/strong\u003e-International Conference on Population and Development\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMIC\u003c/strong\u003e-Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMoHP- Ministry\u003c/strong\u003e of Health and Population\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNDHS\u003c/strong\u003e-Nepal Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSBC\u003c/strong\u003e-Social Behavior Change\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSDGs\u003c/strong\u003e-Sustainable Development Goals\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests, and the research was conducted without any commercial or financial relationships that could potentially create a conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and material\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting our findings can be made publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no competing interests.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDST conceptualized the manuscript; BKS performed the data analysis; DST prepared the first draft; DST, RB, BS, PL, and RH reviewed and edited the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShri N, Singh M, Dhamnetiya D, Bhattacharyya K, Jha RP, Patel P. Prevalence and correlates of adolescent pregnancy, motherhood and adverse pregnancy outcomes in Uttar Pradesh and Bihar. BMC Pregnancy Childbirth. 2023;23(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eThakuri DS, Bhandari R, Khatri S, Dhungana A, Balami R, Hanson-Hall NA. Effect of Healthy Transitions intervention in improving family planning uptake among adolescents and young women in Western Nepal: A pre-and post-intervention study. PLoS One [Internet]. 2023;18(6 JUNE):1\u0026ndash;16. Available from: http://dx.doi.org/10.1371/journal.pone.0286705\u003c/li\u003e\n\u003cli\u003eAzimirad A. Pregnancy in adolescence: It is time to get ready for generations Z and Alpha. 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Available from: https://nepal.unfpa.org/en/publications/nepal-health-sector-strategy-2015-2020\u003c/li\u003e\n\u003cli\u003eMinistry of Health and Population. Nepal Health Sector Strategy. Nepal Heal Sect Strateg [Internet]. 2015;1\u0026ndash;26. Available from: http://nhrc.gov.np/wp-content/uploads/2017/03/Health-Research-Areas-of-Nepal-2019.pdf\u003c/li\u003e\n\u003cli\u003eMinistry of Health and Population (MOHP). Nepal Demographic and Health Survey [Internet]. 2022. Available from: https://dhsprogram.com\u003c/li\u003e\n\u003cli\u003eGurung R, M\u0026aring;lqvist M, Hong Z, Poudel PG, Sunny AK, Sharma S, et al. The burden of adolescent motherhood and health consequences in Nepal. BMC Pregnancy Childbirth. 2020;20(1):1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKhatri RB, Poudel S, Ghimire PR. Factors associated with unsafe abortion practices in Nepal: Pooled analysis of the 2011 and 2016 Nepal Demographic and Health Surveys. 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Am J Oper Manag Inf Syst [Internet]. 2016;1(1):7\u0026ndash;16. Available from: http://www.sciencepublishinggroup.com/j/ajomis\u003c/li\u003e\n\u003cli\u003eBhattarai PC, Paudel DR, Poudel T, Gautam S, Paudel PK, Shrestha M, et al. Prevalence of Early Marriage and Its Underlying Causes in Nepal: A Mixed Methods Study. Soc Sci. 2022;11(4). \u003c/li\u003e\n\u003cli\u003eNational Child Rights Council. The Status of Child Marriage And Impact Upon Girls [Internet]. 2021. Available from: https://plan-international.org/nepal/publications/status-child-marriage-impact-upon-girls/\u003c/li\u003e\n\u003cli\u003eSiddiqi M, Greene ME, Stoppel A, Allegar C. Interventions to Address the Health and Well-Being of Married Adolescents: A Systematic Review. Glob Heal Sci Pract. 2024;12(4):1\u0026ndash;19. \u003c/li\u003e\n\u003cli\u003eNHRC, UNICEF. Behavioural Determinants of Child Marriage and Adolescent Pregnancy in Nepal: A qualitative study [Internet]. 2024. 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Health Psychol Rev. 2015;0(0):1\u0026ndash;22. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6462941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6462941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTeenage pregnancy is a global public health burden. Motherhood during adolescence is identified as a major risk factor for adverse health outcomes for both the mother and the newborn. This paper aims to provide insights into factors associated with teenage pregnancy and adverse pregnancy outcomes in Nepal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData for this study were derived from the most recent round of the Nepal Demographic and Health Survey (NDHS) 2022. A total of 2,643 women aged 15–19 years were included in the analysis for teenage pregnancy, and 3,833 pregnant women aged 15–49 years were included for adverse pregnancy outcomes. Descriptive and multivariable analyses were performed to examine the factors associated with teenage pregnancy and adverse pregnancy outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nOut of the total adolescent girls, approximately 14% experienced teenage pregnancy. Multivariate logistic regression analysis showed that teenage pregnancy varied by different socioeconomic and demographic characteristics. Adolescents from poorest (aOR=2.87, 95% CI: 1.48–5.59), poorer (aOR=2.98, 95% CI: 1.54–5.77), and middle household wealth index (aOR=2.44, 95% CI: 1.22–4.88), those belonging to Janajati (aOR=1.96, 95% CI: 1.32–2.93), Dalit (aOR=2.01, 95% CI: 1.37–2.96), and Muslim ethnic groups (aOR=1.98, 95% CI: 1.02–3.83), and women living in Karnali Province (aOR=1.98, 95% CI: 1.24–3.17) were more likely to experience teenage pregnancy compared to their counterparts. Teenage mothers had higher rates of adverse pregnancy outcomes, such as stillbirths (p\u0026lt;0.001), miscarriages (p=0.013), and lower birth weights among their children (p=0.039), compared to adult mothers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nDespite its adverse health and social impacts, teenage pregnancy remains prevalent in Nepal. The implementation of targeted, multilevel interventions is required for these vulnerable populations, as well as for influencers within their families and communities. Interventions to address this issue should include tailored social behaviour change (SBC) strategies, such as comprehensive sexuality and life skills education, particularly for adolescents who are illiterate or have only basic education, belong to low-wealth households, are part of disadvantaged ethnic groups (Janajati, Dalit, and Muslim), and reside in areas with inadequate socio-economic progress (Karnali Province). Additionally, improving access to adolescent friendly sexual and reproductive health services could help reduce early motherhood and adverse pregnancy outcomes among adolescent girls in Nepal.\u003c/p\u003e","manuscriptTitle":"The high stakes of early motherhood: insights from Nepal's teenage pregnancy crisis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 11:01:52","doi":"10.21203/rs.3.rs-6462941/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-04T05:42:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T15:44:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-10-14T03:24:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T04:34:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-05T05:46:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191515088046644417909671673933064007301","date":"2025-05-30T15:57:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217435393733478163567317070036991537203","date":"2025-05-26T12:00:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118129473314881746257398939396414247550","date":"2025-05-24T14:36:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T08:49:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-24T11:43:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-21T23:10:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-21T23:10:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-16T11:07:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f9613ed-fe25-40f1-b2f3-8e758b0d5874","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T08:08:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-21 11:01:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6462941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6462941","identity":"rs-6462941","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}