Nepal's population is characterised by a young age structure. Like in other cultures around the world, adolescence (10 to 19 years of age) is recognised as the transition stage from childhood to adulthood in Nepal. As a result of high fertility in the past, the estimated population of adolescents was 3,762,770 and it consist approximately 21 percent of the total population. The proportion of male adolescents is about 11 percent and that of female is only 10 percent. The young structure will be the main source of a large percentage growth over the next 20-25 years. In view of the size of the adolescent population and implications for the future, it is imperative to give due attention to the challenges facing the adolescent population.
There are reports from different regions of the country demonstrating that during adolescent females play a very active role not only in domestic affairs, primarily cooking and food preparation, but also in agriculture work. Females, adolescents and adults, are served food after all males in the household have been served. It has also been reported that female adolescents work 10 hours per day but their male siblings work for only 8 hours. Despite these harsh realities very little information on the relationship between nutritional status and reproductive health is available on Nepali female adolescents. It is very likely that the nutritional vulnerability during infancy and childhood continue in adolescence to adulthood and females will face nutritional challenges from before and during child bearing of their own.
So far data is only available on nutrition, mortality and morbidity of the under-five population. Information related to health and nutrition status of adolescents and the contributing factors to under-nutrition is extremely important not only to improve the quality of the adolescents' life but also because it provides valuable insights into the issues that have profound impact on future generations. At the same time there currently exists a void in systematic research and empirical studies on the adolescent population of Nepal. Such research and studies may provide the basis for effective public dialogues and discussions on the formulation of health and gender policies and programmes for the adolescent population.
It is of paramount importance to have an understanding of adolescent behaviour, including sexual and reproductive health, in the context of the individual's overall life situation. Sexual and reproductive health, particularly of females, is influenced by traditional socio-cultural and economic environment so a holistic approach is essential in order to address the needs of adolescent reproductive health successfully. Wide spread poverty, unemployment, gender and ethnic/caste discrimination are some of the factors that affect the nutrition and health of adolescents. The inequities between male and female that exist within communities are the real constraints to improving the health and nutritional status of female adolescents. The attitudes and behaviour that the health programs seek to address arise from socio-economic and cultural systems. Therefore, such programs should be integrated within all aspects of social development.
There is a lack of studies assessing the interrelationships between reproductive health and nutrition among female adolescents in Nepal. Availability of food, seasonal variation and its impact on nutrition and development of female adolescents has not been documented so far. It is now realised that a life cycle approach is required to address the special health and nutritional needs and behaviour patterns of the particular age groups.
Safe Motherhood programs can be expanded and made more effective in two ways. One, by improving the coverage and quality of services. The involvement of men in Safe Motherhood interventions not only make the men aware of women's health needs and conditions, but also enables them to share responsibilities of parenthood. Two, by addressing the special health needs of adolescents (both boys and girls) with their active participation. This not only helps to enhance their co-operation but also prepares them to become responsible parents in the future.
Largely because if high fertility in the past, approximately 45 percent of the total population of Nepal is under 15, and additional 19 percent is between the ages of 15 and 24. The young structure will be the source of a large percentage of the population growth over the next 20-25 years. In view of its size and implications for the future, it is imperative to give due attention to the challenges facing the adolescent population. At the same time, there currently exists a void in a systematic review and analysis of the available data and literature on the adolescent population of Nepal. Such information may provide the basis for effective public dialogues and discussions on the formulation of policies and programmes specifically on the adolescent population.
Debendra Karki, Ph.D. is an Assistant Professor at Kathmandu University Medical School (KUMS) currently on leave as a Health Research Ethics Fellow at the Department of Population and International Health at Harvard School of Public Health.
Debendra Karki, Ph.D.
Health Research Ethics Fellow
Department of Population and International Health
Harvard School of Public Health
Boston, MA, USA