BackgroundIn Nepal, evidence is sparse regarding the use of contraception at first and current relationships among sexually active young people. This study examined the factors associated with modern contraceptive use at first and current sexual relationships.MethodsA descriptive cross-sectional household survey conducted amongst young Nepalese men and women living in the urban areas of the Kathmandu valley. We used logistic regression to model the relationship between selected independent variables and outcome variables (use at first sexual intercourse and current use of modern contraception) among 492 ever sexually active youth aged 15–24 years.ResultsWe found that the key factors associated with current non-use of modern contraceptives among sexually active youth age 15–24 were young age at first sexual contact and a relationship with someone other than a spouse, while significant factor associated with current use of contraception was religion, revealing that Hindu youths having lower odds of use compared to young people who belonged to other religions.ConclusionsThe findings suggest that contraception education should be intensified and directly towards those entering adolescence to encourage youths to adopt contraception at the time of their first sexual relationship. The influence of religion on use of modern contraception needs further exploration.

•Less than a third of youth aged 15-24 had knowledge of the most fertile period and under a half of the possibility of pregnancy at first intercourse.• Women were less likely than men to have used any contraceptive at their first sexual encounter.• Fewer than one in ten young people had knowledge about the most common STI, Chlamydia.• Feelings of shame are the major barrier to accessing sexual and reproductive health services. AbstractObjective Youth have the right to utilise sexual and reproductive health (SRH) services and information to protect themselves from negative SRH outcomes. This study aimed to assess knowledge, experience and use of SRH services amongst youth living in urban areas of the Kathmandu Valley. MethodsWe conducted a two stage cluster sampling cross-sectional household survey of young men and women aged 15-24 living in the Kathmandu Valley using a structured questionnaire. ResultsAmongst the 680 young men and 720 young women participants, less than two-thirds had knowledge about the fertile period and less than a half about pregnancy risk at first sex. Over three quarters of young men and women had knowledge of condoms, and pills but less than half knew about implants or intrauterine devices. Age at first sex was similar for men and women but women were significantly less likely to have participated willingly in their first sexual encounter and were less likely to have used any contraception (for both p < 0.001). Almost all men and women (97.9%) had heard of sexually transmitted infections (STIs) but only 8% had heard about the most common STI, Chlamydia. Over 90% of youth reported feelings of shame as the major barrier to accessing SRH services. ConclusionsGaps exist between youth SRH knowledge and practices which leave them vulnerable to sexual ill health. This may indicate a lack of confidence in SRH services but also likely reflects the cultural and religious environment that hampers open expression of sexual and reproductive issues, particularly for young women.

Kisika F. Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania. PLoS One 2014; 9: e113995. 5Fogliati P, Straneo M, Brogi C, et al. How can childbirth care for the rural poor be improved? A contribution from spatial modelling in rural Tanzania.

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