Nepal’s Hidden Reproductive Crisis: Caught Between Too Soon and Too Late

 As a Public Health Officer who has worked from the remote hills of Karnali to the busy clinics of Kathmandu, I’ve seen a side of women’s health that few talk about — a quiet crisis affecting the reproductive lives of countless women and girls across Nepal.

This crisis doesn’t look the same everywhere. In some places, girls become mothers far too early. In others, women struggle to conceive when they’re ready. But the pain is real in both cases.

Adolescent Pregnancy and Early Motherhood

I’ve sat with 15-year-old girls who had no idea what pregnancy even meant. Many ran away from violence or poverty and ended up pregnant, abandoned, and ashamed. According to the 2022 Nepal Demographic and Health Survey, adolescent pregnancies have decreased to 14% — a step forward. Still, 21% of girls aged 15–19 are married, and child marriage continues to fuel early and often unwanted motherhood. For many of these girls, becoming a mother wasn’t a choice — it was just what happened.

Infertility and the Pain of Waiting

At the other end, in city fertility clinics, I’ve met educated, hardworking 35-year-old women spending huge amounts of money on IVF treatments — each attempt emotionally and financially exhausting. Infertility is rarely talked about in Nepal, but globally, it affects 1 in 6 adults. Nepal likely faces a similar issue, though we still lack national data.

What Do These Women Have in Common?

Blame. Silence. And always — it’s the woman who is blamed.

Too young? She’s irresponsible.

Too old? She’s selfish.

Too many children? Careless.

No children? Incomplete.

We talk about women’s empowerment — but how can we call it empowerment when young girls aren't properly educated about their bodies, and hopeful mothers are left unsupported? The silence isn’t just cultural — it’s built into the system.

Promises on Paper, Problems in Reality

Nepal’s Constitution recognizes reproductive health as a fundamental right. Child marriage is illegal. Abortion has been legal since 2002 and is further protected by the 2018 Right to Safe Motherhood and Reproductive Health Act. The National Health Policy 2019 promotes equality and quality. Over 1,200 Adolescent-Friendly Health Service (AFHS) sites exist.

But in practice, many of these services are under-resourced, inconsistent, and lack the empathy women and girls deserve.

Nepal has made progress — maternal deaths have dropped, family planning has expanded, and teen health services have grown. But serious gaps remain.

Teen pregnancy is still too common. Infertility is barely on the radar. Public infertility services are limited to a few big hospitals, often unaffordable, and not included in the government’s basic health care package. There are no national guidelines, no mental health support, and no standard care.

Even youth-friendly health services often fail to deliver. Many are poorly funded, with staff who aren’t trained to deal with complex or sensitive issues. Girls come in seeking help and leave feeling judged, ashamed, or ignored.

Two Opposite Problems, One Root Cause

If public health talks about a “triple burden of disease,” then this is our double burden of reproductive injustice: girls pushed into motherhood too early, and women shamed for wanting it too late.

So who’s to blame?

The girl who married at 16 after leaving school in Grade 5?

The woman who believed in education and waited, only to be told she waited too long?

Neither.

We must hold the system accountable. It’s time to build a reproductive health system that reflects the real lives of Nepali women — not just the polished words in policy papers.

We need:

Infertility services integrated into public healthcare

Affordable and accessible fertility treatment, not just in big cities

Clear national standards and emotional support for those facing infertility

Truly respectful, stigma-free, and youth-friendly care

A system that listens to women — at every age and at every stage of their reproductive journey

Until that happens, women and girls in Nepal will remain stuck — caught between “too early” and “too late,” silenced by shame and let down by the very institutions meant to help them.

This is not just a “private issue.” This is a national emergency. And it’s already here.