Building Demand for RH Awareness 
among Adolescent Girls in Conflict 
Affected Districts of Nepal (BuD for RH) 
Mid-Term Evaluation 
Submitted to 
CATALYST Consortium
Washington D.C.
Final Report 
September 2005 
CENTER FOR RESEARCH ON ENVIRONMENT 
HEALTH AND POPULATION ACTIVITIES (CREHPA) 
P.O. Box : 9626, Kathmandu, Nepal 
Tel: 5546487, Fax: 5522724 
E-mail: crehpa@crehpa.wlink.com.np 
ACKNOWLEDGEMENTS 
The study team wishes to express its sincere gratitude to CATALYST 
Consortium, Washington DC and CEDPA Nepal for entrusting this important 
study to CREHPA. The study team is especially grateful to Dr. Chhatra Amatya, 
Country Director, CEDPA/Nepal, Dr. Kamlesh Giri, Reproductive Health Officer, 
CATALYST Consortium, Washington DC, Dr. Dibyaman Karmacharya, Technical 
Advisor, CEDPA/Nepal, Ms. Sunila Shrestha, Program Associate, and Ms. 
Radha Paudel, Program Associate, CEDPA/Nepal and for their encouragement 
and guidance throughout the study period. The study team is also grateful to the 
implementing partners, NRCS, AMK and NTAG for their support during the study 
period. 
The fieldwork for this research would not have been possible without co￾operation of program facilitators and district level officials/volunteers of AMK, 
NTAG and NRCS and authorities of Baglung, Mahottari and Udaypur. The study 
team is grateful to all of them. 
Last but not the least, the study team acknowledges the co-operation of the 
teachers and students of the schools covered by the study and for their 
understanding and patient and participating in the individual interviews. The 
study would not have been possible without their voluntary participation. 
- THE STUDY TEAM
The Study Team 
The Core Team
Anand Tamang Study Coordinator 
Jyotsna Tamang Co-Investigator
Kshitiz Yadav Research Officer 
Field Supervisor
1. Anu Bista 
2. Sabita Mahaju 
3. Banika Shrestha 
Field Researcher
1. Saraswoti Kari 
2. Sachita Dangol 
3. Sheela Shrestha 
4. Achala Shrestha 
5. Sharda Pandey 
6. Kamala Karki 
Project Support Unit
Ms. Sabina Tamang Administration & Finance
Ms. Sangita Tamang Administration & Management
Ms. Radhika Singh Word Processing 
Abbreviations and Acronyms 
AED Academy for Educational Development 
AG Adolescent Group 
AMK Aamaa Milan Kendra 
BuD Building Demand 
CEDPA Center for Development and Population Activities 
CREHPA Center for Research on Environment Health and Population 
Activities 
DMPA Depomedroxyprogesterone Acetate 
FCHV Female Community Health Volunteers 
FP Family Planning 
HDI Human Development Index 
HP/SHP Health Post/Sub Health Post 
IP Implementing Partners 
IUD Intra Uterine Device 
LAM Lactational Amenorrhea method 
MCHW Maternal and Child Health Worker 
MTE Mid-term Evaluation 
NGO Non Governmental Organization 
NRCS Nepal Red Cross Society 
NTAG The Nepali Technical Assistance Group 
OBS Optimal Birth Spacing 
OBSI Optimal Birth Spacing Interval 
RH Reproductive Health 
SRH Sexual and Reproductive Health 
TBA Traditional Birth Attendant 
TTBA Trained Traditional Birth Attendant 
TV Television 
USAID United States Agency for International Development 
VDC Village Development Committee 
WHO World Health Organization 
Contents 
Page No. 
Acknowledgements 
The Study Team 
Abbreviations and Acronyms 
Chapter 1: INTRODUCTION 1 
1.1 Background 1 
1.2 Objective of the Mid Term Evaluation (MTE) 6 
1.3 Study Design 6 
1.4 Sampling Design 7 
1.5 Interviewing Strategy 8 
1.6 Research Instruments 9 
1.7 Training and Fieldwork 9 
1.8 Date Management and Analysis 9 
1.9 Organisation of the Study Report 9 
Chapter 2: BACKGROUND CHARACTERISITICS OF THE RESPONDENTS 10 
2.1 Age Distribution of Study Population 10 
2.2 Caste/Ethnicity Composition 11 
2.3 Marital Status & Fertility 11 
2.4 Involvement in Domestic Chores 12 
2.5 Sources of Family Income 13 
Chapter 3: KNOWLEDGE AND PERCEPTION ABOUT REPRODUCTIVE HEALTH 16 
3.1 Knowledge on Physical Changes Occurring among Girls during Adolescence 16 
3.2 Experience of Menstruation 17 
3.3 Perception on Right Age at Marriage 24 
3.4 Reaction to Marriage Proposed by Parents 24 
3.5 Knowledge and Perception about Pregnancy 25 
3.6 Knowledge and Perception about Pregnancy Care 27 
3.7 Knowledge about Harmful Practices during Pregnancy 28 
3.8 Knowledge about Assistance during Delivery 29 
3.9 Perception on Who Should Decide on Family Size 31 
3.10 Knowledge about Family Planning 32 
3.11 Communication on FP 36 
3.12 Use of Contraception 37 
Chapter 4: KNOWLEDGE ON OPTIMAL BIRTH SPACING INTERVAL 39 
4.1 Awareness about Optimal Birth Spacing Interval 39 
4.2 Source of Knowledge on OBSI 40 
4.3 Knowledge about Benefits of OBSI 41 
4.4 Risk of Not Practicing OBSI 44 
4.5 Perceived Age at Which Women Should Not be Getting Pregnant 45 
4.6 Perceived Birth Interval 46 
4.7 Perception of Men's Involvement in OBSI 47 
4.8 Perceived Ways in Which Men Could be Involved in OBSI 48 
Chapter 5: SUMMARY AND CONCLUSIONS 50 
References 
ANNEX 
List of Tables
Page No. 
Table 1.1 Name of the VDCs and the schools covered in each district: 
 Mid term survey 7 
Table 1.2 Number of adolescent respondents covered in each VDC and the 
 sample performance: Mid-term survey 8 
Table 2.1 Percentage distribution of adolescent respondents according to their 
current age: Baseline and mid-term survey 10 
Table 2.2 Percentage distribution of adolescent respondents according to their 
ethnicity/caste: Baseline and mid-term survey 11 
Table 2.3 Percentage distribution of adolescent respondents according to their 
 marital status, exposure to pregnancy: Baseline and mid-term survey 12 
Table 2.4 Percentage distribution of adolescent respondents according to their 
 main types of work and daily working hours in domestic chores: 
 Baseline and mid-term survey 13 
Table 2.5 Percentage distribution of adolescent respondents according to the 
 sources of family income: Baseline and mid-term survey 14 
Table 2.5a Percentage distribution of adolescent respondents according to 
 their involvement in cash earning activities and the nature of work they 
 are engaged for cash income: Baseline and mid-term survey 15 
Table 3.1 Percentage distribution of adolescent respondents according to 
 their knowledge on the physical changes occurring in girls 
 during adolescence: Baseline and mid-term survey 17 
Table 3.2 Percentage distribution of adolescent respondents according to their 
experience on menstruation: Baseline and mid-term survey 17 
Table 3.2a Percentage distribution of adolescent respondents according to their 
knowledge on occurrence of menstruation: Baseline and mid-term survey 18 
Table 3.2b Percentage distribution of adolescent respondents according to their 
experience during first menarche: Baseline and mid-term survey 19 
Table 3.2c Percentage distribution of adolescent respondents according to the 
 types of personal care taken during menstruation: Baseline and 
 mid-term survey 20 
Table 3.2d Percentage distribution of adolescent respondents according to their 
 source of information on menstruation: Baseline and mid-term survey 21 
Table 3.2e Percentage distribution of adolescent respondents according to the 
 types of domestic chores avoided by adolescent girls during 
 menstruation: Baseline and mid-term survey 22 
Table 3.2f Percentage distribution of adolescent respondents according to the 
 cultural rituals performed during the occurrence of menstruation for the 
 first time: Baseline and mid-term survey 23 
Table 3.3 Percentage distribution of adolescent respondents according to their 
perception on right age at marriage for girls: Baseline and 
 mid-term survey 24 
Table 3.4 Percentage distribution of adolescent respondents on their reaction to 
marriage proposal by guardians before their perceived right age: 
 Baseline and mid-term survey 25 
Table 3.5 Percentage distribution of adolescent respondents according to 
 their perceived knowledge about how a woman gets pregnant: 
 Baseline and mid-term survey 26 
Table 3.5a Percentage distribution of adolescent respondents according to the 
perceived knowledge about ways to avoid pregnancy: Baseline and 
 mid-term survey 27 
Table 3.6 Percentage distribution of adolescent respondents according to their 
knowledge about good health practices that pregnant woman should 
 follow: Baseline and mid-term survey 28 
Table 3.7 Percentage distribution of adolescent respondents according to their 
knowledge on practices that are harmful for pregnant woman: Baseline 
 and mid-term survey 29 
Table 3.8 Percentage distribution of adolescent respondents according to their 
knowledge on appropriate person to assist during delivery: 
 Baseline and mid-term survey 30 
Table 3.8a Percentage distribution of adolescent respondents according to their 
perception on appropriate person to assist during their own delivery: 
Baseline and mid-term survey 31 
Table 3.9 Percentage distribution of adolescent respondents according to their 
perception on decision making about family size: Baseline and 
 mid-term survey 31 
Table 3.10 Percentage distribution of adolescent respondents perceived 
 knowledge on Family planning method: Baseline and mid-term survey 32 
Table 3.10a Percentage distribution of adolescent respondents according to their 
knowledge on sources of information of FP method: Baseline and 
 mid-term survey 34 
Table 3.10b Percentage distribution of adolescent respondents according to their 
knowledge of availability of FP method in the locality/ ward: Baseline 
 and mid-term survey 35 
Table 3.10c Percentage distribution of adolescent respondents according to their 
knowledge on types of FP method available in the ward: Baseline and 
 mid-term survey 35 
Table 3.11 Percentage distribution of adolescent respondents according to the 
 person they talked to about FP: Baseline and mid-term survey 37 
Table 3.12 Percentage distribution of adolescent respondents who had ever used FP 
method and type of method ever used: Baseline and mid-term survey 38 
Table 3.12a Distribution of adolescent respondents by current use of FP 
 method: Baseline and mid-term survey 38 
Table 4.1 Percentage distribution of adolescent respondents by their knowledge 
about optimal birth spacing: Baseline and mid-term survey 40 
Table 4.2 Percentage distribution of adolescent respondents by their 
 source of information on OBSI: Baseline and mid-term survey 41 
Table 4.3 Percentage distribution of adolescent respondents according to their 
knowledge about the benefits of OBSI: Baseline and mid-term survey 43 
Table 4.4 Percentage distribution of respondent according to their knowledge 
 about the risk to mother and new born if OBSI is not practiced: 
 Mid-term survey 45 
Table 4.5 Percentage distribution of respondents by their perceived age that 
 women should not be getting pregnant: Baseline and mid-term survey 46 
Table 4.6 Percentage distribution of adolescent respondents perception of birth 
interval: Baseline and mid-term survey 46 
Table 4.7 Percentage distribution of adolescent respondents according to their 
perception about male involvement in OBSI: Baseline and 
 mid-term survey 48 
Table 4.8 Percentage distribution of adolescent respondents according 
 to their perceived ways in which men can be involved in OBSI: 
 Baseline and mid-term survey 49 
List of Figures 
 Page No. 
Figure 3.a Mean number of FP method heard by district: Baseline and 
 mid-term survey 33 
Figure 3.b Percentage of adolescent girls who communicated on FP: 
 Baseline and mid-term survey 36 
Figure 4.a Percentage of adolescent girls who have heard about OBSI 39 
Figure 4.b Percentage distribution of adolescent respondents according 
 to their perception that men should be involved in OBSI 47 
1
Chapter 1 
INTRODUCTION 
1.1 Background 
World Health Organization (WHO) defines adolescents as individuals in the 10-
19 year age group. Adolescence is a phase rather than a fixed time period in an 
individual's life. It is a phase of development on any fronts: from the appearance 
of secondary sex characteristics (puberty) to sexual and reproductive maturity; 
the development of mental processes and adult identity; and the transition from 
total socio-economic and emotional dependence to relative independence (WHO, 
1993). 
The needs of adolescents vary with their sex, stage of development as 
mentioned above, the life circumstances and the socio-economic conditions of 
their environment. Adolescents learn about reproductive health and sexual 
matters by observing the behaviour of the adults around them, by listening to 
peers and the older siblings, through the media in all its forms and by acquiring 
the knowledge of parents or other trusted mentors. Such information however is 
limited and sometimes even erroneous. Since the subject of adolescent sexuality 
remains taboo in most societies, there is widespread ignorance among young 
people of the risks associated with unprotected sexual activity. Unprotected 
premarital sexual relations are taking place at earlier ages giving rise not only to 
risk of early pregnancy and childbearing, but also to induced abortion in 
hazardous circumstances, and to sexually transmitted diseases including human 
immunodeficiency virus leading to AIDS. 
In Nepal, adolescent population is approximately 5.4 million as per 2001 census. 
This population is nearly one fourth (23.6%) of the total population of the country 
(CBS, 2001). Owing to high fertility and young age distribution of population, the 
proportion of adolescents in the total population is likely to increase in the coming 
years. According to the Ministry of Population and Environment (MOPE) and 
Central Bureau of Statistics (CBS), the adolescent population is estimated to 
reach 6 million by the year 2011 and to almost 7 million in 2021 
The Building Demand for Reproductive Health (BuD for RH) is a two year project 
on adolescents' health and development funded by USAID/Nepal through the 
Global CATALYST Consortium Project and implemented by the Center for 
Development and Population Activities (CEDPA), in three districts of Baglung, 
Udayapur and Mahottari. The implementing partners of this project are Aamaa 
Milan Kendra (AMK), Nepal Red Cross Society (NRCS) and Nepal Technical 
Assistance Group (NTAG). 
2
BuD for RH Project's primary goal is to improve the ability of low-income, 
illiterate girls aged 10-19 years, living in conflict areas to make informed 
decisions regarding reproductive health and to access health services and formal 
education. The In-school and Out-school adolescent girls groups were formed in 
5 VDCs each in these three project districts. 
The specific objectives of the project are: 
1) Improved RH awareness and knowledge among adolescent girls in 
conflict areas. 
2) Increased literacy among out-of-school adolescent girls’ program 
participants in conflict areas. 
3) Increased girls' adoption of behaviors that lead to improve RH 
outcomes. 
4) Enabling family and community environment created for support of 
girls' program participation and access to health services. 
The baseline survey was carried out in September-October 2004 by Center for 
Research on Environment Health and Population Activities (CREHPA). The 
project has completed about one year of its two years' term. In order to assess 
the achievements made so far by the project, mid-term evaluation (MTE) was 
conducted by CREHPA 
 
About CATALYST 
The CATALYST Consortium is a global reproductive health activity initiated in 
September 2000 by the Office of Population and Reproductive Health, Bureau for 
Global Health, U.S. Agency for International Development (USAID). The 
Consortium is a partnership of five organizations: the Academy for Educational 
Development (AED), Center for Development and Population Activities (CEDPA), 
Meridian Group International, Inc., Pathfinder International and PROFAMILIA/ 
Colombia. 
CATALYST works in sexual and reproductive health through synergistic 
partnerships and state-of-the-art technical leadership. Its overall strategic 
objective is to increase the use of sustainable, quality reproductive health and 
family planning (RH/FP) services and healthy practices through clinical and non￾clinical programs. 
About CEDPA 
Center for Development and Population Activities (CEDPA) is a US-based non￾profit organization, which has as its mission to empower women at all levels of 
society to participate as full partners in development. In Nepal, CEDPA is 
working towards achieving its mission by helping rural women and girls to 
3
acquire knowledge and skills to make informed decisions and to take appropriate 
actions to address their educational, social and reproductive health needs. 
CEDPA works with and on behalf of women and girls in partnership with a variety 
of government agencies and non-governmental organizations. CEDPA’s support 
aims to contribute to achieving national goals as outlined in government policy 
and planning documents. 
CEDPA’s strategies to achieve its goals and objectives involve mobilizing 
individuals, their families and communities to advocate for and participate in 
disseminating information and delivering a range of services in their own 
communities. 
CEDPA/Nepal and AMK Partnership 
Aama Milan Kendra (AMK) is a national non-governmental organization 
dedicated to the cause of rights and dignity of women. Established in 1975 on the 
auspicious occasion of the International Women’s Year AMK operates with the 
basic premise that women themselves best motivate women. It is the pioneer 
women-focused organization in the country and it undertakes activities to help 
women become more competent and capable of making and acting upon 
decisions to improve their lives. AMK has successfully established itself as one of 
the leading NGOs in the country working for the development and empowerment 
of women, especially disadvantaged women. Its mission is to empower women at 
all levels of society and make them full partners in the task of nation building. 
AMK has an extensive network of 59 local branches spread out in the 19 districts 
of the country and a huge resource of 5,000 volunteers. Since 1999, it has also 
shifted its focus to adolescent girls through its reproductive health and other 
programs that empower their lives towards adulthood. 
CEDPA’s partnership with AMK began in 1993 with UNFPA funding to support 
the strengthening of community-based mothers’ groups in 100 VDCs of 12 
different districts, Morang, Lalitpur, Bhojpur, Jhapa, Bara, Rautahat, Dang, 
Baglung, Syangja, Dhading, Banke, Rupendehi for the technical backstopping. 
This relationship flourished and in 1999 with funding and technical assistance 
from CEDPA, AMK implemented the “Adolescent Girls Initiate for their 
Reproductive health” (A GIFT for RH) Project in each ward of nine VDCs in 
Baglung district. Utilizing CEDPA’s ‘Better Life Options’ program, the project 
successfully increased the ability of adolescent girls to make and act on informed 
decisions regarding their social, economic and health needs and rights. 
4
CEDPA/Nepal and NRCS Partnership 
The Nepal Red Cross Society is the largest humanitarian organization in Nepal. It 
provides humanitarian, social services and disaster relief assistance to Nepal's 
rural poor through its 75 district chapters. NRCS supports a broad range of 
services including ambulance services, blood transfusion services, health 
services, primary health care and first aid services, family planning outreach 
services, drinking water supply schemes and disaster preparedness and relief 
programs. Its activities aim to improve the lives of the vulnerable people, which 
also include the issues of women and girls. 
NRCS has an extensive organizational network with more than 800,000 
volunteers nationwide. Students, youth, and volunteers of Nepal Junior/Youth 
Red Cross Circles also carry out a significant portion of its activities. NRCS has 
the organizational capacity to manage community-based programs because of its 
extensive networks in districts throughout the country. NRCS has branch offices, 
staffs and networks in each of the project districts. It has demonstrated capacity 
to implement complex health and family planning service delivery programs, and 
to develop both national and community-level coalitions in support of its 
initiatives, which contributes to the long-term sustainability of services. In 
addition, NRCS has worked for a long time to promote women's empowerment 
through community mobilization. 
In 1999, with CEDPA support, NRCS formed nine youth action groups to 
increase adolescent boys' knowledge about trafficking and other types of 
exploitation of women as well as health risks such as STIs including HIV/AIDS. 
NRCS also launched the "Youth for Each Other" boys program to complement 
CEDPA's girls' BLOOM program. In Udaypur district, NRCS implemented 
CEDPA funded ACCESS (1994-1998) and ENABLE (1998-2001) Projects aimed 
at RH/FP information and services in the community. NRCS Udaypur was also 
the implementing agency for an operations research project aimed at determining 
effective communication based mechanism to increase access SRH information 
and services on young couples. This operations research was carried out by 
CREHPA with the funding support of FRONTIERS Small Grant Program and 
managed jointly by the Population Council and Tulane University (2000-2003). 
CEDPA/Nepal provided technical support to this operations research project. 
CEDPA/Nepal and NTAG Partnership 
The Nepali Technical Assistance Group (NTAG) focused on the implementation 
of the National Vitamin A Program at its outset; it has also implemented many 
community-based health and nutrition programs in various districts. The National 
Vitamin A Program has already been implemented successfully in 75 districts. It 
has the units for training, behavior change communication materials 
5
development, monitoring, nutrition and health unit, NGO and Government liaison, 
etc. 
NTAG has played a crucial role in the establishment of the Endowment Fund, 
which has helped significantly in the mobilization of Female Community Health 
Volunteers (FCHVs) who contribute considerably in the provision of health 
services at the community level. NTAG is also carrying out mini-surveys, 
monitoring, and evaluation of various programs such as Nutrition Rehabilitation, 
Community-Based Nutrition, Community-Based Integrated Management of 
Childhood Illness (CB-IMCI), Iron Intensification, Kala-azar, Nutrition Information 
Sharing (NIS) Network, etc. 
In the year 2000, NTAG has provided assistance in coordinating the "National 
Conference on Safe Motherhood" organized by CEDPA on 8-10 March. 
About the Project Districts 
Mahottari District lies in the terai (plain) region of the Central Development 
Region of Nepal. It has a total population of 553,481 (2001 Census). 
Approximately 96% of the district's population is rural. Jaleshwor is the district 
headquarters of Mahottari district. The district is connected by the East-West 
National Highway. Yadavs are the dominant ethnic community of the district 
(population=84,836). The other major ethnic community of the district are Muslim 
(74,779), terai Brahmins (36,270), Dhanuk (34,660) and Koiri (28,758). The 
literacy level is low; 45% of adult males and less than half this proportion (22%) 
of the female adults are literate. The net enrolment ratios at the primary and 
lower secondary levels are respectively 74 and 29. The Human Development 
Index (HDI) is 0.322 (ISRSC, 2002). 
Udaypur is a hilly district and lies in the Eastern Development Region of Nepal. It 
has a total population of 287,689 (2001 Census). Approximately, 81 % of the 
population is rural. Gaighat (Triyuga Municipality) is the district headquarters of 
Udaypur district. The dominant ethnic communities of the district are Chhetri 
(60,578), Rai (47,128), Magar (39,721) and Tharu (22,323). About two thirds of 
the adults males (65%) and over two fifths of adult females (42%) of the district 
are literate. The net enrolment ratios at the primary and lower secondary levels 
are respectively 85 and 36. The Human development index (HDI) is 0.355 
(ISRSC, 2002). 
Baglung district is located in the Western Development Region of Nepal. The 
entire district has a hilly topography. The district's total population of 268,937 
(2001 Census). Over 92% of the population is rural. Baglung is the district 
headquarters of Baglung district. The dominant ethnic population of the district 
comprise of Magars (population=74,550), Brahmins (59,532), Chhetris (51,871) 
and Kami (35,150). Nearly three fourths of the adult males (73%) and over a half 
6
of the adult female population (52%) of the district are literate. The net enrolment 
ratios at the primary and lower secondary levels are respectively 89.1 and 33.9. 
The Human Development Index (HDI) is 0.337 (ISRSC, 2002). 
1.2 Objective of the Mid Term Evaluation (MTE) 
To measure mid-term achievements of the CATALYST project on birth spacing 
and family planning in the intervention districts of the Building Demand for 
Reproductive Health program among In-school program participants. 
1.3 Study Design 
The mid-term evaluation (MTE) was confined to 10 out of the total 15 Village 
Development Committees (VDCs) covered by the project. At the district level, 3 
VDCs each were randomly sampled from Baglung and Udaypur and 4 VDCs 
from Mahottari district. In view of the current conflict situation, the names of these 
sampled VDCs were shared with the respective implementing partners (IPs) to 
ascertain the safety of conducting the survey. In each VDC, one school covered 
by the project was chosen, except in Hardiya VDC of Udaypur, where both the 
two schools covered by the project was chosen. 
 Three project districts
7
The names of the VDCs and the corresponding school sampled from the three 
project districts are shown in Table 1.1 below. 
Table 1.1 Name of the VDCs and the schools covered in each district: Mid-term survey 
 Baglung district Mahottari district Udaypur district 
VDC1 Jaidi Bijalpura Sundarpur 
VDC2 Binamare Haathilet Hadiya 
VDC3 Sarkuwa Maisthan Beltar 
VDC4 - Gauribas - 
School 1 Sati Dhunga High 
School, Jaidi 
Jan Jagriti High School, 
Gauribas 
Jyoti Higher Secondary 
School, Beltar 
School 2 Janta High School, 
Sarkuwa 
Janta High School, 
Bijalpura 
Shree High School of 
Siwai, Sundarpur 
School 3 Sarbodaya Janak High 
School, Binamare 
Shree High School, 
Hathilet 
Janta High School, Hadiya 
School 4 NA Panchadhura High 
School, Maisthan 
Than Pokhari High School, 
Hadiya 
1.4 Sampling Design 
The sample frame consisted of all adolescent girls aged 10-19 years and 
studying in grade IX and X of the schools covered under BuD for RH project. In 
each school, the target was to interview 25 girl students. The total sample size 
was 75 girls each in Baglung and Udaypur and 100 girls in Mahottari district. The 
present mid-term survey was able to interview 249 out of the target sample of 
250 adolescent girls. 
Sampling of 25 in-school girls per school was done from the list of the girl 
students of grade IX and X provided to the research team by the IPs. From each 
grade, 12 to 13 in-school girls were chosen using random numbers generated 
through a scientific calculator. Because of the long school vacation (1.5 – 2.0 
months' duration) which coincided with the timing of the fieldwork (fieldwork was 
delayed while securing approval for conducting the survey from Social Welfare 
Council – a mandatory requirement for every NGO), these selected lists of 
students were provided in advance to the IPs for the purpose of inviting them at 
the school premises for the interviews. Table 1.2 presents the number of 
adolescent girl students sampled in each VDC. 
8
Table1.2 Number of adolescent respondents covered in each VDC and the sample 
performance: Mid-term survey 
District In- school girls 
(Grade IX and Grade X) 
Total 
Baglung 
Jaidi 
Binamare 
Sarkuwa 
25 
24 
25 
25 
24 
25 
Total 74 74 
Udaypur 
Sundarpur 
Hadiya 
Beltar 
25 
25 
25 
25 
25 
25 
Total 75 75 
Mahottari 
Bijalpura 
Maisthan 
Haathilet 
Gauribas 
25 
25 
25 
25 
 
25 
25 
25 
25 
Total 100 100 
All Total 249 249 
1.5 Interviewing Strategy 
The concerned IPs visited the homes of all the 25 In-school girls sampled by the 
research team and requested them to arrive at the school premises on the 
separate dates and time allocated for them according to their grade. The female 
research team of CREHPA visited the assigned locations (schools) to interview 
the girls of specific grade on the same day. The second batch of school girls (of 
the same grade) was interviewed on the following day. Face-to-face interviews 
were conducted in private using a structured questionnaire. As a token of 
appreciation for their participants, each of the girl students were provided with 
refreshments by the research team. 
In the present MTE sample, the proportion of those who were interviewed 
previously in the baseline survey comprised of only 35% (87 out of 249 girls). 
Comparatively, Udaypur district sampled less number of baseline respondents 
(28%) while Baglung registered the highest proportion of baseline respondents 
(41%). 
9
1.6 Research Instruments 
A structured questionnaire developed on the lines of the baseline survey with 
deletions and few additions was used for the MTE with In-school adolescent 
respondents. The questionnaire was finalized with the inputs from CEDPA and 
CATALYST representatives. The final version of the mid-term questionnaire was 
prepared in both English and Nepali. 
1.7 Training and Fieldwork 
There were three teams – one team for each district. Each team comprised of 
one female field supervisor and two female researchers. The field supervisors 
were responsible for field management, ensuring right girls being interviewed and 
supervision of questionnaire administration. 
The team members attended an intensive training provided by the core team 
members. The training was held in CREHPA for 4 days. The fieldwork was 
launched between 22 July to 7 August and took approximately 14 days to 
complete. 
1.8 Data Management and Analysis 
All the completed questionnaires were manually edited and coded before these 
were entered into the computer. Data were entered into dBase IV software 
program and then transferred into SPSS software package. 
The analysis was carried out comparing the mid-term results with the baseline 
results in order to observe the changes in knowledge, attitude and behaviour 
over the past one year (August 2004 to July 2005). Frequency and cross 
tabulations are the main quantitative outputs for the present analysis. Significant 
T-tests were performed for the conceptually important variables. 
1.9 Organization of the Report 
This mid-term study report is presented in five chapters. The present chapter 
(Chapter 1) is the Introduction Chapter of this report. Chapter 2 describes the 
demographic and socio-economic characteristics of the respondents while 
Chapter 3 describes the knowledge and perception of reproductive health of 
adolescent girls. Chapter 4 analyses the knowledge on optimal birth spacing 
interval and the Chapter 5 is the summary and conclusions of the mid-term 
evaluation. 
10
Chapter 2 
BACKGROUND CHARACTERISITICS OF THE RESPONDENTS 
This chapter describes the demographic and socio-economic characteristics of 
the in-schools adolescent respondents interviewed in the present survey and 
compares these results with baseline data. The demographic characteristics 
analysed are current age, marital status and fertility. Likewise, the socio￾economic background of the respondents analysed are caste/ethnicity, 
engagement in domestic chores and in income generating activity. 
2.1 Age Distribution of Study Population 
Table 2.1 presents the age distribution into early adolescence (10-14 years) and 
late adolescence (15-19 years) and the specific age distribution of the in-school 
adolescent girls. A higher proportion of the 15-19 year olds were sampled in the 
mid-term survey in comparison to the baseline survey in Baglung (58% at 
baseline; 82% at mid-term) and Mahottari (50% in baseline; 72% in mid-term) 
districts while in Udaypur a marginal difference in the age was seen. The median 
age of the in-school respondents in Baglung and Mahottari is 15 years while in 
Udaypur the median age is 16 years. The age of the adolescent girls interviewed 
ranges from 13 years to 19 years in all the three districts. 
Table 2.1 Percentage distribution of adolescent respondents according to their current 
age: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
Baseline Mid-term Baseline Mid-term Baseline Mid-term Baseline Mid-term
Age 
10 -14 years 41.6 17.6 49.6 28.0 28.0 22.7 39.7 23.3 
 15-19 years 58.4 82.4 50.4 72.0 72.0 77.3 60.3 76.7 
Median age 15.0 15.0 15.0 15.0 15.0 16.0 15.0 15.0 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
Specific Age 
distribution
 
10 - - - - - - - - 
11 - - 1.6 - - - .5 - 
12 4.8 - 4.8 - 3.2 - 4.3 - 
13 17.6 1.4 12.8 9.0 7.2 2.7 12.5 4.8 
14 19.2 16.2 30.4 19.0 17.6 20.0 22.4 18.5 
15 29.6 40.5 30.4 26.0 31.2 25.3 30.4 30.1 
16 20.0 23.0 12.8 29.0 16.8 30.7 16.5 27.7 
17 7.2 10.8 4.0 13.0 10.4 13.3 7.2 12.4 
18 1.6 8.1 2.4 4.0 9.6 4.0 4.5 5.2 
19 - - 0.8 - 4.0 4.0 1.6 1.2 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
11
2.2 Caste/Ethnicity Composition 
As evident from Table 2.2, the ethnic distribution also varied between baseline 
and mid-term in Baglung and Mahottari while in Udaypur the distribution 
remained almost the same. In comparison to the baseline survey, there were 
higher proportions of Brahmin/Chettri respondents in the mid-term survey in 
Mahottari (36% in baseline; 48% in mid-term), while the hill ethnic communities 
(Magar/Rai/Tamangs) were in higher proportions in Baglung during the mid-term 
survey (8% in baseline; 23% in mid-term). The marginalized castes were 
negligible in proportion in all the districts. In Udaypur, slightly higher proportions 
of the terai general caste (Yadav, Tharu, Koiri, Teli) were sampled compared to 
the baseline survey (16% in baseline; 20% in mid-term) (Table 2.2). 
Table 2.2 Percentage distribution of adolescent respondents according to their 
ethnicity/caste: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
 Caste Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Hill Ethnicity 
-Brahmin /Chhetri 81.6 71.6 36.0 48.0 53.6 53.3 57.1 56.6 
-Newar 0.8 - 2.4 2.0 3.2 6.7 2.1 2.8 
-Magar/Rai/Tamang 8.0 23.0 26.4 29.0 24.8 20.0 19.7 24.5 
- Gharti - - - 3.0 - - - 1.2 
- Marginalized castes 
 (Kami/Damai/Sarki)
8.8 5.4 4.0 2.0 2.4 - 5.1 2.4 
Terai Ethnicity 
- Terai general caste - - 29.6 16.0 16.0 20.0 15.2 12.4 
- Terai marginalized caste - - 1.6 - - - 0.5 - 
- Muslim 0.8 - - - - - 0.3 - 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
2.3 Marital Status and Fertility 
Excepting three in-school adolescent girls, all the adolescent girls interviewed are 
unmarried. The three in-school married girls are from Mahottari district and young 
in age - 14, 15 and 16 years. Two of the married girls are from the 
Brahmin/Chettri ethnicity while the one girls was from the terai general caste. All 
the three married respondents interviewed had never been exposed to 
pregnancy (Table 2.3). 
12
Table 2.3 Percentage distribution of adolescent respondents according to their marital 
status, exposure to pregnancy: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Marital Status 
Unmarried 100.0 100.0 99.2 97.0 99.2 100.0 99.5 98.8 
Married - - 0.8 3.0 0.8 - 0.5 1.2 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
Have you ever 
been pregnant? 
 
No NA NA 100.0 100.0 100.0 NA 100.0 100.0 
Total NA NA 100.0 100.0 100.0 NA 100.0 100.0 
N NA NA 1 3 1 NA 2 3 
2.4 Involvement in Domestic Chores 
As evident from table 2.4 all the respondents are involved in some type of 
domestic household work, primarily kitchen work. The involvement of the 
respondents in kitchen work increased from the baseline to the end line in the 
two districts namely Baglung (72% in baseline to 92% in end line) and Mahottari 
(91% in baseline to 93%) while in Udaypur the proportion remained almost the 
same. The proportion of girls collecting firewood and fodder (91%), bringing 
water (84%), washing clothes (91%) and cleaning the house (61%) was higher in 
Baglung district than the other two districts. A large proportion of the in-school 
girls from Udaypur also mentioned washing clothes (88%) and cleaning the 
house (76%) as their main type of work. 
Almost half of the girls are involved in domestic chores about 3-4 hours in a day. 
District wise analysis show that more than half of the girls from Mahottari (52%) 
mentioned that they are involved in domestic chores 1-2 hours in a day while 
50% of the girls from Udaypur reported that they are involved 3-4 hours a day 
and almost half of the girls from Baglung stated that they are involved 3-4 hours 
a day. (Table 2.4) 
13
Table 2.4 Percentage distribution of adolescent respondents according to their main 
types of work and daily working hours in domestic chores: Baseline and mid￾term survey 
 Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Main types of work 
Kitchen work 72.0 91.9 91.2 93.0 96.0 94.7 86.4 93.2 
Collecting firewood and 
fodder 
78.4 90.5 51.2 38.0 57.6 49.3 62.4 57.0 
Bringing water 50.4 83.8 56.0 49.0 44.8 57.3 50.4 61.8 
Cleaning house 21.6 60.8 48.0 52.0 23.2 76.0 30.9 61.8 
Cattle grazing/milking buffalo 5.6 29.7 8.0 11.0 17.6 29.3 10.4 22.1 
Farm works 11.2 28.4 8.8 19.0 20.8 28.0 13.6 24.5 
Washing cloth 4.0 90.5 47.2 36.0 22.4 88.0 24.5 53.8 
Cleaning cowshed 12.0 24.3 6.4 4.0 4.0 24.0 7.5 16.1 
Caring siblings 3.2 4.1 4.0 7.0 4.0 5.3 3.7 5.6 
N 125 74 125 100 125 75 375 249 
Duration of involvement in 
domestic chores
 
Daily, 1-2 hr 48.0 12.2 40.0 52.0 48.8 34.7 45.6 34.9 
Daily, 3-4 hr 44.8 48.6 39.2 39.0 40.0 53.3 41.3 46.2 
Daily, 5-6 hr 4.0 35.1 16.8 8.0 9.6 12.0 10.1 17.3 
Daily, 7 hr or more - 4.1 1.6 1.0 1.6 - 1.1 1.6 
Sometimes, not everyday 2.4 - 2.4 - - - 1.6 - 
Seldom - - - - - - - - 
Never 0.8 - - - - - 0.3 - 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
Percentages total exceed 100 due to multiple responses. 
2.5 Sources of Family Income 
Table 2.5 shows the main source of family income of the adolescent girls during 
the present survey. Agriculture is the dominant sector of the economy of Nepal. 
The large majority of the rural population in Nepal are involved in the agricultural 
sector. In the district-wise analysis, the large majority of the girls in Mahottari 
(81%) and Udaypur (80%) stated that their main source of family income was 
agriculture while only half of the girls from Baglung stated the same (55%). 
14
Table 2.5 Percentage distribution of adolescent respondents according to the sources of 
family income: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
Main sources of income Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Farming 51.2 55.4 80.8 81.0 77.6 80.0 69.9 73.1 
Daily wages 3.2 5.4 1.6 - - - 1.6 1.6 
Business 5.6 1.4 4.0 3.0 6.4 8.0 5.3 4.0 
Working in foreign countries 22.4 2.7 - - - - 7.5 0.8 
Private service 3.2 13.5 4.0 5.0 - 2.7 2.4 6.8 
Govt service 8.8 6.8 8.0 9.0 7.2 4.0 8.0 6.8 
Receives pension - 10.8 - - - - - 3.2 
Uniform service (Army/police) 4.8 4.1 - 1.0 4.8 4.0 3.2 2.8 
Others* 0.8 - 1.6 1.0 4.0 1.3 2.1 0.8 
N 125 74 125 100 125 75 375 249 
*Craftsmanship, Semi-government, Tailoring, Barber, ironsmith, driver, mechanic, 
 singing songs with Sarangi (traditional musical instrument) 
Percentages total exceed 100 due to multiple responses 
2.5.1 Involvement in Economic Activity 
Similar to the baseline survey, the large majority of the in-school girls in the mid￾term survey also do not earn cash income directly. Only one fifth of the girls from 
Baglung (20%), almost less than one twelfth from Mahottari (7%) and a negligible 
proportion from Udaypur (3%) were involved in generating cash income. Among 
those girls from Baglung who were involved in income generating activities, 
majority had earned as seasonal wage farm labourers while some were engaged 
in business and tailoring. Almost half of the girls from Mahottari were involved in 
business whereas the very few had earned through daily wage labourers and as 
tailors (Table 2.5a). 
15
Table 2.5a Percentage distribution of adolescent respondents according to their 
involvement in cash earning activities and the nature of work they are engaged 
for cash income: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
Baseline Mid￾term
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
 Do you earn any cash income directly? 
Yes 7.2 20.3 4.0 7.0 0.8 2.7 4.0 9.6 
No 92.8 79.7 96.0 93.0 99.2 97.3 96.0 90.4 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 125 74 125 100 125 75 375 249 
 What do you do to generate cash 
income? 
 
Daily wage laborer in farm (seasonal) 77.8 86.7 - 14.3 - 50.0 46.7 62.5 
Business 11.1 6.7 20.0 42.9 - - 13.3 16.7 
Tailoring 11.1 6.7 40.0 - 100.0 50.0 26.7 8.3 
Animal husbandry - - 20.0 - - - 6.7 - 
Teaching dance - - 20.0 - - - 6.7 - 
Weaving wool - - - 14.3 - - - 4.2 
Gives tuition - - - 28.6 - - - 8.3 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 9 15 5 7 1 2 15 24 
16
Chapter 3 
KNOWLEDGE AND PERCEPTION ABOUT REPRODUCTIVE HEALTH 
This chapter presents the reproductive health knowledge, attitude, and 
perceptions among the in-school adolescent girls of the three districts. More 
specifically, the chapter discusses about adolescent girls’ knowledge about 
physical changes during adolescence, reasons for menstruation, right age for 
marriage, ways a woman become pregnant, pregnancy care and family planning. 
3.1 Knowledge on Physical Changes Occurring among Girls during 
Adolescence 
The in-school adolescent girls were asked about the physical changes that occur 
in girls at puberty. As evident in the table, knowledge on physical changes 
among the in-school girls has increased in the mid-term evaluation (MTE) in 
comparison to the baseline survey. The proportion of MTE respondents 
mentioning about various aspects of physical changes has increased 
tremendously. For instance, those mentioning onset of menstruation (from 64% 
to 87% in Baglung and 80% to 100% in Udaypur), breasts develop (57% to 89% 
in Baglung; 72% to 78% in Mahottari and 69% to 97% in Udaypur) and under 
arm hair appear (37% to 69% in Baglung; 44% to 85% in Mahottari; 22% to 80% 
in Udaypur) has increased sharply among the MTE respondents. Similarly, 
knowledge that growth spurt occurs during adolescent has also increased by 
two-folds especially in Baglung (36% to 64% in mid-term) and by 20 percentage 
points in Udaypur (51% to 70% in mid-term) while appearance of pubic hair was 
mentioned by the majority in Mahottari (34% in baseline; 67% in mid-term). Other 
physical changes mentioned by the respondents were appearance of pimples, 
enlargement of external genitals, narrowing of waistline etc. (Table 3.1) 
17
Table 3.1 Percentage distribution of adolescent respondents according to their 
knowledge on the physical changes occurring in girls during adolescence: 
Baseline and mid-term survey 
Types of physical Baglung Mahottari Udaypur Total 
changes into puberty 
stage 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Menstruation begins 64.0 86.5 80.0 73.0 80.8 100.0 74.9 85.1 
Breast develops 56.8 89.2 72.0 78.0 68.8 97.3 65.9 87.1 
Growth spurt occurs 36.0 63.5 56.0 49.0 51.2 70.0 47.7 59.8 
Underarm hair appears 33.6 68.9 44.0 85.0 22.4 80.0 33.3 78.7 
Pubic hair appears 27.2 48.6 34.4 67.0 12.0 52.0 24.5 57.0 
Pimples appears 24.0 37.8 12.8 9.0 19.2 24.0 18.7 22.1 
Change in voice 10.4 37.8 6.4 40.0 4.0 18.7 6.9 32.9 
External genital enlarge 4.8 13.5 8.8 24.0 4.0 17.3 5.9 18.9 
Waistline narrows 1.6 6.8 4.8 19.0 0.8 18.7 2.4 15.3 
Others* 1.6 - - - - 5.3 0.5 1.6 
Don't know 9.6 6.4 6.4 7.5 
N 125 74 125 100 125 75 375 249 
*White discharge, attraction towards boys 
Percentages total exceed100 due to multiple responses 
3.2 Experience of Menstruation 
3.2.1 Age at Menarche 
In the mid-term survey, more than half of the in-school girls aged 10-14 years 
(54%) and majority of the girls aged 15-19 years (89%) had experienced 
menstruation in Baglung district. While in Mahottari district higher proportion of 
the adolescent girls has experienced menarche especially in the 15-19 years age 
group (99%) compared to the 10-14 years age group (79%). Similarly in Udaypur 
the large majority of both the age group respondents had experienced menarche 
(82% among 10-14 years; 97% among 15-19 years) (Table 3.2). 
Table 3.2 Percentage distribution of adolescent respondents according to their 
experience on menstruation: Baseline and mid-term survey 
Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Experience 
of 
menstruation
10 -14 15-19 10 -14 15-19 10 -14 15-19 10 -14 15-19 10 -14 15-19 10 -14 15-19 10 -14 15-19 10 -14 15-19 
Yes 42.3 94.5 53.8 88.5 79.0 95.2 78.6 98.6 60.0 94.4 82.4 96.6 61.7 94.7 74.1 94.8
No 57.7 5.5 46.2 11.5 21.0 4.8 21.4 1.4 40.0 5.6 17.6 3.4 38.3 5.3 25.9 5.2 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 52 73 13 61 62 63 28 72 35 90 17 58 149 226 58 191
18
3.2.2 Perceived Reasons for Menstruation 
There has been a remarkable increase in respondents' perceptions about the 
reasons for menstruation. For example, the proportion of MTE respondents 
mentioning ‘physical maturity for pregnancy’ increased from 40% in baseline to 
96% in MTE in Udaypur district. In Baglung, those citing this reason increase 
from 35% in baseline to 51% in the MTE. Similarly in Mahottari the increase was 
from 58% to 68%. The proportions of those saying ‘flow of impure blood’ reduced 
in Mahottari (25% to 17%) while it increased marginally in the remaining two 
districts (10% to 20% in Baglung and 21% to 35% in Udaypur). Les than a sixth 
of the MTE respondent in Mahottari said that the occurrence of menses was a 
healthy sign in girls (to remain healthy). Likewise, Over a fourth of MTE 
respondents in Mahottari and a sixth in Baglung perceived menstruation as a 
natural process. A sharp decline is seen in the proportion of those who 
expressed ignorance about occurrence of menstruation in all the three project 
districts - Baglung (45% to 10%), Mahottari (26% to 4%) and Udaypur (33% to 
1%) (Table 3.2a). 
Table 3.2a Percentage distribution of adolescent respondents according to their 
knowledge on occurrence of menstruation: Baseline and mid-term survey 
 Perceived reasons for Baglung Mahottari Udaypur Total 
menstruation Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Physical maturity for 
pregnancy 
35.2 51.4 58.4 68.0 40.0 96.0 44.5 71.5 
Flow of impure blood 10.4 20.3 24.8 17.0 20.8 34.7 18.7 23.3 
Indication of adolescence 4.0 8.1 4.8 16.0 1.6 - 3.5 8.8 
Natural process 9.6 17.6 8.8 28.0 12.8 6.7 10.4 18.5 
To be healthy - - - 1.0 - 14.7 - 4.8 
The egg remains in the 
ovary and after thick blood 
accumulates, blood flows 
out 
- 6.8 - 5.0 - - - 4.8 
Others* 2.4 1.4 0.8 6.0 - 6.7 1.1 4.8 
Don't know 44.8 9.5 26.4 4.0 32.8 1.3 34.7 4.8 
N 125 74 125 100 125 75 375 249 
*Flow of blood by burst urethra, growth and change of physical features, To have sexual 
intercourse, To marry, Development of reproductive organs, Women have estrogen and 
progesterone hormones when this ovulates women get menstruation. 
Percentages total exceed100 due to multiple responses 
3.2.3 Experience during First Menarche 
A large majority of the adolescent girls in all the three districts mentioned that 
they felt scared when they first experienced their menstruation (61% in Baglung; 
66% in Mahottari and 87% in Udaypur). Feeling shy about the experience was 
reported by two-fifths of the girls in Baglung (41%) and Udaypur (41%) while one 
19
third reported that they felt uncomfortable/awkward (31%) when they first 
experienced menstruation. No difference in menstruation experiences is 
observed between the baseline and the MTE respondents (Table 3.2b). 
Table 3.2b Percentage distribution of adolescent respondents according to their 
experience during first menarche: Baseline and mid-term survey 
Experience during first Baglung Mahottari Udaypur Total 
menarche Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Nothing happened 14.3 8.2 5.5 10.8 3.8 - 7.5 6.7 
Felt scared 61.5 60.7 75.2 65.6 84.9 88.6 74.5 71.4 
Felt shy 27.5 41.0 22.9 26.9 25.5 41.4 25.2 35.3 
Tension/worried 23.1 19.7 18.3 17.2 7.5 8.6 16.0 15.2 
Felt uncomfortable/awkward 9.9 31.1 17.4 9.7 16.0 21.4 14.7 19.2 
Felt like an adolescent/young 2.2 - 0.9 - 3.8 5.7 2.3 1.8 
Was surprised - - - 3.2 - - - 1.3 
Don't know - - 1.8 - 0.9 - 1.0 
N 91 61 109 93 106 70 306 224 
Percentages total exceed100 due to multiple responses 
3.2.4 Types of Care Taken during Menstruation 
The respondents were asked the different types of personal care being taken 
during menstruation. The respondents were asked to spontaneously mention the 
types of care she takes during her menstruation. If she does not mention any of 
the three important care during menstruation (taking bath daily, changing cloth 
daily and drying undergarments/sanitary cloth under the sunlight), the 
interviewers then read out (probed) regarding the remaining practices. 
The baseline-midterm comparison shows that the large majority of the 
adolescent girls mentioned that they bathe daily (90%) and change cloth daily 
(91%). No increase in proportion was seen in the mid-term survey since the 
percentage was already high during the baseline survey. The proportion of those 
who reported that they dry undergarments or pads under the sunlight is universal 
(100% in Baglung; 100% in Mahottari; 96% in Udaypur). The other types of care 
mentioned were cleaning genital area, drying sanitary cloth (talo) in the room, 
changing sanitary cloth (talo) 2-3 times a day, cutting nails, bathing on the third 
day etc. (not shown in the table) (Table 3.2c) 
20
Table 3.2c Percentage distribution of adolescent respondents according to the types of 
personal care taken during menstruation: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
 Types of personal cares 
taken during menstruation 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Bathe daily 
Yes 74.7 68.9 98.2 95.7 100.0 100.0 91.8 89.7 
No 25.3 31.1 1.8 4.3 - - 8.1 10.3 
Change cloth daily 
Yes 80.2 70.5 95.4 98.9 100.0 98.6 92.5 91.1 
No 19.8 29.5 4.6 1.1 - 1.4 7.5 8.9 
Dry undergarments/ cloth 
under the sunlight 
 
Yes 82.4 100.0 95.4 100.0 100.0 95.7 93.1 98.7 
No 17.6 - 4.6 - - 4.3 6.8 1.3 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 91 61 109 93 106 70 306 224 
3.2.5 Source of Knowledge about Menstruation 
As evident in table 3.2d, majority of the in-school adolescent girls reported that 
they learned about menstruation before they had entered menarche (61%). This 
proportion was especially high in Mahottari (71%) followed by Udaypur (63%) 
and Baglung (44%). Mothers followed by friends and sisters continue to be the 
main sources of information about menstruation during the mid-term evaluation. 
The majority of the adolescent girls in Baglung (79%), Mahottari (72%) and 
Udaypur (79%) reported that they had learnt about menstruation through their 
mother while three fifths of the girls mentioned that sisters were the main source 
of information in Mahottari (57%) and Udaypur (63%). The proportion mentioning 
'mother' as their source of information has increased by 10 percentage points in 
Baglung (67% to 79%) and Mahottari (60% to 72%) while it increased by 20 
percentage points in Udaypur (59% to 79%). In Baglung (61%) and Mahottari 
(65%), friends constitute an important source of information for menstruation. 
Moderate increased was seen in all the three districts among those who 
mentioned that friends were their source of information for menstruation (47% to 
61% in Baglung; 51% to 65% in Mahottari; 34% to 47% in Udaypur). The 
contribution of teachers and facilitators or health workers in providing information 
on menstruation has not shown to be that remarkable in all the project districts. 
Only some MTE respondents in Mahottari (15%) cited teachers/facilitators as the 
sources of information for menstruation while the proportion was negligible in 
Baglung and Udaypur (Table 3.2d). 
21
Table 3.2d Percentage distribution of adolescent respondents according to their source 
of information on menstruation: Baseline and mid-term survey 
Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Did you learn about 
menstruation before or after 
it happened?
 
Before menstruation 62.6 44.3 63.3 71.0 48.1 62.9 57.8 61.2 
After menstruation 37.4 55.7 36.7 29.0 51.9 37.1 42.2 38.8 
N 91 61 109 93 106 70 306 224 
Source of information on 
menstruation 
 
Mother 67.0 78.7 60.6 72.0 59.4 78.6 62.1 75.9 
Sisters 36.3 42.6 59.6 57.0 53.8 62.9 50.7 54.9 
Friends 47.3 60.7 50.5 64.5 34.0 47.1 43.8 58.0 
Other female members of the 
household 
16.5 31.1 24.8 43.0 7.5 11.4 16.3 29.9 
Teacher/Facilitators 4.4 1.6 6.4 15.1 0.9 4.3 3.9 8.0 
Health worker - - - 7.5 3.8 4.3 1.3 4.5 
Population book - 6.6 - 2.2 - - - 2.7 
Neighbour - 1.6 - - - 1.4 - 0.9 
N 91 61 109 93 106 70 306 224 
Percentages total exceed100 due to multiple responses 
3.2.6 Types of Domestic Chores Avoided during Menstruation 
Women in Nepal follow certain cultural norms and practices during menstruation. 
As evident form table 3.2e, almost three fourths of the in-school adolescent girls 
do not enter place of worship (73%) and do not enter the kitchen or clean the 
house (78%). According to the district wise comparison, the large majority of the 
girls from Mahottari (83%) and Udaypur (93%) mentioned that they do not enter 
place of worship while only one third of the girls in Baglung (36%) mentioned this. 
Other commonly mentioned domestic chores avoided during menstruation 
include ‘not cleaning cowshed and milking buffalo’ and ‘avoids entering garden 
and field to collect fodder and work’. The differences in the percentage figures 
between the baseline and the MTE are not conspicuous (Table 3.2e). 
22
Table 3.2e Percentage distribution of adolescent respondents according to the types of 
domestic chores avoided by adolescent girls during menstruation: Baseline 
and mid-term survey 
Types of domestic chores Baglung Mahottari Udaypur Total 
avoided during 
menstruation 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Does not enter place of 
worship 
49.5 36.1 71.6 82.8 85.8 92.9 69.9 73.2 
Does not enter kitchen and 
does not clean house 
100.0 82.0 61.5 60.2 77.4 72.9 78.4 70.1 
Does not clean cowshed and 
milk buffalo 
15.4 18.0 17.4 12.9 13.2 12.9 15.4 14.3 
Avoids entering garden and 
field to collect fodder and 
work 
19.8 24.6 33.9 19.4 29.2 22.9 28.1 21.9 
Does not bring water 15.4 32.8 9.2 6.5 - 11.4 7.8 15.2 
Does not carry heavy load 3.3 3.3 2.8 14.0 0.9 1.4 2.3 7.1 
Does everything - 8.2 8.3 - 2.8 2.9 3.9 3.1 
Others* - 4.9 4.6 7.5 0.9 7.1 2.0 6.7 
N 91 61 109 93 106 70 306 224 
* Does not touch litters, does not graze cattle 
Percentages total exceed100 due to multiple responses 
3.2.7 Types of Rituals Performed during First Menstruation 
The adolescent girls who had experienced menstruation were asked the different 
cultural practices that had to be performed when a girl first started her 
menstruation. As shown in the table, various types of cultural practices were 
mentioned. In the MTE, most girls in Baglung (84% as compared 30% in 
baseline) stated that when a girl first starts her menstruation she is kept in a 
house of another person for a certain number of days to avoid her from seeing 
others. This practice was mentioned by only half of the girls in Mahottari (50%) 
and Udaypur (49%). Half of the girls in Baglung (49%) mentioned that a girls is 
kept in a room for certain number of day to avoid from seeing others (particularly 
by males) while more than one third of the girls in Mahottari (37%) and Udaypur 
(39%) stated the same practice. Some of the other practices mentioned were 'not 
being allowed to touch water source', 'not to enter kitchen or temple', 'not allowed 
to see the sun', 'not to observe the roof of her own house', sprinkle cows urine for 
purification etc. (Table 3.2f). 
23
Table 3.2f Percentage distribution of adolescent respondents according to the cultural 
rituals performed during the occurrence of menstruation for the first time: 
Baseline and mid-term survey 
Baglung Mahottari Udaypur Total 
Cultural practices Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Keep the girl in the house of a person 
whose caste is different for a certain 
number of days (ranging from 1-22 
days) to avoid her from seeing others 
and thereafter she is given new clothes
29.7 83.6 29.6 50.0 35.8 48.6 31.8 58.7 
Not allowed to see father/brother 52.7 - 8.3 - 32.1 - 29.8 - 
Keep her in a room for certain number 
of days (ranging from 2-22 days) to 
avoid her from meeting others 
98.9 49.2 45.0 37.0 60.4 38.6 66.3 40.8 
Not allowed to touch drinking water 
source/enter the kitchen/not allowed to 
enter temple
2.2 55.7 - 21.7 16.0 25.7 6.2 32.3 
After certain number of days (7-15) she 
has to take bath and wear clean 
clothes and is allowed to enter the 
house after being sprinkled with gold to 
purify her 
- 34.4 - 16.3 - 10.0 - 19.3 
Not allowed to see the sun - 4.9 - 22.8 - 8.6 - 13.5 
Not allowed to observe the roof of her 
own house 
- 8.2 - 9.8 - 21.4 - 13.0 
Sprinkle cows urine for purification - - - 3.3 - 18.6 - 7.2 
Others* 14.3 - 11.9 7.6 2.8 7.1 9.5 5.3 
No custom/tradition - 6.6 47.7 29.3 23.6 44.3 25.2 27.8 
Don’t know - - - - - 1.4 - 0.4 
N 91 61 109 93 106 70 306 224 
*Should not use cloth used during menstruation, Cut the rope where the bamboo is tied for 
fencing (in the room where the girl is kept), cannot eat meat/fruits, enter the house with new 
clothes, sprinkle water with gold kept in it, Not allowed to touch the cow for 22 days, Not allowed 
to stamp on grass (dubo-which is usually used for religious purpose) After 12 days she is brought 
back from the house of the other person and a priests wife has to put vermilion on her forehead, 
On the first day of menstruation the girl has to tie the bamboo wall with a rope in seven places 
and on the seven days two sisters has to cut the rope in seven places, Not allowed to drink cows 
milk, Tie the rope which is usually tied for bamboo fencing in three places on the first day and on 
the 7th day cut the rope with a sickle and take bath with 3 manas (about 1.5 ltrs.) of water' 
Percentages total exceed100 due to multiple responses 
24
3.3 Perception on Right Age at Marriage 
The recent amendment of the Civil Code 2020 increased the legal age at 
marriage for a girl to keep par with that of a boy. As per the new Marriage Act, it 
is 18 years with parental consent and 20 years without the parental consent for 
both a boy and a girl. Prior to the legislation, the legal age at marriage for a girl 
was with parental consent and 18 years without parental consent while for a boy 
it was 18 and 21 years respectively. It was disappointing to find that in the 
present MTE, there was 3 married adolescent girls aged 14 to 16 years. Whether 
or not they were already married at the time of the baseline survey (one year 
ago) is difficult to establish since they did not fall in the baseline sample. 
 
Table 3.3 compares the baseline and mid-term perceptions of the respondents 
regarding the right age of marriage for a girl. The proportion of respondents who 
perceived 20 years is the right age for marriage for a girl has increased in the 
mid-term survey (70% in baseline to 81% in mid-term). This increase is 
statistically significant at the level of .01. The perceived right age as mentioned 
by the respondents ranges from 16 years to 25 years. District wise comparisons 
show that slightly higher proportions of the girls from Mahottari (84%) mentioned 
20 years as the right age for marriage for a girl followed by Udaypur (80%) and 
Baglung (77%). 
Table 3.3 Percentage distribution of adolescent respondents according to their 
perception on right age at marriage for girls: Baseline and mid-term survey 
Appropriate age Baglung Mahottari Udaypur Total 
for marriage Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Up to 19 years 20.0 9.5 11.2 11.0 11.2 9.3 14.1 10.0 
20 yearsΦ 68.0 77.0 73.6 84.0* 68.8 80.0* 70.1 80.7*** 
21years and above 12.0 13.5 15.2 5.0 20.0 10.7 15.7 9.2 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
Φ t-test performed for only this response 
*** p≤ .01 ** p≤ .05 * p≤ .10 
3.4 Reaction to Marriage Proposed by Parents 
Similar to the baseline survey, the MTE respondents were asked what they 
would do if their parents or guardians proposed to marry them off before the 
appropriate age perceived by them. More than half of the respondents in the 
MTE reported that they would convince their parents to postpone the marriage 
(56%) while two fifths of the girls stated that they would revolt against the 
decision taken by their parents (42%). The proportion of the respondents saying 
that they would convince their parents increased sharply in Baglung district from 
25
22% in Baseline to 54% in MTE which is noteworthy. This increase is highly 
significant (p≤ .01). In the remaining two districts the proportion of those saying so 
was already high (51-52%) in the baseline and increased marginally to 53-60%. 
On the contrary, the proportion of the respondents saying that they would revolt 
or disagree with parents decision has declined sharply in Baglung district only 
from 74% in Baseline to 40% in the MTE. In the remaining two districts, it has 
either increased marginally (Mahottari) or remained the same (Udaypur) (Table 
3.4). 
Table 3.4 Percentage distribution of adolescent respondents on their reaction to 
marriage proposal by guardians before their perceived right age: Baseline and 
mid-term survey 
What would you do if your Baglung Mahottari Udaypur Total 
guardians propose to marry 
you off before that age? 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Accept parent decision 4.0 5.4 12.0 - 1.6 - 5.9 1.6 
Try to convince parents to 
postpone the marriage+ 22.4 54.1*** 51.2 60.0 52.0 53.3 41.9 56.2***
Disagree/revolt 73.6 40.5 36.8 40.0 46.4 46.7 52.3 42.2 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 125 74 125 100 125 75 375 249 
+
 t-test performed for only this response
*** p≤ .01
3.5 Knowledge and Perception about Pregnancy 
3.5.1 Knowledge about Ways to Become Pregnant 
Both spontaneous and probed knowledge about ways of becoming pregnant was 
solicited from the respondents. If the respondents did not mention any of the 
three conditions of pregnancy (through sexual intercourse between a girl and a 
boy, sexual intercourse without using FP, through sexual intercourse during a 
specific cycle) the interviewers were probed on the non-mentioned responses. 
As shown in Table 3.5, knowledge that a woman can get ‘through sexual 
intercourse’ and ‘sexual intercourse without using FP method’ was nearly 
universal among the adolescent in-school girls in all the three districts. 
Respondents who mentioned women can get pregnant through sexual 
intercourse during a specific cycle has also increased over the years (in MTE) in 
all the three districts. This increase is highly significant (p<.01) (Table 3.5) 
26
Table 3.5 Percentage distribution of adolescent respondents according to their 
perceived knowledge about how a woman gets pregnant: Baseline and mid￾term survey 
How can a woman become Baglung Mahottari Udaypur Total 
pregnant? Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Through sexual intercourse 
between a boy and a girl 
 
 Yes 98.4 100.0 99.2 100.0 100.0 100.0 99.2 100.0
 No 1.6 - 0.8 - - - 0.8 - 
Sexual intercourse without 
using FP method 
 
 Yes 95.2 98.6 93.6 99.0 89.6 100.0 92.8 99.2***
 No 4.8 1.4 6.4 1.0 10.4 - 7.2 0.8 
Through sexual intercourse 
during a specific cycle 
 
 Yes 26.4 44.6 39.2 69.0 27.2 76.0 30.9 63.9***
 No 73.6 55.5 60.8 31.0 72.8 24.0 69.1 36.1 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 125 74 125 100 125 75 375 249 
Significant test performed only for total 
*** p≤ .01 ** p≤ .05 * p≤ .10 
3.5.2 Knowledge about Ways to Avoid Pregnancy 
Knowledge about at least two ways to avoid pregnancy - abstinence and using 
contraception - was already nearly universal among the baseline respondents. 
However, less than a third of the baseline respondents knew that avoiding sex 
during certain period could prevent pregnancy to occur. 
 
In the MTE, all the adolescent girls were aware about abstinence (100%) and 
contraception as ways to avoid pregnancy. There has been a two-fold increase in 
proportion of those saying 'Avoiding sex during certain period of a woman's cycle' 
in the mid-term survey (32% in baseline 'vs' 64% in mid-term). This increase is 
highly significant (p≤ .01). At the district level, the proportion mentioning ‘avoiding 
sex during certain period of her cycle’ increased sharply in Udaypur (25% to 
76%) and Mahottari (41% to 70%) and moderately in Baglung (30% to 42%) 
(Table 3.5a) 
27
Table 3.5a Percentage distribution of adolescent respondents according to the 
perceived knowledge about ways to avoid pregnancy: Baseline and mid-term 
survey 
How can a woman avoid Baglung Mahottari Udaypur Total 
pregnancy? Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
 Abstaining from sex 
 Yes 98.4 100.0 99.2 100.0 99.2 100.0 98.9 100.0 
 No 1.6 - 0.8 - 0.8 - 1.1 - 
Avoid sex during certain 
period of her cycle 
 
 Yes 30.4 41.9 40.8 70.0 24.8 76.0 32.0 63.5***
 No 69.6 58.1 59.2 30.0 75.2 24.0 68.0 36.5 
Using contraception 
 Yes 96.8 100.0 95.2 100.0 92.8 100.0 94.9 100.0***
 No 3.2 - 4.8 - 7.2 - 5.1 - 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
Significant test performed only for total 
*** p≤ .01 ** p≤ .05 * p≤ .10 
3.6 Knowledge and Perception about Pregnancy Care 
As in the Baseline survey, all the MTE respondents were asked about the good 
health practices that should be followed by pregnant women. As evident from 
Table 3.6, knowledge on good health practices has increased in all the program 
areas. For instance, knowledge was nearly universal regarding eating nutritious 
food during pregnancy in Baglung (87% to 99%) and Udaypur (89% to 96%). 
While in Mahottari the proportion saying so declined by seven percentage points 
(from 88% to 81%). 
Respondents' knowledge about the need for health check up during pregnancy 
has also increased by nearly two folds almost in Baglung (42% to 81%) and 
Mahottari (46% to 79%) and quite considerably in Udaypur (51% to 72%). Other 
perceived good health practices such as rest and performing only light works 
which is very important for a pregnant woman has increased steeply in Udaypur 
(65% to 91% in mid-term) while the increase was moderate in Baglung (70% to 
84%) and Mahottari (79% to 82%) (Table 3.6) 
28
Table 3.6 Percentage distribution of adolescent respondents according to their 
knowledge about good health practices that pregnant woman should follow: 
Baseline and mid-term survey 
Types of practices pregnant Baglung Mahottari Udaypur Total 
woman should follow Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
To eat nutritious foods 87.2 98.6 88.0 81.0 88.8 96.0 88.0 90.8 
Rest and perform light works 70.4 83.8 79.2 82.0 64.8 90.7 71.5 85.1 
Regular health check up 42.4 81.1 46.4 79.0 51.2 72.0 46.7 75.0 
Personal hygiene 20.0 40.5 30.4 40.0 21.6 33.3 24.0 38.2 
To take Iron tablets/Vitamin 0.8 2.7 7.2 20.0 - 13.3 2.7 12.9 
Vaccination (TT) 3.2 9.5 18.4 25.0 9.6 24.0 10.4 20.1 
Not to drink/smoke 4.0 6.8 4.0 11.0 4.8 16.0 4.3 11.2 
*Others 2.4 2.7 2.4 11.0 - 10.7 1.6 8.4 
Don't know 4.8 - 5.6 - 3.2 - 4.5 - 
N 125 74 125 100 125 75 375 249 
* Avoid long travel, Physical exercise, Avoid sexual intercourse 
Percentages total exceed100 due to multiple responses 
3.7 Knowledge about Harmful Practices during Pregnancy
Table 3.7 shows the proportion of adolescent respondents citing various hrmful 
practices which needs to be avoided during pregnancy. It is evident from the 
table that the respondents' knowledge about harmful practices such as 'heavy 
work' (86%) and 'not paying attention to food' (76%) was mentioned by an 
overwhelmingly large proportion of the respondents 
District-wise comparison shows that there has been a steady increase among 
the girls who mentioned 'heavy work' in Baglung (73% to 92%) and Mahottari 
(71% to 83%) but a slight decline in Udaypur (96% to 83%). Likewise, the 
proportion of those mentioning 'hard work' increased by two-fold among the girls 
in Mahottari (32% vs. 63%) and by 13 percentage points in Udaypur (30% vs. 
43%). Similarly the proportion of girls mentioning 'not paying attention to food' 
has increased steadily in all the three districts (52% to 84% in Baglung; 67% to 
58% in Mahottari; 45% to 92% in Udaypur). Some of the other commonly 
mentioned harmful practices were 'not going for check-up' which has sharply 
increased in Udaypur (2% to 31%), 'not taking rest' and 'smoking and drinking' 
(Table 3.7). 
29
Table 3.7 Percentage distribution of adolescent respondents according to their 
knowledge on practices that are harmful for pregnant woman: Baseline and 
mid-term survey 
Types of perceived Baglung Mahottari Udaypur Total 
practices harmful for 
pregnant woman 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Heavy work 72.8 91.9 71.2 83.0 96.0 82.7 80.0 85.5 
Hard work 20.0 20.3 32.0 63.0 29.6 49.3 27.2 46.2 
Not taking rest 23.2 23.0 40.0 44.0 22.4 44.0 28.5 37.8 
Not paying attention to food 52.0 83.8 67.2 58.0 44.8 92.0 54.7 75.9 
Not going for check up 20.0 28.4 16.8 41.0 1.6 30.7 12.8 34.1 
Smoking and drinking 3.2 9.5 5.6 14.0 8.8 16.0 5.9 13.3 
Use of medicines without 
medical prescriptions 
4.0 10.8 10.4 10.0 2.4 8.0 5.6 9.6 
Being unhygienic 1.6 14.9 2.4 6.0 0.8 2.7 1.6 7.6 
Long travel 6.4 4.1 1.6 6.0 0.8 8.0 2.9 6.0 
Sexual relationship 3.2 4.1 4.8 5.0 1.6 5.3 3.2 4.8 
Not taking TT vaccine - 1.4 2.4 6.0 - 9.3 0.8 5.6 
Anxiety 1.6 1.4 - 5.0 0.8 2.7 0.8 3.2 
Others* - - 3.2 2.0 - 1.3 5.3 1.2 
Don't know 8.0 - 6.4 - 1.6 - 5.3 - 
N 125 74 125 100 125 75 375 249 
*Should not wear high heel shoes, Not taking iron capsules and iodine salt, sleeping on her chest, 
should not wear tight undergarments 
Percentages total exceed100 due to multiple responses
3.8 Knowledge about Assistance during Delivery 
3.8.1 Appropriate Person to Assist Delivery 
The National Safe Motherhood Program encourages women to deliver at 
facilities under the care of skilled attendants when it is feasible and ensures that 
facilities are upgraded and providers are trained to manage complications. The 
high maternal morbidity and mortality in Nepal can be attributed to the adoption 
of traditional birthing practices that are not generally safe. At the national level, 
only 9 percent of births are delivered at the health facilities compared with 89 
percent at home (MoH, 2001). 
Similar to the baseline survey, the respondents of MTE were asked to mention 
the type of person most appropriate to assist a delivery. As seen from Table 3.8, 
three fourths of the MTE respondents stated that doctor should be the main 
person to assist during a delivery (73%) while two thirds of them mentioned 
trained TBA (63%) and half of them mentioned nurse as the appropriate person 
(51%). The proportion of those citing doctor as an appropriate person for 
assisting delivery increased by over 20 percentage points in Baglung (43% to 
62%) and Udaypur (50% to 73%) and slightly less this proportion in Mahottari 
30
(69% to 82%). In Mahottari, the proportion of those stating trained TBA increased 
by nearly three folds (26% to 73%) while it was about two fold increase in 
Baglung (26% to 42%) and Udaypur (37% to 69%). 
Overall, the proportion of in-school girls mentioning other types of health workers 
such as maternal and child health worker (MCHW) (14% to 26%), female 
community health volunteers (FCHV) (10% to 24%) and auxiliary health worker 
(AHW)/health assistant (4% to 11%) has increased in the mid-term survey in 
comparison to the baseline survey. The increase has been more pronounced in 
Baglung district only (Table 3.8). 
Table 3.8 Percentage distribution of adolescent respondents according to their 
knowledge on appropriate person to assist during delivery: Baseline and 
mid-term survey 
Knowledge of appropriate Baglung Mahottari Udaypur Total 
person to assist during 
delivery 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Doctor 43.2 62.2 68.8 82.0 50.4 73.3 54.1 73.5 
Trained TBA 26.4 41.9 26.4 73.0 36.8 69.3 29.9 62.7 
Nurse 29.6 28.4 33.6 57.0 46.4 66.7 36.5 51.4 
TBA 9.6 28.4 19.2 4.0 8.0 14.7 12.3 14.5 
Family member 11.2 5.4 20.0 4.0 8.8 6.7 13.3 5.2 
MCHW 16.0 32.4 20.8 27.0 4.0 17.3 13.6 25.7 
Neighbors 4.0 - 0.8 1.0 0.8 6.7 1.9 2.4 
AHW, HA, Health worker 9.6 33.8 0.8 2.0 - - 3.5 10.8 
FCHV 13.6 14.9 14.4 38.0 1.6 14.7 9.9 24.1 
Don't know 0.8 - 3.2 - 1.6 - 1.9 - 
N 125 74 125 100 125 75 375 249 
3.8.2 Persons Appropriate to Assist in Their Own Delivery 
The respondents were further asked about the type of person they would prefer 
to assist them at the time of their own delivery. It is evident from Table 3.8a that 
the proportion of respondents citing a doctor increased in all the three districts. It 
was also interesting to note that more than half of the respondents in Udaypur 
(55%) and less than a half in Mahottari (45%) and only about one fifth in Baglung 
(20%) said that they would prefer their family member at the time of their down 
delivery. However, the proportions have decreased significantly in both Udaypur 
and Mahottari in the MTE from the baseline figures of 74% and 78% respectively. 
Compared to the baseline, the increase in the proportion of those preferring a 
traditional birth attendant (TBA) in Baglung (2% vs. 41%) and Udaypur (7% vs. 
45%) has been very sharp whereas the increase has been negligible in Mahottari 
(11% vs 15%). In Mahottari, however, the proportion of respondents citing trained 
TBA has increased from one fourth in the baseline to nearly two fifths in the MTE 
– an increase of 10 percentage points (25% vs. 38%) (Table 3.8a). 
31
Table 3.8a Percentage distribution of adolescent respondents according to their 
perception on appropriate person to assist during their own delivery: 
Baseline and mid-term survey 
 Appropriate person to Baglung Mahottari Udaypur Total 
assist during delivery Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Family member 16.0 20.3 77.6 45.0 73.6 54.7 55.7 40.6 
Doctor 32.8 52.7 63.2 75.0 26.4 56.0 40.8 62.7 
TBA 2.4 40.5 11.2 15.0 7.2 45.3 6.9 31.7 
Trained TBA 16.8 5.4 24.8 38.0 25.6 14.7 22.4 21.3 
Nurse 25.6 25.7 30.4 56.0 31.2 61.3 29.1 48.6 
FCHV 8.0 10.8 7.2 20.0 - 14.7 5.1 15.7 
MCHW 8.8 25.7 14.4 19.0 5.6 9.3 9.6 18.1 
Health post in charge 
/Health worker 
8.0 1.6 - 3.2 
Other* 4.0 - 0.8 - - - 1.6 - 
Don't know 1.6 - 3.2 - 0.8 - 1.9 - 
N 125 74 125 100 125 75 375 249 
*Friends, Neighbours 
Percentages total exceed 100 due to multiple responses. 
 
3.9 Perception on Who Should Decide on Family Size 
Respondents' perception on who in the family should decide the number of 
children to have (family size) was solicited in the MTE also. As evident from 
Table 3.9, the most adolescent girls in all the three districts perceived that both 
woman and her husband should decide jointly about how many children to have 
in a family. This response was already high in the baseline survey (73%), which 
increased to 80% in the MTE. At the district level, the percentage increase of 
respondents saying 'joint decision' was more pronounced in Mahottari (68% vs. 
79%) and Baglung (76% vs. 84%). Few respondents gave importance to 
husband or woman herself as the decision maker in the MTE (Table 3.9). 
Table 3.9 Percentage distribution of adolescent respondents according to their 
perception on decision making about family size: Baseline and mid-term 
survey 
Who decides when and Baglung Mahottari Udaypur Total 
how many children are to 
be born in family? 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Woman and husband 76.0 83.8 68.0 79.0 75.2 78.7 73.1 80.3 
Woman herself 12.0 5.4 12.8 10.0 16.0 17.3 13.6 10.8 
Husband 8.0 10.8 16.0 11.0 4.8 4.0 9.6 8.8 
In-laws 1.6 - 0.8 - 0.8 - 1.1 - 
Don't know 2.4 - 2.4 - 3.2 - 2.7 - 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 125 74 125 100 125 75 375 249 
32
3.10 Knowledge about Family Planning 
3.10.1 Knowledge about Family Planning Methods 
In-school girls' knowledge about various FP methods was already very high at 
the time of the baseline survey. In the MTE, the percentages increased further in 
all the districts. For instance, in Udaypur, the mean number of methods heard by 
the baseline respondents was 6.1, which increased to 8.9 in the mid-term survey. 
Similarly, mean number of methods known by a school girl in Mahottari increased 
from 6.4 in the baseline to 8.4 in the MTE and in Baglung it increased from 5.7 to 
7.6 which is highly noteworthy. 
Knowledge about oral pills (99%), condom (100%) and Depo provera (99%), 
male sterilization (98%) and female sterilization (97%) was nearly universal 
among the girl students interviewed in the MTE. A sharp increase in knowledge 
was also evident for Norplant (64% in baseline; 92% in mid-term), IUD/Copper T 
(70% to 93%). Moreover, two thirds of the adolescent girls have also heard about 
calendar method (67%), while half of them have heard about lactational 
amenorrhoea method (LAM) (51%), which is encouraging. (Table 3.10) 
Table 3.10 Percentage distribution of adolescent respondents perceived knowledge 
on Family planning method: Baseline and mid-term survey 
Baglung Mahottari Udaypur Total 
 Baseline Mid-term Baseline Mid-term Baseline Mid-term Baseline Mid-term 
 Pills 
Yes 78.4 98.6 85.6 98.0 84.8 100.0 82.9 98.8 
No 21.6 1.4 14.4 2.0 15.2 - 17.1 1.2 
Condom 
Yes 98.4 100.0 92.8 100.0 96.0 100.0 95.7 100.0 
No 1.6 - 7.2 - 4.0 - 4.3 - 
 Depo provera 
Yes 95.2 97.3 96.8 100.0 99.2 100.0 97.1 99.2 
No 4.8 2.7 3.2 - .8 - 2.9 0.8 
Norplant 
Yes 52.8 85.1 69.6 98.0 68.8 92.0 63.7 92.4 
No 47.2 14.9 30.4 2.0 31.2 8.0 36.3 7.6 
IUD/Copper-T 
Yes 66.4 85.1 73.6 98.0 70.4 93.3 70.1 92.8 
No 33.6 14.9 26.4 2.0 29.6 6.7 29.9 7.2 
Male Sterilization 
Yes 76.8 98.6 88.8 97.0 88.0 100.0 84.5 98.4 
No 23.2 1.4 11.2 3.0 12.0 - 15.5 1.6 
Female Sterilization 
Yes 78.4 97.3 94.4 95.0 88.8 100.0 87.2 97.2 
No 21.6 2.7 5.6 5.0 11.2 - 12.8 2.8 
 Withdrawal method 
Yes 13.6 25.7 14.4 26.0 5.6 54.7 11.2 34.5 
No 86.4 74.3 85.6 74.0 94.4 45.3 88.8 65.5 
Calendar method 
Yes 14.4 48.6 22.4 69.0 7.2 81.3 14.7 66.7 
No 85.6 51.4 77.6 31.0 92.8 18.7 85.3 33.3 
Breastfeeding 
Yes - 23.0 - 62.0 - 65.3 - 51.4 
No - 77.0 - 38.0 - 34.7 - 48.6 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 125 100 125 75 375 249 
33
5.7
7.6
6.4
8.4
6.1
8.9
6.1
8.3
0
2
4
6
8
10
Baglung Mahottari Udaypur Total
Baseline
Mid-term
Mean number
Figure 3.a Mean number of FP method heard by district: Baseline and mid-term survey 
3.10.2 Sources of Information on Family Planning 
The adolescent girls were asked to mention the sources of information about the 
various family planning methods they were aware of. It is apparent from Table 
3.10a that at the time of the baseline survey, only about a fifth of the in-school 
respondents (21%) cited friends of adolescent groups as sources of information 
on family planning methods. In the MTE, this proportion soared by more than 
three folds (72%). Friends of the adolescent girls' group as the sources of 
information were more frequently cited in Udaypur (83%) than in other districts. 
 
Radio was cited as the main source of family planning information by 
respondents in Udaypur (61% in baseline to 81% in MTE) and Mahottari (38% to 
61%). In Baglung the proportion has declined from 68% to 51%. In the MTE, 
roughly two fifths of the respondents mentioned that they had also acquired 
information about family planning method from Choose Your Future Manual 
(42%) and other health related text books (29%) (Table 3.10a). 
34
Table 3.10a Percentage distribution of adolescent respondents according to their 
knowledge on sources of information of FP method: Baseline and mid-term 
survey 
 Baglung Mahottari Udaypur Total 
Sources of information Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Family/relatives 32.0 12.2 59.2 27.0 35.2 25.3 42.1 22.1 
Radio 68.0 51.4 61.6 38.0 60.8 81.3 63.5 55.0 
Friends of Adolescent 
group 
16.0 66.2 29.6 69.0 17.6 82.7 21.1 72.3 
Health institution 24.0 18.9 16.8 26.0 24.0 18.7 21.6 21.7 
TV 8.0 4.1 44.0 26.0 32.8 52.0 28.3 27.3 
Poster/pamphlet/printed 
materials 
45.6 12.2 35.2 7.0 28.8 12.0 36.5 10.0 
From choose your future 
manual/adolescent classes 
- 48.6 - 38.0 - 40.0 - 41.8 
From books on health and 
text books 
- 36.5 - 25.0 - 28.0 - 29.3 
Other friends - 8.1 - 12.0 - 13.3 - 11.2 
Teacher 11.2 5.4 4.0 11.0 2.4 17.3 5.9 11.2 
FCHV 1.6 4.1 10.4 11.0 0.8 4.0 4.3 6.8 
Others* 4.8 - 6.4 6.0 4.0 1.3 5.1 2.8 
N 125 74 125 100 125 75 375 249 
*Neighbour, Medical shop, Srijana samuha, Husband, Street drama, from gaunghar clinic, IRDS 
training, CARE Nepal training 
Percentages total exceed 100 due to multiple responses.
3.10.3 Knowledge of Sources of Contraceptive Supplies in the Locality 
Table 3.10b presents the respondents' knowledge of the places in their locality 
where one can obtain family planning contraceptives. The proportion of the 
respondents citing FCHV/TBA as sources of contraceptive supplies increased 
sharply in Mahottari (18% to 55%) and Udaypur (9% to 67%) and to some extent 
in Baglung (7% to 28%). HP/SHP as the sources of contraceptive supplies were 
cited by the majority of the respondents of Mahottari district only (57%) while 
medicine shop (chemists) was mentioned by a considerable proportion of 
respondents in Mahottari (42%) and Udaypur (44%) (Table 3.10b). 
35
Table 3.10b Percentage distribution of adolescent respondents according to their 
knowledge of availability of FP method in the locality/ ward: Baseline and 
mid-term survey
 Places where FP method Baglung Mahottari Udaypur Total 
obtain in the ward Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Not available 42.4 24.3 38.4 - 8.8 13.3 29.9 11.2 
FCHV/TBA 7.2 28.4 18.4 55.0 8.8 46.7 11.5 44.6 
HP/SHP 37.6 27.0 22.4 57.0 34.4 30.7 31.5 40.2 
Health workers 2.4 4.1 4.8 12.0 8.8 2.7 5.3 6.8 
Medical shops 5.6 4.1 9.6 42.0 20.8 44.0 12.0 31.3 
Retail shop - - - - - 6.7 - 2.0 
Others* - 6.8 2.4 1.0 3.2 1.3 1.9 2.8 
Don't know 11.2 9.5 14.4 - 27.2 2.7 17.6 3.6 
N 125 74 125 100 125 75 375 249 
*Woman's saving groups, Gaunghar clinic, MCHW, private clinic 
Percentages total may exceed 100 due to multiple responses 
3.10.4 Knowledge about Types of FP Methods Available in Their Ward 
The MTE respondents were asked about the types of FP methods available in 
the ward. Nearly all of them perceived that the Pills (90%) and condom (92%) 
were available in their ward. DMPA (Depo provera) as the method readily 
available in their locality/ward was mentioned by nearly two thirds of the MTE 
respondents (64%). The district-wise comparison of the baseline and mid-term 
results reveal about 20 percentage points increase in knowledge among the girls 
in Mahottari on the availability of pills (73% in baseline; 91% in mid-term) while 
only a slight increase was seen among those who mentioned condom in 
Mahottari (81% in baseline; 94% in mid-term) and Udaypur (79% in baseline; 
83% in mid-term) as the corresponding percentages were already high in the 
baseline survey. 
Table 3.10c Percentage distribution of adolescent respondents according to their 
knowledge on types of FP method available in the ward: Baseline and mid￾term survey 
 Types of FP method Baglung Mahottari Udaypur Total 
available in the ward Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Pills 65.5 88.0 72.9 91.0 72.5 90.5 70.6 90.1 
Condom 91.4 80.0 81.4 94.0 78.8 98.4 83.2 92.0 
Depo-Provera (Injection) 56.9 56.0 61.0 72.0 72.5 57.1 64.5 63.8 
Norplant - - - 1.0 - - - 0.5 
Don't know - 2.0 - - - - - 0.5 
N 58 50 59 100 80 63 197 213 
Percentages total exceed100 due to multiple responses 
36
19
51
22
79
49
99
30
77
0
20
40
60
80
100
Baglung Mahottari Udaypur Total
Baseline
Mid-term
3.11 Communication on FP 
The adolescent respondents were asked if they had talked to anyone regarding 
FP and the person they had communicated with. As evident from figure 3.b 
communication on FP among adolescent girls has more than doubled from the 
baseline survey (30% in baseline to 77% in mid-term). Almost all the girls from 
Udaypur stated that they had talked to someone about family planning (99%) 
while four fifths of the girls from Mahottari (79%) mentioned the same. Only half 
of the in-school girls from Baglung reported that they had talked to someone 
about FP (51%). The baseline and midterm comparison show that there has 
been steep increase among adolescent girls who communicated on family 
planning in all three districts. This increase was highly significant at the level of 
p≤ .01. 
It is interesting to note that the large majority of the girls mentioned that they 
have talked to their friends (74%) on FP. The baseline and mid-term comparison 
shows that only a slight increase among those who communicated with their 
sisters (34% to 41%). In the mid-term survey friends from adolescent group was 
also mentioned by the majority of the girls in Baglung (82%) while half of the girls 
from Mahottari (49%) and one third from Udaypur (38%) mentioned the same. 
Other persons mentioned were mothers, female family members, health 
personnel etc. 
Figure 3.b Percentage of adolescent girls who communicated on FP: Baseline and mid￾term survey 
37
Table 3.11 Percentage distribution of adolescent respondents according to the person 
they talked to about FP: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
With whom have you 
talked on family planning?
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Friend 62.5 39.5 74.1 78.5 59.0 86.5 63.4 73.8 
Sister 8.3 10.5 51.9 49.4 37.7 48.6 34.8 41.4 
Friends in AG - 81.6 - 49.4 - 37.8 - 51.3 
Mother - 15.8 18.5 24.1 16.4 23.0 13.4 22.0 
Other female family member 8.3 2.6 44.4 43.0 18.0 23.0 22.3 27.2 
Teacher 20.8 - - 3.8 - 1.4 4.5 2.1 
Health personnel 8.3 - - 7.6 1.6 10.8 2.7 7.3 
Husband - - 3.7 - - - 0.9 - 
Others* 4.2 - 7.4 - 6.6 2.7 13.4 1.0 
N 24 38 27 79 61 74 112 191 
* FCHV, Neighbour, Father 
Percentages total exceed 100 due to multiple responses 
3.12 Use of Contraception 
As in the baseline survey, all the MTE respondents, irrespective of their marital 
status, were asked about contraceptive ever use and current use. Of the total 
adolescent girls, 3 in-school girls from Mahottari were married. 
3.12.1 Ever Use of Contraception 
Table 3.12 shows the ever use of contraception among adolescent girls in the 
three districts. Only one in-school girl from Mahottari had ever used a family 
planning method. The contraceptive that she used was condom. 
38
Table 3.12 Percentage distribution of adolescent respondents who had ever used FP 
method and type of method ever used: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
 Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Have you ever used a 
family planning method? 
 
Yes - - 0.8 1.0 - - 0.3 0.4 
No 100.0 100.0 99.2 99.0 100.0 100.0 99.7 99.6 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
N 125 74 125 100 125 75 375 249 
Ever used FP method 
Pills - - - - - - - - 
Condom - - - 1 - - - 1 
Depo-Provera (Injection) - - - - - - - - 
Withdrawal method - - 1 - - - 1 - 
Female sterilization - - - - - - - - 
N - - 1 1 - - 1 1 
3.12.2 Current Use of FP 
As evident from table, only one in-school girl from Mahottari was currently using 
condom (Table 3.12a). The adolescent girl who uses condom was asked where 
she has obtained the method the last time and the duration of current use of the 
family planning method. She had obtained condom from the pharmacy the last 
time and had been using condom since the last four months (Table not shown). 
Table 3.12a Distribution of adolescent respondents by current use of FP method: 
Baseline and mid-term survey 
 Mahottari Total 
 Baseline 
(N) 
Mid-term 
(N) 
Baseline 
(N) 
Mid-term 
(N) 
Are you currently using any family 
planning method? 
 
Yes 1 1 1 1 
No - - - - 
N 1 1 1 1 
Currently using family planning method 
Pills - - - - 
Depo-Provera (Injection) - - - - 
Condom - 1 - 1 
Withdrawal method 1 - 1 - 
Female sterilization - - - - 
N 1 1 1 1 
39
65
96
20
100
65
99
50
98
0
20
40
60
80
100
Baglung Mahottari Udaypur Total
Baseline
Mid-term
Percent
Chapter 4 
KNOWLEDGE ON OPTIMAL BIRTH SPACING INTERVAL 
This chapter examines the change in knowledge of in-school adolescent girls 
regarding optimal birth spacing interval concept. This chapter also focuses on the 
perception of girls regarding men's involvement in optimal birth spacing and the 
ways to enhance male's involvement in this important reproductive health 
decision. 
4.1 Awareness about Optimal Birth Spacing Interval 
As shown in Figure 4.a, awareness on optimal birth spacing interval (OBSI) has 
become nearly universal among in-school girls. At the time of the baseline 
survey, only about a fifth of in-school girls in Mahottari and about two thirds in 
Udaypur and Baglung had known about OBSI. The increase in knowledge is 
highly significant (p≤ .01). 
During the baseline, most of the adolescent girls believed OBSI as "the decision 
making to have another child". Adolescent girls perspectives have changed in the 
MTE and now they consider OBSI as decision making for spacing births/time 
(ranging from 2-8 years) between one child and another. It may be mentioned 
that the number of in-school girls giving correct response (spacing time between 
one child and another should be 3-5 years) was 'nil' in the baseline. In the 
present MTE, more than three-fourths of the adolescent girls from Udaypur 
(77%), almost half of the girls from Baglung (47%) and two fifths of the girls from 
Udaypur (38%) stated that OBSI is the 3-5 years of spacing time between one 
child and another. Two thirds of the girls from Baglung also mentioned that OBSI 
is the decision making for the spacing time between one child and another (Table 
4.1). 
Figure 4.a Percentage of adolescent girls who have heard about OBSI 
40
Table 4.1 Percentage distribution of adolescent respondents by their knowledge about 
optimal birth spacing: Baseline and mid-term survey 
Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Have you ever heard about 
optimal birth spacing interval 
(OBSI)? 
 
Yes 64.8 95.9*** 19.7 99.0*** 64.8 98.7*** 50.0 98.0***
No 35.2 4.1 80.3 1.0 35.2 1.3 50.0 2.0 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 122 100 125 75 372 249 
If yes, what is OBSI? 
Decision making for the desired 
number of children 
27.2 2.8 16.7 11.1 12.3 18.9 19.4 11.1 
Decision making for the time to 
have a child 
9.9 2.8 12.5 10.1 63.0 16.2 33.3 9.8 
Decision making for the spacing 
time between one child and 
another 
81.5 36.6 83.3 3.0 21.0 18.9 55.4 17.6 
Spacing time between one child 
and another should be 3-5 year+ 
- 46.5 - 38.4 - 77.0 - 52.5 
Spacing time between one child 
and another should be 5 years 
- 9.9 - 13.1 - 2.7 - 9.0 
Spacing time between one child 
and another should be 3 years 
- 7.0 - 15.2 - 1.4 - 8.6 
Others* - 7.0 - 18.2 - 5.6 - 11.1 
Don't know - - - 1.0 7.4 - 3.2 0.4 
N 81 71 24 99 81 74 186 244 
* Spacing time between one child and another should be (2-5, 2-3, 3-4, 4-5, 8 years)
Percentages total exceed100 due to multiple responses
*** p≤ .01 
+
 t-test performed for only this response
4.2 Source of Knowledge on OBSI 
The in-school adolescent girls were asked about their sources of information on 
OBSI. This question was asked only to the respondents of MTE. It is evident from 
Table 4.2 that the large majority of the respondents mentioning friends of 
adolescent groups as their main sources of information on OBSI (72%). The 
district wise distribution shows that the higher proportion of the girls from 
Udaypur (78%) followed by Mahottari (72%) and Baglung (66%) citing friends of 
adolescent girls' group. It was also encouraging to note that half of the girls from 
all the districts (51% in Baglung; 59% in Mahottari; 57% in Udaypur) also 
mentioning 'Choose Your Future Manual' and adolescent classes as sources of 
information ob OBSI. About a quarter of the MTE respondents (25%) also cited 
41
school text book /curricula on health and population as sources of information on 
OBSI (25%) (Table 4.2). 
Table 4.2 Percentage distribution of adolescent respondents by their source of 
information on OBSI: Baseline and mid-term survey 
Source of information on OBSI Baglung Mahotari Udayapur Total 
Friends of AG 66.2 71.7 78.4 72.1 
From Choose your future manual/from 
adolescent classes 
50.7 58.6 56.8 55.3 
From school curriculum/ Health and 
population book 
28.2 22.2 25.7 25.0 
From radio 11.3 6.1 8.1 8.2 
From teacher 2.8 9.1 9.5 7.4 
Other friends 4.2 2.0 6.8 4.1 
Health institutions/health personnel 1.4 5.1 4.1 3.7 
From TTBA/FCHV 1.4 4.0 1.4 2.5 
From TV - - 4.1 1.2 
Facilitators - - 4.1 1.2 
Others* 1.4 - 4.0 2.0 
N 74 100 75 249 
* WOREC training, sister
Percentages total exceed100 due to multiple responses
4.3 Knowledge about Benefits of OBSI 
Knowledge on benefits of OBSI to the mother, new born, father, family and 
community was solicited from the in-school adolescent girls. As shown in the 
table, proportion of the respondents mentioning the benefits of OBSI has 
increased. The proportion of those stating that OBSI will improve maternal health 
situation has slightly increased as this proportion was already high during the 
baseline survey (84% in baseline; 92% in mid-term overall). This increase was 
significant (p<.05). In comparison to Baglung and Mohattari, a significant 
increase was seen among the girls in Udaypur (p<.01). Similarly those 
mentioning other benefits such as 'have enough time to take care of the child and 
herself' has slightly increased while a sharp increased was seen among those 
who perceived that OBSI would reduce maternal mortality (3% to 31%). This 
increase was found to be highly significant especially in Mahottari and Udaypur 
(p<.01). Other benefits which were mentioned during the mid-term survey (but 
not during the baseline) are 'women will have sufficient time to do other work', 
'will not be infected with STDs and cancer', 'women will be healthy (physically 
and mentally)' and 'avoidance of premature rupture of membrane'. 
Various benefits of OBSI to the newborn have been cited by the MTE 
respondents. Of these the most frequently cited response was 'the new born 
would receive enough breast milk' if OBSI was practiced (92%). The proportion of 
the MTE respondents citing this benefit increased significantly in all the districts 
42
(79% to 97% in Baglung; 67% to 84% in Mahottari; 63% to 97% in Udaypur). The 
large majority of the girls also stated that the newborn would receive enough care 
from the parents (74%). A considerable increase was also seen among girls from 
Udaypur (47% to 73%) and Mahottari (25% to 36%) who perceived that the new 
born would grow healthy if OBSI is practiced. 
It is interesting to note that the proportion of those saying that they were 
'ignorant' (those who gave don’t know responses) about the benefits of OBSI to 
the father has decreased sharply in Mahottari (57% in baseline; 19% in mid-term) 
and Udaypur (57% in baseline; 19% in mid-term) while the decrease was only 
moderate in Baglung (43% in baseline; 32% in mid-term). Adolescent girls cited 
various benefits of OBSI to the father. Of the various benefits mentioned, almost 
half of the respondents stated that OBSI helps in 'reducing economic pressure' 
and this proportion has increased sharply among the girls from Udaypur (5% in 
baseline; 62% in mid-term) while a 20 percentage point increase was seen 
among the girls from Baglung (22% in baseline; 42% in mid-term) and only a 
moderate increase was seen among girls from Mahottari (29% in baseline; 37% 
in mid-term). Apart from this more than half of the girls from Mahottari (56%) and 
two fifths of the girls from Udaypur (45%) perceived that OBSI would 'reduce 
physical and mental problem' of the father. The other benefits mentioned were 
'receives more attention from the partner', 'easy to take care of children', 
'sufficient time to work and 'less expenditure during post-delivery'. 
Various benefits to the family were also mentioned. The commonly perceived 
benefits were 'reduction of spending due to illness', 'reduction in economic 
pressure' and 'enough time to find income for the family'. The baseline-mid term 
comparison showed that there has been a substantial increase among the 
adolescents in Mahottari (13% in baseline; 53% in mid-term) and Udaypur (20% 
in baseline; 49% in mid-term) who believed that OBSI reduces spending due to 
illness. The proportion of adolescent girls stating that practicing OBSI 'decreases 
population' has increased in Mahottari (8% to 32%) while it remained the same in 
the other districts. Reduction in economic pressure has also increased in 
Baglung (3% in baseline; 30% in mid-term), Mahottari (8% in baseline; 25% in 
mid-term) and Udaypur (5% in baseline; 53% in mid-term). 
As evident from the table, knowledge on the benefits of OBSI to the community is 
moderate. About one third of the adolescent girls have mentioned that the 
community can benefit with the decrease in population (32%). Other perceived 
benefits are ‘development within the community’ (25%), ‘poverty reduction’ (23%) 
and clean environment (35%). The proportion of those who mentioned that the 
community will remain clean and peaceful has increased in the mid-term (9% in 
baseline; 35%). As compared to the baseline survey, only one fifth of the 
adolescent girls gave ‘don’t know’ responses (40% in baseline; 22% mid-term). 
(Table 4.3) 
43
Table 4.3 Percentage distribution of adolescent respondents according to their 
knowledge about the benefits of OBSI: Baseline and mid-term survey 
 Baglung Mahottari Udaypur Total 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Benefit to mother 
Improve maternal health situation+ 87.7 90.1 79.2 89.9 81.5 95.9 83.9 91.8 
Have enough time to take care of 
child and her self 
53.1 49.3 45.8 27.3 30.9 81.1 42.5 50.0 
Have enough time to take care of 
the family 
19.8 14.1 16.7 9.1 11.1 17.6 15.6 13.1 
Reduce maternal mortality rate+ 4.9 8.5 4.2 44.4 1.2 33.8 3.2 30.7 
Others* - 1.4 - 5.1 - 6.8 - 4.5 
Don't know 1.2 1.4 4.2 1.0 6.2 - 3.8 0.8 
Benefit to new born 
Enough breast feeding 79.0 97.2 66.7 83.8 63.0 97.3 70.4 91.8 
Receive enough care from the 
parents 
79.0 84.5 58.3 63.6 34.6 77.0 57.0 73.8 
Healthy 44.4 35.2 25.0 36.4 46.9 73.0 43.0 47.1 
Fully immunized 3.7 - - 11.1 6.2 - 4.3 4.5 
Will have less chances of being 
malnourished 
- - - 2.0 - 5.0 - 2.5 
Don't know - 1.4 8.3 1.0 3.7 - 2.7 0.8 
Benefit to father 
Reduce physical and mental 
problem (stress) 
34.6 18.3 8.3 55.6 35.8 44.6 31.7 41.4 
Receive more attention from the 
partner 
12.3 8.5 20.8 19.2 3.7 13.5 9.7 14.3 
Reduce economic pressure 22.3 42.3 29.2 37.4 4.9 62.2 15.6 46.3 
Will be easy to take care of children - 5.6 - 16.2 - 9.5 - 11.1 
Will have sufficient time to work - 2.8 - 2.0 - 12.2 - 5.3 
Less expenditure during post 
delivery 
- 7.0 - - - 2.7 - 2.9 
Don't know 43.2 32.4 41.7 13.1 56.8 18.9 48.9 20.5 
Benefit to family 
Have enough time to find more 
income for the family 
38.3 28.2 25.0 25.3 38.3 33.8 36.6 28.7 
Reduction in spending due to 
illness 
33.3 15.5 12.5 52.5 19.8 48.6 24.7 40.6 
Population control /healthy family 13.6 14.1 8.3 32.3 3.7 5.4 8.6 18.9 
Reduce economic pressure 2.5 29.6 8.3 25.3 4.9 52.7 4.3 34.8 
Possibility of receiving care from 
their son and daughter-in-law 
- 8.5 - 12.1 - 14.9 - 11.9 
No arguments in the family - 2.8 - 13.1 - 10.8 - 9.4 
Responsibility towards the son and 
daughter-in-law (economic, social) 
will be reduced 
- 5.6 - 6.1 - 8.1 - 6.6 
Don't know 33.3 26.8 50.0 4.0 39.5 6.8 38.2 11.5 
44
Benefit to community 
Contribute to community 
development 
17.3 9.9 4.2 13.3 37.0 33.8 24.2 25.4 
Decrease population 28.4 33.8 29.2 29.3 22.2 32.4 25.8 31.6 
Reduce infant mortality rate 3.7 7.0 - 16.2 1.2 9.5 2.2 11.5 
Poverty reduction 33.3 5.6 12.5 43.4 6.2 12.2 18.8 23.0 
Reduce maternal mortality rate 3.7 2.8 4.2 19.2 3.7 13.5 3.8 12.7 
Healthy community - - 8.3 - - - 1.1 - 
Clean/peaceful community 9.9 36.6 12.5 27.2 6.2 44.6 8.6 35.3 
Don't know 39.5 31.0 50.0 15.2 38.3 23.0 40.3 22.1 
N 81 71 24 99 81 74 186 244 
* Women will have sufficient time to do other work, Will not be infected with STDs and cancer, Women will 
be healthy (physically and mentally), Avoidance of premature rupture of membrane (breaking of the waters 
too early) 
Percentages total exceed100 due to multiple responses
+
 t-test performed for only this response 
4.4 Risk of Not Practicing OBSI 
Knowledge on risk of not practicing OBSI to the mother and newborn was also 
solicited. This question was asked to the respondents during the present MTE 
only. As evident from the table, various types of risks to the mother if OBSI is not 
practiced was mentioned. The large majority of all the adolescent girls in the 
three districts (Baglung 73%; 84% in Mahottari; 85% in Udaypur) believed that 
mortality will be high among mothers (‘the possibility of the death of the mother’) 
if OBSI is not practiced. The majority of the girls in Baglung (68%), Mahottari 
(62%) and Udaypur (58%) believed that the ‘health of the mother will be weaken’ 
if OBSI is not practiced. The risk of uterine infection after delivery was also 
mentioned by half of the girls from Udaypur (55%) and one third from Mahottari 
(33%) while very few in Baglung mentioned this risk (6%). 
Similarly, various risks to the newborn as a consequence of not practicing OBSI 
were cited by the respondents. The major risk stated by them varied across the 
three districts. For instance, more than three fourths of the girls from Udaypur 
(78%) and half of the girls from Baglung (55%) mentioned that the new born child 
may not get enough breast milk which will affect the child's immunity system and 
in turn may be likely to be malnourished. More than two fifths of the girls from 
Mahotari and Udaypur mentioned that the newborn baby may have low birth 
weight. Two fifths of the girls from Udaypur (41%) stated that the chances of 
physical development needed in an infant may be low due to various reasons 
such as lack of breast milk, low birth weight etc. The other risk mentioned were 
risk of pre-term birth, the new born may not receive enough care from the 
parents, may be physically challenged etc. (Table 4.4)
45
Table 4.4 Percentage distribution of respondent according to their knowledge about the 
risk to mother and new born if OBSI is not practiced: Mid-term survey 
 Baglung Mahotari Udayapur Total 
Potential risk to mother 
Possibility of maternal death 73.2 83.8 85.1 81.1 
Mentally tensed and physically weak 67.6 61.6 59.5 62.7 
Possibility of infection of uterine lining after delivery 5.6 33.3 55.4 32.0 
Problems in the uterus/uterus cancer 1.4 15.2 6.8 8.6 
Excess bleeding 5.6 8.1 8.1 7.4 
Anemia - 7.1 4.1 4.1 
Risk of premature rupture of membrane (breaking of 
the waters 
2.8 2.0 6.8 3.7 
Risk of uterus prolapse 4.2 5.1 1.4 3.7 
Possibility of miscarriage 1.4 2.0 4.1 2.5 
Others* 1.4 2.0 6.8 3.3 
Don't know 1.4 - - 0.4 
Risk to new born 
The new born child may not get enough breast milk 
and will not have immunity power and likely to be 
malnourished 
54.9 19.2 78.4 47.5 
Possibility of low birth weight baby 14.1 43.4 48.6 36.5 
Will not be able to get sufficient breast milk 31.0 34.3 17.6 28.3 
Chances of lack of physical development needed in 
an infant 
28.2 11.1 40.5 25.0 
Risk of pre-term birth 11.3 46.5 4.1 23.4 
Weak/ill 18.3 27.3 20.3 22.5 
May die 2.8 23.2 18.9 16.0 
The new born will not get enough care and love from 
mother 
25.4 9.1 - 11.1 
Can be born physically disabled (lulo langado) 1.4 17.2 8.1 9.8 
Malnourished - 17.2 - 7.0 
Don't know 1.4 - - .4 
N 71 99 74 244 
*Possibility of bleeding during the third trimester period (7-9months), White discharge, Difficulty 
during delivery, Breast cancer, and Weak eyes.
Percentage total may exceed 100 due to multiple responses 
4.5 Perceived Age at Which Women Should Not be Getting Pregnant 
Table 4.5 shows the perceived age at which women should not be getting 
pregnant anymore. The majority of the MTE respondents were aware that 
women should stop childbearing at the age of 35 years and after. Those who 
specifically pointed out 35 years as the cut off age increased from 23% in the 
baseline to 34% in the MTE while those citing more than 35 to 45 years decrease 
from 46% to 25%. The proportion of those citing 45 years and over as the age to 
stop childbearing has increased marginally from 12% in the baseline to 15% in 
the MTE. This increase is more conspicuous in Mahottari district (10% to 18%) 
(Table 4.5). 
46
Table 4.5 Percentage distribution of respondents by their perceived age that women 
should not be getting pregnant: Baseline and mid-term survey 
 At what age should a Baglung Mahottari Udaypur Total 
woman not be 
getting pregnant? 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
30-34 years 8.0 8.1 15.6 17.0 20.8 9.3 14.8 12.0 
35 years 36.8 48.6 27.9 32.0 5.6 21.3 23.4 33.7 
>35-45 years 45.6 10.8 34.4 24.0 58.4 40.0 46.2 24.9 
After 45 years 8.8 13.5 9.9 18.0 12.0 12.0 10.2 14.9 
Other ages - 19.0 - 9.0 - 14.7 - 13.7 
Don't know 0.8 - 12.3 - 3.2 2.7 5.4 0.8 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 122 100 125 75 372 249 
4.6 Perceived Birth Interval 
The adolescent girls were asked about their perception on the ideal birth interval 
that a woman should adopt before giving birth again. Two third of the girls in 
Udaypur (64%) and one-third of the girls in Baglung (37%) stated that a woman 
should wait for 3-5 years before giving birth again. The proportion of respondents 
in Mahottari citing 3-5 years is very low; 8% only. Nearly two fifths of the girls in 
Baglung (39%) and Mahottari (40%), mentioned that a woman should wait for at 
least 5 years before giving birth again. Two fifth of the girls in Mahottari also 
mentioned that a woman should 2-4 years before giving birth again (40%). None 
of the MTE respondents in Baglung and very few in Mahottari (3%) and Udaypur 
(5%) cited less than I year to 4 years as birth intervals (Table 4.6). 
Table 4.6 Percentage distribution of adolescent respondents perception of birth interval: 
Baseline and mid-term survey 
How long do you think it is Baglung Mahottari Udaypur Total 
best for a woman to wait after 
giving birth to give birth 
again? 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Less than 1 year 0.8 - 0.8 - - - 0.5 - 
1-less than 2 years 3.2 - 6.6 - 2.4 1.3 4.0 0.4 
less than 4 years 19.2 - 13.9 3.0 18.4 4.0 17.2 2.4 
3-5 years - 36.5 - 8.0 - 64.0 - 33.3 
4years and above 74.4 2.7 77.0 5.0 77.6 - 76.3 2.8 
5 years - 39.2 - 40.0 - 20.0 - 33.7 
2-4 years - 18.9 - 40.0 - 9.3 - 24.5 
2.5 years - 2.7 - 4.0 - - - 2.4 
Doesn't matter 0.8 - - - 0.8 - 0.5 - 
Don't know 1.6 - 1.6 - 0.8 1.3 1.3 0.4 
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 
N 125 74 122 100 125 75 372 249 
47
78
95
20
96 90 95
63
95
0
20
40
60
80
100
Baglung Mahottari Udaypur Total
Baseline
Mid-term
4.7 Perception of Men's Involvement in OBSI 
The perception that men should be involved in OBSI has increased significantly 
in the MTE. At the time of the baseline survey, only about a fifth of the adolescent 
girls in Mahottari (20%) opined that men should be involved in OBSI. The 
baseline figures for the remaining two districts (Udaypur = 90% and Baglung = 
78%) were already high. In the present MTE, this knowledge became nearly 
universal in all the three project districts (95-96%) (Figure 4.b). 
Figure 4.b Percentage distribution of adolescent respondents according to their 
perception that men should be involved in OBSI 
Various reasons were cited for the importance of men’s involvement in OBSI. 
The commonly mentioned reason in all the three districts was that birth spacing 
is a concern of both the husband and wife (76%). One fourth of the girls also 
mentioned that since men are the heads of the family, they should be involved in 
birth spacing (25%). At the district level, the proportion of those saying so was 
higher in Mahottari (42%) than the other two districts. Other reasons were: 'men 
decide the number of children they want' and men also choose the method hence 
they should be involved in OBSI' (Table 4.7) 
48
Table 4.7 Percentage distribution of adolescent respondents according to their 
perception about male involvement in OBSI: Baseline and mid-term survey 
Why do you think men Baglung Mahottari Udaypur Total 
should be involved in 
OBSI?
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
BS is common issues for 
both partners (wife and 
husband) 
64.9 80.0 62.5 63.5 47.8 88.7 56.4 75.9 
Men are the head of the 
family 
16.5 7.1 8.3 41.7 12.4 21.1 13.7 25.3 
Men decide the number of 
children they want 
13.4 2.9 12.5 20.8 6.2 21.1 9.8 15.6 
Men decide to choose a BS 
method they want 
5.2 8.6 12.5 2.1 4.4 9.9 5.6 6.3 
It is the responsibility of the 
father to decide about next 
child 
- 2.9 - - - 1.4 - 1.3 
Others* - - - 5.2 - - - 2.1 
Don't know 16.5 12.9 20.8 5.2 32.7 4.2 24.8 7.2 
N 97 70 24 96 113 71 234 237 
*Women will be able to take care of her health, Men decide to choose a family planning method 
they want.
Percentages total exceed100 due to multiple responses
4.8 Perceived Ways in Which Men Could be Involved in OBSI 
Perception on ways that men could be involved in OBSI was solicited from the 
adolescent girls. Close to half of the girls stated that men can participate in OBS 
counseling with his spouse while accessing OBS services (46%). Some of them 
also mentioned that man could use FP method instead of his wife (25%). Other 
respondents stressed that men should be focused while implementing programs 
relating to OBSI. The proportion of those who mentioned that they don’t know 
has decreased sharply from 49% in the baseline to 16% in the MTE. 
49
Table 4.8 Percentage distribution of adolescent respondents according to their 
perceived ways in which men can be involved in OBSI: Baseline and mid-term 
survey 
 How could the men be Baglung Mahottari Udaypur Total 
involved in OBSI? Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Baseline Mid￾term 
Participate in OBS 
counselling with his partners 
while accessing OBS services 
35.1 38.6 45.8 50.0 34.5 46.5 35.9 45.6 
Provide support to his partner 
to continue to use FP 
13.4 2.9 4.2 11.5 6.2 9.9 9.0 8.4 
The male partner can use FP 
method instead of his partner 
18.6 61.4 12.5 14.6 3.5 4.2 10.7 25.3 
Wife can suggest her 
husband about Birth Spacing 
1.0 1.4 8.3 10.4 - 19.7 1.3 10.5 
Implement programs relating 
to OBSI in the community 
such as training, street 
drama, workshop, make 
health related man group and 
group discussion 
- 1.4 - 21.9 - 15.5 - 13.9 
Involve men in all the 
programs that women are 
also involved 
- - - 14.6 - - - 5.9 
Others* - 1.4 4.2 2.1 - 5.6 0.4 3.0 
Don't know 41.2 17.8 33.3 8.3 58.4 23.9 48.7 15.6 
N 97 24 113 234 
*Take men to the health provider so that they can be told about OBSI, Conduct OBSI classes like 
the AG classes, The health workers should visit door to door and give information about OBSI, 
Provide counseling about Birth Spacing after gathering men in the community 
Percentages total exceed100 due to multiple responses 
50
Chapter 5 
SUMMARY AND CONCLUSIONS 
The purpose of the mid-term evaluation (MTE) was to measure the mid-term 
achievements of the CATALYST project on birth spacing and family planning in 
the intervention districts of the BuD for RH Project among in-school girls currently 
studying in grades IX and X. The study covered 249 girls of eleven schools from 
10 VDCs of Baglung, Mahottari and Udaypur districts. Only a third of these 
students had been interviewed previously in the baseline survey. 
No significant difference in age composition of respondents between the baseline 
and MTE sample is observed in Udaypur while in the remaining two districts, the 
representation of 15-19 years old in-school girls was high. Similarly, variation in 
the ethnic composition of the respondents is observed in Baglung and to some 
extent in Mahottari when compared to the corresponding baseline ethnic 
composition. Further analysis is required to analyse the influence of these two 
factors (age and ethnicity) on the RH knowledge and perception of the 
respondents. 
 
The MTE study showed that adolescent in-school girls' awareness about the 
types of physical changes occurring among girls and the correct knowledge 
regarding why menstruation occur in girls have increased sharply in all the three 
districts. It was encouraging to find the impact of the project on adolescent girls' 
good personal hygiene being taken during menstruation such as taking bath 
daily, changing cloth daily and drying undergarments under the sunlight. 
Mothers continue to be the main source of information regarding menstruation for 
the adolescent girls. However, the MTE showed that there has a remarkable 
increase among the girls receiving information regarding menstruation. 
Adolescent girls' knowledge about the right age at marriage for a girl (20 years) 
and ways to get pregnant or to avoid getting pregnancy were also significantly 
high in the MTE as compared to the baseline figures. Likewise a steady increase 
in knowledge on harmful practices for a pregnant woman was also observed 
among the girls in all the districts. 
The proportion of those who stated that doctor, trained TBA and nurse are the 
appropriate persons to assist delivery increased in the mid-term survey. In the 
case of their own delivery, a considerable proportion of adolescent girls would 
also rely on their family member. It was evident from the MTE that some of the 
adolescent girls did not differentiate between trained TBA and traditional birth 
attendant. However, no probing was done, in the survey to ascertain whether or 
51
not they meant trained TBA (Talimprapta Sudeni) whenever they cited an 
appropriate person for assisting births. 
In-school girls' knowledge about various FP methods was already very high at 
the time of the baseline survey. In the MTE, the percentages increased further in 
all the districts. The mean number of method the girls were aware about 
increased from 6.1 to 8.3 which s noteworthy. Knowledge about oral pills, 
condom, Depo provera, male sterilization and female sterilization was nearly 
universal among the girl students. Sharp increase in awareness of other methods 
of contraception was also evident in the MTE. It was further encouraging to find 
girls in the in-school adolescent group shared information regarding 
contraceptive methods among themselves. 
Awareness about OBSI has increased significantly in all the three program 
districts. As compared to the baseline respondents, the MTE respondents related 
OBSI more with the spacing time between one child and another for at least 3-5 
years. It was further encouraging to find that the main sources of information for 
the girls happened to be the adolescent girls' group and the special adolescent 
classes conducted for the group on "chose a future". Most of the MTE 
respondents are convinced that OBSI benefits the mother, her new born, the 
father and the family members. The proportion of those who were ignorant about 
the benefits of practicing OBSI decreased in MTE. 
The knowledge about the importance of male involvement in OBSI was already 
very high among the adolescent girls in Udaypur and Baglung but low in 
Mahottari district. The MTE showed a dramatic increase in knowledge among the 
in-school girls of Mahottari also. Perceptions on ways that every man could be 
involved in OBSI by participating in OBS counseling along with his wife and by 
adopting FP method himself were also commendable. 
The above evidences show that the project has been effective to a large extent in 
enhancing RH knowledge among the rural in-school girls. 
References 
CBS, 2001. Population Monograph of Nepal. Central Bureau of Statistics, 
Kathmandu. 
ICRSC, 2002. District Demographic Profile of Nepal. Informal Sector Research 
& Study Centre, Kathmandu. 
Ministry of Health [Nepal], New Era, and ORC Macro, 2002. Nepal Demographic 
and Health Survey 2001. Calverton, Maryland, USA: Family Health 
Division, Ministry of Health; New Era and ORC Macro. 
WHO, 1993. The Health of Young People: A challenge and a promise, World 
Health Organization, Geneva, 1993