How young advocates are preventing child marriage and early pregnancy in Nepal

Evidence shows that investing in adolescent sexual and reproductive health and rights (SRHR) reduces adolescent pregnancy and child marriage, improves health, empowers girls and strengthens economies.

Between 2000 and 2021, the global adolescent birth rate fell by 34%, and between 2010 and 2020 child marriage declined by 24%. Progress has been driven by efforts across diverse sectors, from health to education, with integral contributions from young leaders. However, pregnancy and childbirth related complications are the leading cause of death among 15-19-year-old girls and more than 12 million teenage girls give birth globally every year.

We sat down with Darshana Rijal, a young social leader in Nepal, who is also the vice president of the youth-led organization YUWA (which means 'youth' in Nepali). She has participated in several WHO-supported workshops and conferences as a young leader making change in this space.

Darshana strongly advocates for improved policies that support sexual and reproductive health, family planning services and health information for young people, including sexuality education and programmes that give young people a voice in decision-making.

Q: How much of a problem is child marriage in the communities where you work?

A: Poverty, lack of education and deeply entrenched norms push girls into early marriage. I have met young women who were forced to leave school because they were getting married. In humanitarian crises or climate disasters, girls are at even higher risk as families struggle with economic pressures and see marriage as their last resort to get some money in.

Q: What other problems do young people in your community face?

A: One of the biggest barriers for young people to access health care is stigma. When adolescents seek contraceptives or other services, they are often judged by health professionals. This prevents them from getting the care they need. There are even more challenges for adolescents living in rural areas where child marriage is most common.

Q: What have you learned in your work with communities throughout Nepal?

A: Education programmes can be life changing. After setting up a system with the government, we ensured girls stayed in school instead of being forced into child marriage. Now, more and more young people are completing their education. For instance, we conducted a three-day class on sexual and reproductive health and rights in rural Nepal, where child marriage rates are high. We taught young people about consent, healthy relationships, and that girls should have a say in their relationships. Later, we learned that some of them had successfully stopped child marriage by speaking with their parents and convincing them to wait until the legal age of 21. We also did a monitoring visit back to the area, and it was amazing to see how the young people we taught had become educators themselves. They were passing on knowledge about consent, healthy relationships, and girls' rights.

Q: Through your work, what successes have you seen when rolling out targeted work on child marriages and adolescent pregnancy?

A: Education programmes need to be accessible. We visited three different communities to teach about sexual and reproductive health and rights. In one, we used regular Nepali, while in the other two, we worked with local facilitators in their native languages. The response was much stronger in the communities where we used local languages - it showed us that resources need to be in languages young people can relate to. In some villages, no one had ever graduated high school.

Q: What is your biggest demand in relation to young people's health?

A: We as young people must be at the forefront of this change. When girls are given the power to lead, they transform not only their own lives but also their entire communities. I want to see a world where a girl's potential is not cut short. They are not only the future, but they are also the present cornerstones of our society. For me, activism is about challenging the status quo and creating opportunities for youth to lead change. In Nepal, adolescents make up a very large group of our population, so it is ensuring that our rights are respected and prioritized. We are often misheard and misrepresented and put aside, when in reality adolescent needs are vast and concrete, especially for adolescent girls.

WHO is launching a guideline for preventing early pregnancy and poor reproductive outcomes in low- and middle-income countries. The guideline promotes the meaningful engagement of adolescents in the design, implementation, monitoring and evaluation of efforts to address their rights and needs.

Partnering with a wide range of organizations, including those that are youth-led, will be essential to the uptake of the recommendations in the updated guideline. Reflecting this, WHO's Department of Sexual and Reproductive Health, including the UN Special Programme in Human Reproduction (HRP), plans to develop policies and tools, including communication materials, that are accessible and useful to young people and youth-led organizations.