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Program for the Special Needs of Young Married Clients

Up to three out of five adolescent women aged 15–19 years in South Asia and Sub-Saharan Africa are married. Marriage commonly marks the point in a woman’s life when childbearing becomes socially acceptable, and in some cultures, women face extreme pressure to demonstrate their fertility soon after marriage. Unfortunately, pregnancy among adolescents involves heightened risks. At the same time, health care during first pregnancies often ranks low among a family’s priorities. Delaying marriage and early pregnancy could reduce maternal morbidity and mortality, increase child survival, and extend adolescent girls’ education, personal development, and employment opportunities. However, social norms and limited access to reproductive health (RH) and family planning (FP) information and services perpetuate the social and physical vulnerability of married young women.

In partnership with CARE Nepal, ACQUIRE implemented the Nepal Reproductive Health Married Adolescent Couples’ Project (RHMACP), a two-year project to test approaches and tools for improving RH outcomes for this population. ACQUIRE utilized an ecological model, recognizing that interventions are needed at multiple levels—the individual, community, health system and policy levels—to bring about behavior change for married adolescents. The RHMACP established a peer education network to disseminate RH information to married couples, supported local health facilities to provide youth-friendly services, and fostered an enabling environment among parents, in-laws, and influential community members to increase married adolescents’ access to and use of health services. A cadre of highly motivated and influential youth leaders and peer educators from each participating village engaged their communities and accessed government funds to complete health infrastructure projects at the village level. RHMACP also encouraged debate on social and gender norms that impact adolescent health and personal development, including early marriage, the dowry system, and compulsory education for all children. The positive impact of this project on individual young married clients and their communities and the level of support it garnered from all political parties in one of the most culturally conservative areas of Nepal make it a model worthy of applying and scaling up elsewhere.

This section of the archive contains reports on the process and results of the RHMACP, including research about early marriage, family planning, childbearing, HIV awareness, and antenatal care. You will also find curricula for training peer educators to conduct their community work and for training health care providers to set up youth-friendly services for married couples. This section is rounded out with briefs, presentations, and stories from the field that reflect the transformative nature of the RHMACP interventions, as young people seized opportunities offered by the project to make positive changes in their lives and in their communities.