Date of Award

2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Anne M. Teitelman

Second Advisor

Connie M. Ulrich

Abstract

Compared to other South Asian Association for Regional Cooperation (SAARC) countries, Nepal has a higher maternal mortality ratio, a lower rate of skilled attendance at birth, and the highest adolescent birth rate amongst all SAARC countries. Deaths during pregnancy are particularly evident in rural Nepal, where women have significantly lower rates of skilled attendance at delivery and a lower caesarean section delivery rate than women who live in urban areas. There is also a need for more research on the sexual and reproductive health of unmarried young people in Nepal due to changing sociocultural norms surrounding relationships. This dissertation research first conducted an integrated review of the literature on the use of sexual health services by unmarried adolescents and young adults (ages 15 to 24) in the SAARC region (Chapter Two). Chapter Two highlighted the need to research the sexual health services that adolescents and young adults are most in need of and how to deliver these services. Next, two primary studies were conducted in Nepal (Chapters Three and Four): 1) a cross-sectional quantitative study which explored correlates of intended and actual sexual health service use for unmarried young adults (ages 18 to 25) in Kathmandu, Nepal (n=203); and 2) a qualitative descriptive study that examined the maternal care seeking experiences of women (ages 18 to 30) in Ramechhap District, Nepal (n=20). In Chapter Three, higher perceived youth friendliness of the health system (OR, 1.11; CI, 1.01 – 1.23; p < 0.05), a history of unwanted sexual contact (OR, 2.28: CI, 1.21 – 4.29; p < 0.05), and prior alcohol consumption (OR, 2.09; CI, 1.04 – 4.18; p < 0.05) were statistically significant predictors of intended sexual health service use. Participants in Chapter Four faced barriers to maternal care which included clinic distance, lack of family support, and cost of care. The three papers are followed by a discussion of the significance and ethical implications of key findings (Chapter Five). This dissertation research will help to inform future SRH work in Nepal and potentially the development of innovative nurse driven solutions that aim to improve SRH care.

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