Shyam Thapa

Early marriage and early motherhood in Nepal.

This paper examines age patterns of first marriage and motherhood and covariates of early marriage, delayed consummation of marriage and early motherhood in Nepal using data from the 2000 Nepal Adolescent and Young Adult Survey (NAYA). Both unmarried and married male and female youths (age 14-22) were included in the survey. The analysis is based on 2800 urban youths and 5075 rural youths with complete information on the variables examined. Proportional hazard models are used to estimate covariates of early marriage and early motherhood, and logistic regression models are used to estimate covariates of delayed consummation of marriage. The results show that early marriage and early motherhood are quite common among Nepalese women, especially in rural areas. Early marriage is much less common among men. Delayed consummation of marriage is common among very young brides, especially in rural areas. The main covariates associated with early marriage and early motherhood are respondents education, region of residence and ethnicity. The main covariates of delayed consummation of marriage are age at first marriage, region of residence and ethnicity. The study highlights the need to focus on less educated female youths in the Terai region in order to reduce the reproductive and child health risks associated with early marriage and early childbearing.

To what extent does breastfeeding explain Birth-interval effects on early childhood mortality?

This article shows that in Nepal breastfeeding almost completely explains the effects of following birth interval on childhood mortality during the first 18 months of age and partially explains the effect of following birth interval on childhood mortality between 18 and 60 months of age. Breastfeeding does not explain the effect of preceding birth interval on childhood mortality. The analysis is based on an application of hazard models to data from the 1976 Nepal Fertility Survey.

Vasectomy effectiveness in Nepal: a retrospective study

The main purpose of this retrospective, cross-sectional study was to evaluate the effectiveness of vasectomy in an ongoing public sector program in Nepal. We evaluated semen samples from men who had previously had a vasectomy, and asked about the occurrence of pregnancies in the mens partners. In addition, the surgeons who performed the vasectomies completed a questionnaire about their techniques. A two-stage stratified sampling procedure was used to select 1263 men from among over 30,000 men, who had previously undergone a no-scalpel vasectomy, mostly by ligation and excision, in 32 districts between July 1996 and June 1999. Semen samples were preserved and analyzed at a central laboratory. A US andrology laboratory validated the lab results. Twenty-three men (2.3%, 95% confidence interval [CI] 1.1-3.6) had >/=500,000 sperm/mL in their semen. Fifteen of those men reported pregnancies conceived after their vasectomy. In addition, six men with azoospermia reported pregnancies for which conception occurred within 3 months after vasectomy. Eleven men with azoospermia reported pregnancies for which conception occurred more than 3 months after vasectomy. Reported pregnancy was more likely in younger partners. The life table pregnancy rates for all men interviewed were 0.7 (95% CI 0.2-1.1), 1.7 (95% CI 1.4-2.1) and 4.2% (95% CI 3.2-5.2) at 3, 12 and 36 months, respectively. In low-resource, programmatic settings, vasectomy failure rates may be higher than commonly cited rates, especially in younger populations. Additional research is needed to determine if other occlusion techniques could reduce failure rates. Counseling on vasectomy should always convey the possibility of failure and partner pregnancy.

Abortion Law in Nepal: The Road to Reform

Abstract In 2002 Nepal’s parliament passed a liberal abortion law, after nearly three decades of reform efforts. This paper reviews the history of the movement for reform and the combination of factors that contributed to its success. These include sustained advocacy for reform; the dissemination of knowledge, information and evidence; adoption of the reform agenda by the public sector and its leadership in involving other stakeholders; the existence of work for safe motherhood as the context in which the initiative could gain support; an active women’s rights movement and support from international and multilateral organisations; sustained involvement of local NGOs, civil society and professional organisations; the involvement of journalists and the media; the absence of significant opposition; courageous government officials and an enabling democratic political system. The overriding rationale for reforming the abortion law in Nepal has been to ensure safe motherhood and women’s rights. The first government abortion services officially began in March 2004 at the Maternity Hospital in Kathmandu; services will be expanded gradually to other public and private hospitals and private clinics in the coming years. Résumé En 2002, le Parlement népalais a adopté une législation libérale sur l’avortement, après presque 30 ans d’efforts. Cet article retrace l’histoire du mouvement de réforme et répertorie les facteurs qui ont contribuéàson succès : un plaidoyer soutenu pour la réforme ; la diffusion de connaissances et d’informations ; l’adoption du calendrier de réforme par le secteur public qui a dirigé les activités pour recruter d’autres partenaires ; l’existence de projets pour une maternité sans risque comme contexte dans lequel l’initiative a pu gagner des appuis ; un mouvement actif pour les droits des femmes, et le soutien d’organisations internationales et multilatérales ; la participation d’ONG locales, de la société civile et d’organisations professionnelles ; le concours de journalistes et des médias ; l’absence d’opposition notable; de courageux fonctionnaires et un système politique démocratique autorisant le changement. La justification de la réforme était de garantir une maternité sans risque et de protéger les droits des femmes. Les premiers services publics d’avortement ont officiellement ouvert en mars 2004àla Maternité de Katmandou et ils seront progressivement étendus ces prochaines annéesàd’autres hÁpitaux publics et privés etàdes dispensaires privés. Resumen En el 2002, el parlamento de Nepal aprobó una ley de aborto liberal, después de casi tres décadas de esfuerzos para lograr reformas. En este artáculo se revisa la historia del movimiento de reforma y la combinación de factores que contribuyeron a su éxito. Entre estos figuran: la continua gestoráa y defensa de la reforma; la difusión de conocimientos, información y pruebas; la adopción de la agenda de reforma por parte del sector público y su liderazgo para hacer partácipe a otras partes interesadas; las actividades promotoras de la maternidad sin riesgos como el contexto en que la iniciativa podráa ganar apoyo; un movimiento activo de los derechos de las mujeres y el apoyo de organizaciones internacionales y multilaterales; la participación sostenida de las ONG locales, la sociedad civil y las organizaciones profesionales; la participación de los periodistas y los medios de comunicación; la ausencia de una oposición significativa; funcionarios gubernamentales valientes y un sistema polático democrático favorable. La justificación principal para reformar la ley de aborto en Nepal ha sido el garantizar la maternidad sin riesgos y los derechos de las mujeres. Los primeros servicios gubernamentales de aborto se iniciaron oficialmente en marzo de 2004 en el Hospital de Maternidad de Katmandú y, en los próximos años, éstos se ampliarán gradualmente a otros hospitales, públicos y privados, y a clánicas privadas.

A hospital-based study of abortion in Nepal.

This report presents the major findings of a study of induced abortion in Nepal, based on 165 cases out of the 1,576 female patients identified as having abortion-related complications who were admitted to five major hospitals in urban Nepal during a one-year study period. Traditional birth attendants had been the service providers for two-fifths of the women. A longer delay in hospital referrals and lengthier hospital stays occurred for cases of induced abortion than for those of spontaneous abortion. Twelve of the 165 women in the study died in the hospital, most of them from tetanus. Deaths resulting from abortion-related complications represented more than half of all maternity-related deaths in the hospitals studied. The authors suggest that health risks could be reduced considerably by strengthening the hospital-referral system and by taking some preventive steps, such as educating the traditional birth attendants and other paramedical providers about the consequences of unsafe abortion practices; increasing the availability of contraceptive methods; and promoting the use of menstrual regulation, which has recently become available in Nepal on a limited scale, mostly in private clinics.

Effect of Iron Supplementation during Pregnancy on Birthweight: Evidence from Zimbabwe

Background Iron deficiency in pregnant women has been shown to reduce the oxygen supply to the fetus, cause intrauterine growth retardation, and increase the risk of premature delivery and reduced birthweight. Yet the effects of iron supplementation programs on pregnancy outcomes are not well documented for developing countries. Objective To examine the relation between iron supplementation of mothers during pregnancy and childrens birthweight using data from a national population-based survey in Zimbabwe. Methods The analysis uses information on 3,559 births during the five years preceding the 1999 Zimbabwe Demographic and Health Survey. The effect of iron supplementation during pregnancy on birthweight was estimated by multiple regression, controlling for potential confounding effects of prenatal care, childs sex and birth order, mothers education and nutritional status (measured by body-mass index), household living standard, smoke exposure, and other variables. Results Babies born to mothers who received iron supplementation during pregnancy were 103 g heavier (95% confidence interval, 42–164; p = .001), on average, than babies born to mothers who did not receive iron supplementation during pregnancy. The difference was 64 g (95% confidence interval, 2–125; p = .043) for children whose birthweights were taken from health cards and 163 g (95% confidence interval, 44–281; p = .008) for children whose birthweights were reported by their mothers. Conclusions Iron supplementation during pregnancy is associated with significantly higher birthweight, independent of other pregnancy care factors, mothers nutritional status, smoke exposure, and a number of demographic and socioeconomic factors. Prenatal iron supplementation programs can improve pregnancy outcomes and promote child survival in developing countries.

The teen tobacco epidemic in Asia: Indonesia, Nepal, Philippines, Taiwan, and Thailand

This paperxs examines the prevalence of smoking, the age pattern of initiation of smoking, and factors associated with current smoking status among 15–19 year olds in five Asian societies, using data from large‐scale youth surveys. The life‐table method is used to examine the age pattern of initiation of smoking and logistic regression is used to examine factors associated with current smoking status. Smoking prevalence is high among boys but very low among girls. Among boys, 82 percent in Indonesia, 73 percent in Thailand, 70 percent in the Philippines, and 35 percent in Nepal begin smoking by age 20. In all countries, smoking is much more prevalent among teens who have experienced some transitions to adulthood. In Indonesia and Nepal, teen smoking is more prevalent in less developed regions. Among Filipino girls, residence in metro Manila is associated with high probability of smoking. In most countries, teens who have close relationships with parents are less likely to smoke.

Efficacy of three variations of periodic abstinence for family planning in Indonesia.

A prospective study to determine the efficacy of three alternative guidelines for the practice of periodic abstinence (PA) for family planning was conducted in Indonesia. The three methods studied were the Billings ovulation method, the Dorairaj modified mucus method, and a local version of the mucus method. For each method, the study encompassed a three-month learning phase and an additional 12-month effectiveness phase. Data from a total of 850 acceptors showed that, despite some variations in the sociodemographic characteristics of the acceptors, the Billings ovulation method had the lowest (10.4 per 100 women) and the local mucus method had the highest (26.5 per 100 women) overall life-table discontinuation rates in the effectiveness phase. One-year life-table unplanned pregnancy rates ranged from 2.5 per 100 women for the Billings method to a high of 11.5 per 100 women for the local method acceptors. Unplanned pregnancy was the main reason for termination.

Effects of vitamin A supplementation on child mortality: evidence from Nepal's 2001 Demographic and Health Survey.

Objective  To assess the effect of Nepals vitamin A supplementation programme on child mortality at age 12–59 months.

Delayed Asian Transitions to Adulthood

1Important events in the transition to adulthood are examined for young men and women in six Asian societies. Broad description of the pattern of many events is followed by a detailed consideration of event-sequences among school-leaving, home-leaving and entrance to marriage. The recent Asian experience is set against recent patterns in Western societies, and broad similarities and differences are noted. In both sets of countries there is clear evidence of significant delay in the key transitional events, many of which are being pushed into the third decade of life. Also in both regions there is evidence of a high demographic density of events in the central years of transition. The standardization of individual event distributions may not be occurring in the Asian countries examined, but there is clear evidence of individuation or a rising diversity of sequences or paths taken. Suggestions are offered regarding themes for future research on Asian adulthood transitions, in light of ongoing, market-led globalization.