COVID-19 disrupted adolescents' sexual and reproductive health information and service pathways in Nepal through interconnected environmental, social, and individual factors, requiring an ecosystem approach addressing all three levels to maintain continuity of SRHR care during public health emergencies.
Key Findings
Results
School closures during COVID-19 reduced adolescents' access to school-based SRH information and opportunities to interact with teachers and peers.
School closures were identified as a key environmental disruption to SRH information pathways
Loss of peer interaction and teacher contact were specifically noted as consequences of school closures
This finding emerged from thematic analysis of data collected from 64 adolescents aged 15-19 years and 22 service providers
Study was conducted in Sindhupalchowk district, Nepal
Results
Interruptions in health service delivery during the pandemic compromised adolescents' pathways to SRH information and services.
Service delivery disruptions were identified as a distinct environmental factor affecting SRH care pathways
Both adolescents and health care providers reported on these disruptions
22 key informant interviews with service providers contributed to this finding
The disruption operated through interconnected environmental, social, and individual factors
Results
Adolescents reported changes in sexual behaviours and mental health effects during the COVID-19 pandemic.
Changes in sexual behaviours were reported by adolescent participants aged 15-19 years
Mental health effects were identified as an individual-level consequence of the pandemic
These findings emerged from six focus group discussions and 12 in-depth interviews with 64 adolescents
Social cognitive theory was used as the analytical framework to interpret individual, social, and environmental influences
Results
Female Community Health Volunteers (FCHVs) were identified as important community-based actors for maintaining adolescent SRH care during emergencies.
FCHVs were highlighted as a key component of community-based SRHR approaches during public health crises
Their role was seen as complementary to accessible, confidential, and adolescent-responsive clinical services
Strengthening local actors and volunteers was identified as a priority intervention
The study used a participatory approach with active engagement from community actors throughout the research process
Results
Virtual child club programmes, digital information platforms, and psychosocial services were identified as recommended strategies to strengthen adolescent SRH pathways during crises.
Virtual child club programmes were recommended for self-help and social interaction
Digital information and psychosocial services were identified as key components of crisis-responsive SRH care
Provider capacity strengthening and coordinated interventions among stakeholders were also prioritised
These recommendations emerged from thematic analysis involving 86 total participants including adolescents and service providers
Results
Adolescents' SRH needs during public health emergencies extend beyond clinical services to include emotional, social, and trusted support.
The study identified opportunities for emotional and social support as distinct needs separate from clinical SRH services
Trusted support was specifically mentioned as a component of adolescent SRH need
An ecosystem approach addressing individual, social, and environmental factors together was recommended
Strengthening adolescents' self-efficacy and conducive social environments were highlighted as key enablers
Methods
The study used social cognitive theory as an analytical framework to explore individual, social, and environmental influences on adolescent SRH pathways during COVID-19.
A qualitative methods design was employed with thematic analysis
Total of 86 participants: 64 adolescents aged 15-19 years and 22 service providers
Data collection included six focus group discussions, 12 in-depth interviews, and 22 key informant interviews
Study was conducted in Sindhupalchowk district, Nepal under a larger project on SRHR of adolescents and women
A participatory approach was adopted through active engagement with adolescents, community actors, health service providers, and local stakeholders
What This Means
This research examined how the COVID-19 pandemic affected young people's ability to access sexual and reproductive health (SRH) information and services in Nepal, specifically in Sindhupalchowk district. Researchers interviewed and held group discussions with 64 adolescents aged 15 to 19 and 22 health care providers, asking them about what changed during the pandemic and what would have helped. The study found that the pandemic disrupted access to SRH care through multiple overlapping pathways: schools closed, cutting off a major source of health information and peer support; health services were interrupted; and young people reported changes in their sexual behaviors and mental health as a result.
The research highlights that adolescents' health needs during crises go beyond just receiving medical care — they also need emotional support, trusted relationships, and social connection. Community health workers known as Female Community Health Volunteers (FCHVs) were seen as especially important in filling gaps when formal services were unavailable. Virtual programs, digital health information, and psychosocial support were identified as promising ways to keep young people connected to care during emergencies. Building young people's confidence in managing their own health (self-efficacy) and creating supportive social environments were also seen as critical.
This research suggests that maintaining adolescent reproductive health care during public health emergencies requires a coordinated, community-wide approach that addresses social and emotional needs alongside physical health needs. Relying solely on clinical services is not enough — communities, schools, volunteers, and digital platforms all need to work together to ensure young people can still access the information and support they need when normal services are disrupted.
Thapa S, Bucha B, Shrestha S, Dhital R, Dixit K, Rawal L, et al.. (2026). Qualitative Exploration of Need for Adolescent Sexual and Reproductive Health Care and Service Pathways Readiness During Pandemic in Nepal.. Health expectations : an international journal of public participation in health care and health policy. https://doi.org/10.1111/hex.70931