Promoting sexual and reproductive health in development and governance priorities for youth in Nepal: a qualitative exploration using reproductive justice framework.

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Learn more: PMC Disclaimer | PMC Copyright Notice Health Promot Int . 2026 May 29;41(3):daag070. doi: 10.1093/heapro/daag070 Promoting sexual and reproductive health in development and governance priorities for youth in Nepal: a qualitative exploration using reproductive justice framework Pabitra Neupane 1, ✉ , Pari Adhikari 2 , Barsha Luitel 3 , Lirisha Tuladhar 4, 5 , Pratistha Dhakal 6 , Amit Timilsina 7 Author information Article notes Copyright and License information 1 Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal 2 Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal 3 Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal 4 Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal 5 Department of Social Work, University of Kentucky, Lexington, KY 40506, United States 6 School of Medical Sciences, Kathmandu University, Dhulikhel, Kavrepalanchowk 45200, Nepal 7 Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal ✉ Corresponding author: Pabitra Neupane, Program Development and Advisory Unit, Research and Community Development Center, Budhanilkantha, Kathmandu 44600, Bagmati Province, Nepal. E-mail: neupanepavitra@gmail.com Roles Pabitra Neupane : Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Writing - original draft, Writing - review & editing Pari Adhikari : Data curation, Formal analysis, Validation, Visualization, Writing - original draft, Writing - review & editing Barsha Luitel : Conceptualization, Data curation, Investigation, Writing - original draft, Writing - review & editing Lirisha Tuladhar : Conceptualization, Data curation, Investigation, Writing - original draft, Writing - review & editing Pratistha Dhakal : Conceptualization, Data curation, Investigation, Writing - original draft, Writing - review & editing Amit Timilsina : Conceptualization, Formal analysis, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing Collection date 2026 Jun. © The Author(s) 2026. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. PMC Copyright notice PMCID: PMC13221700  PMID: 42216836 Abstract This qualitative study explores the perceptions of promoting sexual and reproductive health (SRH) as a priority in development and governance among youth in Nepal. Despite progressive national frameworks supporting gender equality and SRH, the SRH indicators and ground reality suggest a pressing need for improved commitment to ensuring safe and quality SRH services. Using a reproductive justice lens, the study engaged 105 diverse participants including youth leaders, former youth leaders, donors, and local government officials through in-depth interviews, key informant interviews, and focus group discussions conducted across all seven provinces of Nepal. While youth-led initiatives demonstrate promising efforts in policy advocacy, and digital engagement, they often encounter systemic and institutional hurdles like tokenism, policy exclusion, limited funding; and socio-cultural barriers such as deep-seated social stigma, and lack of inclusive programming. These barriers disproportionately impact marginalized groups, including sexual and gender minorities, persons with disabilities, and Dalit and Madheshi communities. To enable real progress in promoting SRH, this study identified a shift away from existing top-down approaches towards localized and decentralized strategies fostering youth agency, co-creation, and co-ownership of programs along with local governments, mainstreaming gender, and decentralizing resources and power for effective SRH promotion strategies. Keywords: gender justice, sexual and reproductive health, youth leadership, intersectionality, health promotion, reproductive justice Contribution for Health Promotion. Using reproductive justice framework, this paper contributes to broaden the health promotion of sexual and reproductive health (SRH) beyond five key components using the lens of intersectionality, analysis of power dynamics, and centering marginalized communities. Highlights effectiveness of youth-led advocacy, digital innovations, youth agency, and inclusive programming for ensuring meaningful participation in SRH health promotion. Emphasizes structural inequalities; systemic, socio-cultural, and institutional barriers including tokenism, stigma, and exclusion that limit equitable youth participation. Identifies youth agency, co-creation, strategic partnerships, and decentralized programs as essential for promoting sustainable and efficient SRH health promotion programs. Provides actionable insights for change including calling for policy and curriculum reforms, and increased funding that reorients SRH services toward prevention and meaningful inclusive community participation. Introduction The Constitution of Nepal guarantees access to safe motherhood and reproductive health services for women and girls in Nepal ( Government of Nepal 2015 ). This commitment has been further solidified in the National Youth Policy 2015, the Safe Motherhood and Reproductive Health Act 2018, and the National Health Policy 2019 ( MOYS 2015 ; Nepal Law Comission 2018 ; MOHP 2019b ). These constitutional right is translated into action through a robust framework of policies and strategies, including the Gender Equality and Social Inclusion (GESI) Policy, and the Adolescent Health and Development Strategy to name few key policy documents ( MOHP 2019a ; Nepal Law Comission 2018 ). To operationalize these policies, the Government of Nepal has rolled out a wide range of initiatives, from implementing safe motherhood program, family planning and reproductive health program, and school health nurse program; to formulating a comprehensive sexual and reproductive health education, national health insurance coverage, and provision of primary health care; to focusing on gender-specific strategies such as gender-based violence prevention and response program, gender responsive budgeting, and provision of menstrual pad at schools, to name a few ( Government of Nepal 2015 ; Ministry of Health and Population 2022 ). Nepal is currently positioned to benefit from a significant demographic dividend. According to the 2021 census, adolescents (ages 10–19) make up 20% of the population, whereas the youth demographic (ages 16–40) make up 42.5% ( National Statistics Office 2021 ) While the government recognizes the potential of this demographic dividend, specifically the opportunity for high impact age-specific interventions and investment; broader program coverage, and better RH outcome in larger population and geography, Nepal has encountered systemic setbacks that have hindered progress towards improving national sexual and reproductive health (SRH) indicators and achieving Sustainable Development Goals ( Meyer 2019 ; Pant 2024 ). Early marriage (median 18.3 years) and early childbearing (20.6 years) remain persistent challenges, with 14% of adolescents already pregnant ( MOHP 2022 ). These trends contribute to a maternal mortality rate of 151 deaths per 100 000 live births, reflecting gaps in quality and continuity of care. Furthermore, low contraceptive use (14%), and high unmet need for family planning (31%) among adolescents, combined with lack of legal literacy regarding safe abortion, further heighten the health risks for women aged 18–35 ( MOHP 2022 ; Ghimire et al. 2024 ). While around 80% of women now receive four or more antenatal care visits and deliver in health facilities, only about 60% receive timely postnatal care ( MOHP 2022 ). In addition to these realities, the development initiatives in Nepal have observed decline in funding landscape, particularly on promotion of SRH, which threatens to roll back the improved indicators on gender and SRH, and overall well-being of marginalized and vulnerable demographics ( Tamang et al. 2020 ; Maistrellis et al. 2022 ; Mallik et al. 2023 ; Mainali 2024 ). These evidence thus indicate an urgent need for collective efforts across youth organizations, advocacy groups, policymakers, and local governments to promote, protect, and fulfill gender justice and SRH in Nepal ( Acharya 2024 ). Specifically, more evidence, aligned with the Ottawa Charter for Health Promotion, is needed to understand how to translate the national SRH policies into effective subnational programs for better SRH outcomes ( Wilberg et al. 2021 ; Saadati et al. 2022 ). The Ottawa Charter for Health Promotion helps to better understand the systemic structures, and political decisions that impact sexual and reproductive health and rights among the adolescent, youth, vulnerable, and marginalized population and helps to reaffirming health for all. Thus, this study adapts five building blocks of Ottawa Charter, namely building public health policy, re-orienting health services, creating supportive environment, strengthening community actions, and developing personal skills, to establish a comprehensive framework through which to collect and analyze the data to explore and understand ways to promote SRH in development and governance priorities in Nepal ( Fry and Zask 2017 ; Thomas et al. 2025 ). Furthermore, in this study, Reproductive Justice (RJ) framework has also been employed, that bridges the gap between both reproductive rights and social justice principles, identifying how intersecting layers of oppression compromise social justice and human rights of women and marginalized groups ( Ross 2021 ). Specifically the three pillars of RJ framework which is intersectionality (respecting commonality in experience, recognizing layers of systemic inequalities, analyzing interlocking factors of oppression, claiming rights), analyzing power system and structure (understanding concept of power, power dynamics, existing power mechanism, and processes), and centering marginalized communities (inclusiveness of marginalized population, documenting the lived experience of marginalized communities, acknowledge heterogeneity, and diversity) during the conceptualization, tool development, research method, and findings interpretation ( Ross 2021 , Timilsina et al. 2022 ). Thus, based on the needs established so far and employing the aforementioned frameworks, this study aims to understand and explore current practices, knowledge, barriers and enablers to mainstreaming SRH as a national development priority, ensuring that the health promotion in Nepal is inclusive and effective. Materials and methods Study design and setting This study uses nonpositivist ontological and epistemological research paradigm, which helps to generate evidence rooted in individual and social experiences, cultural contexts, and personal beliefs. Based on this, exploratory qualitative research design was adopted to explore the existing knowledge, perceptions, experiences, contexts, and nuanced meanings surrounding SRH in Nepal ( Cresswell 2013 ). The study was conducted in all seven provinces of Nepal and includes participation from all geographical region, including the Mountain, Hill, and Terai belts of Nepal. Participants and sampling Purposive sampling was employed for selecting the wide range of participants for this research to ensure the data captured the diverse and ground realities of youth leadership across Nepal ( Campbell et al. 2020 ). This included the current and former youth leaders from rural and urban areas as well as, representatives from sexual and gender minorities (SGM) communities, persons with disabilities, and Dalit, Madheshi, and Muslim youths. To gain insights into governance and funding realities, we also engaged local government officials and representatives from external development partners supporting gender and SRH efforts in various capacities across Nepal. The study spanned 10 districts across all 7 provinces, strategically selected to represent Nepal's varied geographical and socio-cultural landscape: Sunsari district in Koshi province, Dhanusa district in Madhesh province, Kaski district in Gandaki province, Kapilvastu and Banke districts in Lumbini province, Kathmandu and Lalitpur districts in Bagmati province, Mugu and Surkhet districts in Karnali province, and Kailali district (Sudurpaschim province). Thus, in collaboration with the local SRH and gender-focused organizations, we identified youth leaders who were active members or executives in youth-led organizations, adolescent networks, and traditional community entities like “Guthis.” In total, 105 participants participated in this study. Youth participants aged 18 to 35 and identified as men, women, or SGM. Additionally, there was no age limit for representative from external development partners and local government officials participating in the research. The socio-demographic characteristics of each participant are provided in Table 1 . Table 1. Socio-demographic characteristics of the participants. Socio-demographic characteristics Number Age 18–24 40 25–30 35 31–35 20 36+ 11 Gender Men 46 Women 50 Sexual and gender minorities 10 Ethnicity Brahmin/Chhetri 57 Indigenous 22 Madhesi and Muslim 21 Dalit 10 Disability status People living with disability (PLWD) 11 Provinces Koshi 13 Madhesh 14 Bagmati 14 Gandaki 12 Lumbini 13 Karnali 11 Sudurpaschim 17 Other Past youth leader 7 Representative from donor organization 5 Open in a new tab Data collection Fieldwork for data collection was conducted between December 2024 and March 2025 using a multi-method qualitative approach. Combining in-depth interviews (IDIs), key informant interviews (KIIs) and focus group discussion (FGDs) helped to triangulate individual experiences with broader community and policy perspective ensuring trustworthiness. The semi-structured interview guide developed for this purpose included exploration areas such as existing gender and SRH programs at the community, youth engagement in sexual and reproductive health promotion program, and facilitators and barriers for gender mainstreaming SRH to promote youth's health and well-being. Prior to data collection, experienced research assistants in qualitative data collection were recruited, who underwent rigorous orientation on the objective, research methodology, and research ethics, co-developed and refined the tools. To ensure the data quality, the tools were pretested with 10 participants for the face validity and refined after a pilot with five additional individuals, not included in the final study. Before reaching out to the participants we identified organizations working on the issues of gender, sexual and reproductive health and rights (SRHR), youth empowerment and other issues from different part of the country. We explained them about the study, its objective, and discussed about the criteria of the participants to be selected for the study. After making partners organization clear about the study and criteria for the participants selection, they provided us the list of possible participants and research team contacted the persons provided them and selected the most suitable participant for the study. Then the participants were contacted and explained about the objective of the study. Upon their approval, the interviews were conducted and recorded in the voice recorder. In total, 105 diverse participants were interviewed—38 participants from IDIs, 22 from KIIs and 45 from seven FGDs conducted. All the collected interviews and discussions were transferred to the cloud server from voice recorder to avoid data loss. The IDI took 50 min on average, whereas KII lasted 45 min on average and 1 h for FGD. The research assistant collected field notes, probed the participants adequately, first author and last author had a debrief meeting with the research assistant to ensure data trustworthiness. We prioritized the data saturation process for the study as described by Fusch and Ness (2015) . Data analysis Reflexive thematic analysis, guided by Braun and Clarke, was adopted to analyze and develop themes based on the data ( Clarke and Braun 2017 ). For this, we have ensured methodology congruence with the six phases of reflexive thematic analysis as suggested by Braun and Clarke which includes familiarization with the data, coding the data, generating initial themes, developing and reviewing themes and subthemes, defining and refining themes and subthemes, and presenting the findings. Data collection was done in Nepali language, and then transcribed accordingly. Then the recordings were then translated to English language verbatim ensuring the data is not mistranslated and misinterpreted, and careful cross-checking to prevent any loss of meaning in translation. The research team (P.N., A.T., P.A.) immersed themselves in repeated reading, noting down interesting ideas to get familiarized with the data. After this, transcripts were processed for the coding using Dedoose software, a computer software for qualitative data management. Inductive coding was utilized to generate the initial codes, and aggregate the codes into broader sub-themes and themes based on the shared characteristics. Additionally, latent analysis was conducted to understand the underlying assumptions and meaning of the data for sense making and interpreting the meaning of the data. This collaborative process involved the entire co-author team in developing, reviewing, and refining of the codes, and finalization of codebook, including sub-themes and themes, and their interpretation. In total 104 codes, 7 subthemes, and 3 overarching themes were developed based on the generated data as stated in Table 2 . Rigorous methodology used in this study ensures credibility, transferability, dependability, neutrality, confirmability, and trustworthiness of the data. Table 2. Codebook showcasing codes, subthemes, and themes. Theme Subtheme Codes Perception towards gender equality and Sexual and reproductive health Understanding and discourse on gender mainstreaming GESI policy and its practice Social inclusion policies in youth organizations Policy gaps in recognizing marginalized communities including LGBTIQ + communities Discriminatory policies Lack of gender-inclusive quotas Importance of SRH and gender programs SRH and gender as the current funding need Perception of gender roles Importance of using inclusive gender categories for gender equality Persistent gender gap in the society Understanding of gender justice Equal recognition to nonbinary individuals in achieving gender justice Representation of women and underrepresented groups in leadership Neglect of issues specific to boys Identity challenges among nonbinary individuals Mechanisms for mainstreaming gender Personal, interpersonal and community agency Importance of building agency in advocating for gender issues Importance of building power in comprehensive understanding of SRH. Restrictions on women’s personal freedom Women’s limited agency in decision-making Existing efforts and challenges youth face in promoting SRH Existing gender and SRH program centering diverse youth Positive developments CSE thematic working groups chaired by government Limited funding opportunities available from local government for gender justice and SRH; Gaps in gender justice and SRH mainstreaming efforts from the government Nepotism in allocating funds Tokenistic spaces and mindsets Gender-centric capacity building sessions Status of youth-efforts being gender-friendly Digital platforms and social media as effective mediums in raising awareness on gender and SRH issues Perspective on gender equality and social inclusion Implementing inclusive programs for PwDs, people living with HIV, and other marginalized community Joint efforts through advocacy networks Advocacy programs for nondiscrimination Collaboration with government entities Designing IEC materials on CSE and SRH that are accessible by all Legal efforts for gender issues including same-sex marriage Empowering youths with CSE Conducting women empowerment programs Best practices in designing and implementing inclusive youth-focused programs Barriers in gender mainstreaming and SRH integration Ableism Sexism Casteism Nepotism Favoritism Tokenism Limited access to resources Limited access to information and opportunities Difficulties in making programs and procedures inclusive) Language barriers Geographical barriers Barriers to entry in workforce Lack of gender and disability inclusive services Financial barriers Bureaucratic hurdles Procedural complexities Unstable government affecting coordination and program implementation Lack of understanding and acceptance regarding topics of gender among general public Lack of understanding and acceptance regarding topics of CSE among policy makers Budgetary and policy exclusion for LGBTQIA + rights Lack of gender-mainstreaming in school curriculum Teachers’ hesitance to deliver CSE curriculum. Sensitization in urban versus rural setting Barriers for LGBTQIA + communities in freely expressing themselves Barriers to empowerment and self-decision Lack of gender sensitivity among youths Gender-based discrimination and abuse Biased perception towards working women Prejudice towards youth educators Stigma and taboo associated with SRH Stigma and taboo associated with and gender issues Difficult societal context Lack of organizational preparedness in dealing with intersectionality Lack of organizational preparedness in ensuring inclusion in program design Lack of understanding and internalization about gender issues Lack of conceptual clarity on gender and SRH Focus on short-term project specific funding Mainstreaming justice and equity in SRH policies and programs Strengthening agency and meaningful participation Mining the space for exposure Strengthening capacities Gender friendly policies Making amendments in curriculum to make it gender-friendly Creating supportive environments Empowering marginalized groups Use of digital platforms and internet Funding and investments in young people Funding and investments on teachers, service providers about accessible and inclusive CSE, SRH knowledge and services Promoting open information and knowledge sharing on SRH; changing mentalities Creating psychological support spaces for youth leaders Equal opportunities for all Inclusive participation in all programs Working collaboratively with local government for sustainability Involvement of various stakeholders for ownership Addressing intersectionality Designing programs in alignment with government priorities and programs Engaging with parents, guardians and community gatekeepers to improve CSE implementation Ensuring government accountability Increasing involvement with youth Strengthening alliances and collective action Understanding donor priorities Intersection with other burning issues Decentralizing the focus, power, and access to resources Local adaptation Cultural appropriateness Empowering local governments Empowering local leaders and youths Regional adaptation Decentralization of programs Open in a new tab Ethical considerations The ethical approval for this study was provided by ethical review board of Nepal Health Research Council on 13 November 2024 (Reference number: 919). The research adapted Declaration of Helsinki and core biomedical ethical principles, including nonmaleficence, beneficence, justice, and autonomy. Besides obtaining written informed consent from all participants prior to the interview, participants were also explained about the purpose of the study, right to participate and leave the study, dissemination of the findings of the study, and were ensured about their confidentiality and anonymity in the study. To protect participant identity, all data were pseudonymized, adhering to the General Data Protection Regulation guidelines. Researcher's positionality The authors in this study are from the health, gender and social science background with over a decade of experience in gender and SRH programs. Our careers have been defined by close collaboration with adolescents, youth-led civil society organizations, and all tiers of the Government of Nepal. Thus, the collective background of authors in SRHR and RJ has directly contributed to collective understanding, ideation, methodology, findings, and interpretation of the results of this intersectional study area. The identification of the research gap surrounding the inequity in power and resources, limited youth access in SRH decision-making process, national context that excludes marginalized communities, and limited studies exploring this area has led us to investigate this complex intersectional issue through the lens of RJ framework. To manage the inherent power dynamics of the research process, we employed youth research assistants to conduct interviews with the young participants fostering a space of comfort and relatability. Meanwhile the lead author interviewed representatives from government and civil society organizations acknowledging the professional influence and specific emotional response. By being transparent about our roles, we aimed to remain reflexive about how our own perspectives shaped the interpretation of these intersectional findings as described in the next section. Result The findings of the study interpret the perception of participants towards gender equality and SRH, existing efforts and challenges of youth in promoting SRH and perceived ways to mainstream justice and equity in SRH policies and program. We have categorized these insights into three core themes: first, understanding the participants and discourse on SRH mainstreaming; second, the existing interventions, efforts, and challenges to mainstream the gender equality and SRH program; and third, the pathways to mainstream gender equality and SRH policies and programs as shared by the participants of this study. Perception towards gender equality and sexual and reproductive health This theme explores the participants’ understanding and discourse on SRH mainstreaming, as well as the role of personal, interpersonal and community agency in driving health promotion. Understanding and discourse on gender and sexual and reproductive health mainstreaming Local government representatives shared that they have very limited direct initiatives on SRH, depicting significant gap between policy and practice. Most of the local health programs mainly offer geriatric care like door-to-door initiatives for blood pressure monitoring, blood sugar testing, and anti-drug abuse initiatives. While the participants in this study highlighted limited efforts specifically on sexual and reproductive health, but the SRH and gender issues are not yet a prioritized agendas for the local governments, receiving only indirect or occasional attention. A local government representative shares: We do not have programs on same topics (SRH) but in the same sector, we have allocated lump sum of one lakh (Rs. one hundred thousand) in this year’s budget for children under 18 years. We have already conducted 2–3 programs from that budget related to child rights. −36 years old, male local government representative Furthermore, the participants highlighted how policy exclusion create significant hurdles for marginalized groups in achieving equity. As a result, youth, especially from the LGBTQIA + community, continue having hard time securing employment opportunities as well as obtaining basic identity certification. The Nepalese government has provisions and quota for Dalits, persons with disabilities, and marginalized groups, which helps in uplifting them. However, if the government also had provisions for the LGBTQIA + community, it would help uplift them and enable them to reach similar better positions. −32 years old, trans woman, youth leader Personal, interpersonal and community agency The participants highlighted that leadership in the sphere of health promotion of SRH demands more than positional authority requiring the development of personal agency to make informed, confident decisions and take a firm stance on important issues. To be in a leadership position and work on SRH and gender issues, several skills are crucial. Firstly, building agency is important to confidently make decisions and take a stand on issues. It is also essential to create a supportive environment where youth can freely express themselves. Additionally, exposure to different perspectives and a conducive environment for growth are beneficial. −36 years old, female, past youth leader Similarly, in organizational policy context, some participants discussed various mechanisms ranging from the use of equity principles and creating a safe space for the lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) + community to share their concerns, to ensure proper frameworks of reservations and quota for marginalized groups, that their organization has in place to foster inclusion and participation of women, LGBTQIA + individuals and people with disabilities in all their structures and programs. Few participants also reported implementation of GESI policies within their organization. On the contrary, such mechanisms were missing in the local government and their practices. We have been trying to include marginalized groups who have been recognized by the government, such as Dalits, indigenous people, and LGBTQIA communities. In our general programs, both intentionally and unintentionally, we aim to integrate various communities including the Khasare community as well as individuals with disabilities. We have consciously decided to incorporate GESI and that’s what we are doing. Before we implement any program, we conduct GESI orientations to orient them on incorporating both men and women as mandated.—30 years old, female, donor Existing efforts and challenges youth face in promoting SRH This theme examines the reality of current youth-focused programs, existing interventions efforts and challenges to mainstream the gender equality and SRH program. Existing gender and SRH program centering diverse youth Participants identified some systemic barriers to the success of SRH initiatives, even when such initiatives existed. Major concern reported was the inadequate and inequitable distribution of funding. One participant who expressed that even when the funds were available, they are often allocated based on nepotism rather than merit or need-based. Another participant expressed concerns on the lack of accountability of government towards youth agendas on gender. However, the challenge of inclusive policies is not solely a government failure; it persists within youth organizations as well even in the availability of funds Another issue is that even when funds are provided, there is often a lack of inclusion. This is not only the responsibility of the government or the donors. While there may be inclusion during training sessions, it is not reflected in the governance and mandates of the organizations. It is often limited to the inclusion of women and men, neglecting the inclusion as a whole. This is a significant problem that needs to be addressed.—35 years old, male, past youth leader Majority of the participants working for adolescent and youths highlighted their efforts to design and develop gender and SRH programs which include awareness session, digital health platforms, Comprehensive Sexuality Education, bodily autonomy, adolescent empowerment program. Similarly, some participants also highlighted their efforts in mapping and mobilizing local educational resources to their cultural appropriateness so that they guide youth’s preferred learning pathways rather than impose traditional empowerment techniques. Such arrangements were also made for persons with disabilities through facilitation of content in local languages, sign language interpretation services and braille content. Few other leaders emphasized the importance of leveraging digital platforms such as TikTok, Facebook, and YouTube to engage youth more effectively as well as reach a broader audience, and shares: In an effort to make our resources more accessible, we are localizing our content in languages such as Bhojpuri, Maithali, Awadi, and Rai, which are the most commonly spoken languages in local contexts. We have also provided sign language interpretation services and developed Braille content for those with visual impairments. We do not impose our preferred learning pathways on youth; rather, we encourage them to pursue whatever they are interested in and offer guidance and resources to support their learning.—23 years old, male, youth leader Youth leaders highlighted several key achievements and ongoing efforts with regard to youth-led gender justice programming in Nepal. From radio programs and awareness workshops to development of information, education and communications (IEC) materials, digital advocacy, and formation of youth councils in advocating for gender issues, the majority of youth leaders reported the presence of interventions focused on gender mainstreaming in their organizations and positive changes achieved. Some participants also shared improved legal environment and media representation for the LGBTQIA + community, amendments in youth policies, population policy highlighting the importance of gender and SRH in overall health promotion, due to the continued advocacy efforts from youths. Some newspaper that used to exclude coverage of LGBTIQ issues, has now started featuring stories about this community due to our continued advocacy. […]. Our advocacy efforts have also resulted in a Supreme Court ruling recognizing that discriminating against LGBTIQ individuals based on gender identity is unconstitutional. The Supreme Court has also issued a statement declaring that same-sex marriage should be registered.—23 years old, male youth leader Another youth leader described their organization’s focus on a wide range of topics under gender equality and their efforts at diversifying and sustaining their youth-led efforts. Areas of work for youth leaders working in gender and SRH mostly included comprehensive sexuality education (CSE) strengthening, awareness on menstruation, safe abortion, gender-based violence, peer education, training for health-service providers, policy dialogues with government, and other gender-centric capacity building programs. Many participants also reported inclusivity as a major component at the center of their initiatives. Various mechanisms of equity, reservations and quotas in boards and leadership positions and GESI were used by different youth organizations to ensure inclusion while designing health promotion program in SRH. However, some activists, especially those with marginalized gender and socio-economic identities, found such mechanisms tokenistic and nepotistic. At the organization where I have worked for the last two years, we have been focusing on gender equality and GESI, working to diversify our services. We have addressed topics related to menstruation, from menarche to menopause. For every program, we aim to ensure sustainability by collaborating with local governments even before budget planning. We strive to make the local government prioritize youth and SRH issues, and we advocate for these priorities.—31 years old, female, representatives from funding agency On the contrary, majority of the rural youths reported that such programs on gender justice and SRH did not translate at the local government level. Programs were mostly limited to other health issues and program priorities including drug addiction, vocational training, child health, health camps, and medicine supply among others, with little to no initiatives on gender and SRH. Moreover, majority of the leaders in the local governments showed a narrow understanding of SRH issues, viewing them as primarily female health problems or gynaecological concerns. We have a Primary Health Service Centre that is located near us. It currently has four staff members. Within the next 6–7 months, we will have our own office. We provide free medicine and health services from there, and we conduct health camps once a month. During these health camps, we provide various services related to female health, gynaecological problems, and ENT.—56 years old, male, local government representative Barriers in mainstreaming gender and SRH program Participants highlighted that discrimination based on gender, along with deep-seated social prejudices regarding the perceived incapability of youth particularly persons with disabilities and those identifying as SGM remains a major barrier to advancing gender equality. The participants highlighted that gender discrimination manifests in unequal treatment of boys and girls, reflecting deep-rooted societal norms perpetuating child marriage, poor menstrual hygiene management, and early abortions persist. In Nepal, there are various challenges related to SRH and gender justice, particularly in remote areas of Karnali and Sudurpaschim. Issues such as child marriage, menstrual hygiene, and early abortion persist. Gender discrimination is also prevalent, with unequal treatment of boys and girls. There is a significant scope for improvement in SRH.—36 years old, female, past youth leader Discrimination and prejudice in Nepal is multi-layered, extending beyond traditional gender inequality and sexism. This encompasses casteism, ableism, ageism, nepotism, and tokenism. Youth participants reported that while they are often included in programs and initiatives, this inclusion is frequently superficial serving more as a symbolic gesture than genuine engagement. Promises of meaningful participation are undermined when youth, particularly those from marginalized backgrounds, are excluded from decision-making and planning processes. Such practices not only perpetuate systemic inequities but also limit the effectiveness of efforts toward achieving true gender equality and social justice. Some of the youth leaders living with disabilities also shared that they are often discriminated and excluded from the opportunities from both government and nongovernment organizations. It is frustrating to continue facing prejudice and misconceptions about the abilities of persons with disabilities when it comes to opportunities.—25 years old, male, youth leader living with disability. Limited accessibility to information on SRH was identified as another barrier to SRH promotion. This barrier begins in classroom with absence of relevant information in school curricula and unavailability of digital devices, as well as limited opportunities and resources due to discrimination faced by youth. For those youth who are ‘far from the mainstream’, this is even more aggravated due to lack of access to digital devices and resources, further isolating them from reliable SRH related information. One participant especially noted how this disparity led youths to rely on misinformation available on the internet. The provision of SRH education for youth is often inadequate, as it is primarily integrated into general health education. This leads to a reliance on misinformation, myths, and unreliable sources such as online search engines. While some youth have access to information through mobile phones and the internet, many others do not, creating disparities in knowledge and awareness.—36 years old, female, past youth leader Financial limitations were recognized as major reason for lack of accessibility to opportunities, resources and information on gender issues and SRH by majority of the participants in this study suggesting the impact of financial constraints affecting advocacy efforts and their effectiveness, continuation of programs that focuses ability to support GBV survivors. Due to a lack of funds, we are unable to support all the GBV survivors, despite the large number who need help. INGOs and donor organizations invest substantial amounts in various sectors; if we could secure just 1% of those funds for the disability sector, we could implement many more programs and have sufficient resources. —35 years old, female, youth leader living with disability. Our discussion with youth leaders identified systemic barriers, bureaucratic hurdles and procedural complexities as the other major barriers for mainstreaming of gender justice and health promoting SRH programs in policy and program. The youth leaders also highlighted low acceptance and understanding regarding the challenges faced by diverse youth contributing to the systemic barriers. Systemic exclusion of LGBTQIA + communities from budgetary allocations for rights and programs was raised by the SGM to have contributed to leaving their rights and programs chronically underfunded. Another participant emphasized the need for integrating LGBTQIA + and disability-related topics into educational curriculum to better support marginalized communities and foster a more inclusive and supportive environment. Even though the government of Nepal has mandated that a budget be allocated for Sexual and Gender Minorities, municipalities often lack awareness of this requirement. As a result, we have been traveling from place to place to provide information and urge them to comply, and we continue to advocate for this issue. —21 years old female, Lesbian, Youth Leader) Most youth leaders reported that their socio-cultural environment was a major barrier to implementation and positive reception of gender mainstreaming activities. The impact of societal norms on gender and SRH issues were reported to particularly affect women, noting that such restrictive attitudes further affect their mental and physical health. Majority of the youth participants in this study expressed how such family and societal constraints not only affected youth beneficiaries but also youth leaders who work on gender and SRH issues, Such barriers were found to be even bigger for marginalized groups, mostly those from LGBTQIA + communities who deal with the additional burden of identity crisis and face discrimination due to their nonbinary identity, including systemic difficulties and challenges in everyday interactions. One of the challenges is the societal context. Early marriage is prevalent, and dating culture or premarital sex is not considered normal in our society. This social norm, to some extent, acts as a deterrent to teenage pregnancy. However, it also restricts youth from exploring their sexual and reproductive health and rights (SRH) freely. This can lead to early and child marriage, and vulnerability for those in relationships. Lack of information on SRH often results in mental and physical problems, particularly affecting women and girls.—36 years old, female, past youth leader Majority of the participants also discussed the stigma surrounding these topics. While one youth leader even reflected on facing resistance from her own family despite advocating for menstrual health and breaking taboos, demonstrating how it is not just beneficiaries but also the youth leaders who encounter societal resistance when addressing sensitive gender and SRH issues, another participant highlighted their personal experience of using strategic approaches and incentives like food to ensure attendance and participation from people in rural areas. Even today, my parents do not allow me to enter the kitchen during my period. While I work on SRH and try to convince people that menstruation is normal and that it is okay to enter the kitchen, I am still unable to convince my own family.—25 years old, female, youth leader Mainstreaming justice and equity in SRH policies and programs This theme describes ways to mainstream gender equality and SRH policies and programs. The following sub-themes each uniquely contribute to the broader narrative discussed in this paper—“creating agency; meaningful participation, co-creation and co-ownership”; and “decentralizing the focus, power and access to resources.” Strengthening agency and meaningful participation Participants reported the importance of building agency, power, and supportive environments to empower youths regarding gender issues and SRH as well as increase inclusion. Building personal agency to confidently make decisions, creating a conducive, supportive environment for youth to express themselves and fostering exposure to diverse perspectives were identified as key skills for effective leadership in SRH and gender. To be in a leadership position and work on SRH and gender issues, several skills are crucial. Firstly, building agency is important to confidently make decisions and take a stand on issues. It is also essential to create a supportive environment where youth can freely express themselves. Additionally, exposure to different perspectives and a conducive environment for growth are beneficial.—36 years old, female, past youth leader As per the participants, tackling systemic barriers and discrimination requires individuals to first acknowledge and address gender discrimination on a deeply personal level. This process involves cultivating the determination to consistently challenge inequities and remaining steadfast in the face of obstacles. As reflected in the participant’s perspective, genuine progress toward gender equality demands an unwavering commitment not abandoning efforts midway but persisting with purpose and conviction to dismantle discriminatory structures and mindsets. To work towards gender equality, one must first acknowledge and confront gender discrimination at a deep, personal level. There needs to be a strong determination to challenge and reduce gender discrimination and a commitment to not give up midway. I believe this is essential. —23 years old, lesbian, female, youth leader Youth leaders emphasized the need for a personal commitment to confronting gender discrimination as a fundamental step towards achieving gender mainstreaming. Participants also identified various significant gaps in establishing a holistic intersectional program framework, including the lack of acknowledgement and internalization of persistent gender discrimination among youth leaders, lack of conceptual clarity on gender and SRH, focus on short-term project-specific funding and activities, fragmentation of efforts and lack of unity, and a lack of organizational preparedness with intersectionality and inclusion. The main concern here is that these organizations themselves may not be adequately prepared in terms of intersectionality and inclusion. They may lack self-commitment to addressing these issues in a disciplined manner. Discrimination can arise when they become ready to address these matters. Some individuals are conscious of this and acknowledge that either they don't have space or lack funding….—35 years old, male, past youth leader Moreover, several measures to overcome barriers and address the mental health challenges specific to SRH and gender activism were proposed. Few participants proposed promoting open information and knowledge-sharing forums and platforms, self-help groups, and support network for strengthened agency. One key measure identified was establishing formal and informal support circles and psychological support systems for youth leaders. I think there should be a support network. When meeting with activists, we often focus solely on the issues at hand. However, it is also important to address emotional and mental health. For instance, negative comments or stressful situations, whether from family or online, can impact our well-being. There should be an environment where these concerns can be addressed, whether through informal support circles or professional help. —28 years old, female, youth leader Youth leaders highlighted the importance of harnessing youth power through collaboration among organizations, avoiding duplicates, and creating platforms for sharing and learning. Participants also emphasized the importance of working with governments to ensure sustainable actions. Working in alignment with donor timelines and priorities especially in the planning phase was identified as both a struggle as well as advantage but also a key measure to secure funding. Government agencies should not be excluded. For addressing youth issues, SRH issues, and gender issues, stakeholder mapping of government bodies is essential. From a sustainability perspective, youth-led organizations alone cannot handle all interventions. Therefore, we need to build a knowledge base at the government level, identifying the necessary elements to be integrated into government mechanisms, making it easier to work with them.—27 years old, female, youth leader Decentralizing the focus, power, and access to resources Participants discussed the need for bottom-up approach to address national, socio-cultural and local needs and contexts in program and activities to address community SRH issues. They emphasized the need to first analyze local conditions and collaborate with donors and local partners to gather relevant information about marginalized groups, ensuring that their participation is meaningful in programs. Additionally, they stressed the involvement of influential community figures, such as religious leaders, local representatives and teachers, to address cultural intersections with the sensitive SRH topics. Flow of information to local leaders and representatives and then subsequently to and through students was reported to be an important factor by the majority of participants to expand programs effectively at the local level. When discussing SRH, it’s important to be culturally sensitive. This is crucial because SRH topics often intersect with customs, religion, and other cultural factors. Influential figures in these areas, such as religious leaders, should be involved and made aware of these issues as well.—27 years old, female, youth leader Majority of IDI participants outside of Kathmandu highlighted that despite Nepal’s commitment to federalism, most projects and funding opportunities remain concentrated in Kathmandu (capital city) while youth organizations outside the capital city continue to be marginalized, limiting both local innovation and equitable health promotion. A 19-year's female youth leader from rural areas shares: I believe that programs should not only be focused on the center (Kathmandu), but they should also be decentralized so that people in other areas, like Dhangadi, can get the same opportunities. I think those who are already working in this field need further assistance from the organizations, and those who are just starting their careers need guidance and mentorship. Organizations can act as a medium to provide such support.—19 years old, female, youth leader Participants from the rural part of the country shared that, grassroot level youth led organizations faced difficulties to access funding from donors as well as government largely due to stringent eligibility criteria that favor well-established groups with extensive financial histories and national and international linkages. When the request for proposal is asked, the eligibility criteria set by donors are very tough to acquire funds. Like they ask for experience of handling crore (ten million Nepalese rupees) of annual portfolio. How many organizations from rural Nepal may meet such criteria? Thus, I think there needs to be more flexible funding where the youth and youth organizations can grow themselves and develop capabilities.—33 years old, male, youth leader Discussion One of the major findings of this study is that the existing patriarchal values, beliefs and practices, and socio-economic inequalities has led to unequal and gendered power dynamics, perpetuating harmful social and gender norms and practices. This tension between patriarchal grip and socio-economic inequalities in Nepal restricts youth agency, with stricter societal limitations compromising the supportive environment required for the implementation of health promotion program in SRH. These findings align with existing studies from low- and middle-income countries that highlight how various socio-economical barriers, ranging from individual to collective to systemic level, dictate how young people perceive and access SRH programs and services ( Maharjan et al. 2019 ; Sidamo et al. 2023 ; Olajubu et al. 2025 ). Low awareness on gender and SRH, and high resistance from family and community members further compromise and limit youth autonomy, more so in SRH matters ( Shrestha and Wærdahl 2020 ; Tiwari et al. 2022 ; Nepal et al. 2023 ; Vohra-Gupta et al. 2023 ). To address the issues on limited awareness, harmful social and gender norms, low social support for gender and SRH inclusivity, this study highlights the importance of strengthening individual and community agency to overcoming these barriers, underscoring the need for systemic changes to address societal and legal obstacles. For instance, many youth-led and youth-focused initiatives such as orientation to adolescent and youths on gender and SRH, advocacy with government, digital interventions such as mobile application and e-learning portal, teacher's training on CSE, use of social media to impart information, adolescent friendly information corner, development and dissemination of IEC materials, family and community campaigns, have made significant progress in re-orienting SRH programs and services from curative perspective to prevention and promotion approach for better SRH outcomes. This study further reports insufficient government support and bureaucratic hurdles, the presence of “multiple -isms” (such as ageism, sexism, casteism, favoritism, tokenism, and ableism), lack of holistic gender and SRH understanding, limited resources for policy implementation, low mobilization of youth leaders and organizations, limited understanding for gender justice programs, and inadequate accountability in fund allocation. These factors have compromised meaningful and diverse youth participation on community action in the planning, implementation, mainstreaming, and decision-making process, impacting re-orientation of curative services to prevent SRH morbidity and promotion of safe and dignified SRH practices. These challenges reflect similar findings in low- and middle-income countries. For example, in Malawi, despite supportive SRH policies, youth, especially married rural and less educated women experienced tokenistic and superficial involvement in the policymaking process with societal and cultural determinants further adding to the problem ( Villa-Torres and Svanemyr 2015 , Melles and Ricker 2018 , George et al. 2020 ). Thus, this study suggests for mapping youth's need regarding gender and SRH, sensitization of local leaders on importance of meaningful participation and consultation of diverse youth in preparing and implementing local policies and programs, effective mobilization youth leaders and organization in imparting gender and SRH information and increasing access to gender and SRH related services. Furthermore, this study calls for holistic approaches, such as capacity building, mental health support, and inclusive education, resonates with existing research advocating for intersectional solutions and long-term investments in community-driven initiatives ( Dlamini et al. 2019 ; Peterson et al. 2020 ; Szymuś et al. 2024 ). Extending to existing literature which highlights donor driven programs, lack of collective health promoting intervention, lack of meaningful youth participation for mainstreaming of gender and SRH in policy, program and practice; this study reports systematic organizational barriers that exist within the youth organization and informal groups (such as project driven SRH program, -isms within the organizations or group, lack of leadership transformation, poor project management practices, perceived corrupt) to advance health promotion intervention ( Natil 2020 ; Van Wessel et al. 2021 ; Seibel 2022 ; Timilsina et al. 2022 ; Bauml et al. 2024 ; Pozniakovska et al. 2025 ). The findings of this study further urge for the donor education and commitment on funding flexibility in terms of youth-led scoping/mapping study, project designing, adaptation and modification based on local context for health promotion on SRH, provision of core funding, sustainable multi-annual projects rather than short term projects, investment on youth centric support program on gender and SRH, investment in soft skills program such as use of software's, typing skills, proposal development, financial management, local level planning process, formation of informal support circles, and access to mental health resources and self-care provision for inclusive and enabling environment for SRH advocates, activists, leaders, researchers and professionals to help mainstream and localize gender and SRH. Strength and limitation of the study This is one the few studies that aims to understand the current practices, knowledge, barriers and enablers to mainstream SRH as a development priority and discusses the findings in-line with the building blocks of Ottawa Charter for Health Promotion. By utilizing this global framework, we provide a structured analysis into how SRH and gender mainstreaming can be integrated into broader development priorities while giving it a context-specific look to navigate regional and collective hurdles in doing so. The study includes participants and perspective from diverse backgrounds from all seven province of Nepal which is strength of this study, ensuring a high-degree of transferability and depth to our findings. This study adapts RJ lens as a framework which has helped in collection, analysis and interpretation of data from intersectional, power analysis and keeping marginalized communities at the center of the study. While the study provides comprehensive understanding of health promotion on SRH, specific health promotion studies on specific SRH issues is recommended for better contextualization of health promotion program on gender and SRH. Similarly, the health promotion strategies for marginalized communities should be studied separately considering specific SRH knowledge, behavior, and practices. Conclusion The empirical evidence of this study identifies systemic, structural, socio-cultural, and economic barriers for youths particularly from marginalized identities that hinders supportive environment for individual and community action for preventive and promotive SRH actions. Similarly, deeply rooted patriarchal norms, discriminatory attitudes, limited institutional support, lack of inclusive policies, tokenism, and inadequate financial and logistical resources compromises community agency to design, integrate and implement healthy public policy and re-orientation of SRH programs and services. When resources are inadequate and inaccessible and policies are centered on curative care rather than preventive and promotive care, the vulnerable and marginalized groups are the hardest hit. However, our findings also offer key holistic and actionable interventions needed to mainstream SRH as a development priority for health promotion. These include strengthening youth agency, co-creation and strategic partnerships, reforms in policy and educational curriculum, increased funding, enhanced individual and institutional skills and capacity, and prioritization of SRH in local-level planning and resource allocation. Moreover, embracing a RJ framework in health promotion and health governance studies allows for a holistic and intersectional approach that places the lived experiences of diverse youth and the marginalized groups at the center of policy and program design. Acknowledgments We would like to acknowledge participant of this study for their valuable participation. We would like to acknowledge Dr Ashutosh Timilsina, Dr Tara Ballav Adhikari, Kriti Bhattarai, Sajja Singh, Reyusha Chalise, and Naresh Sharma Awasthi for their contribution during the research. Contributor Information Pabitra Neupane, Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal. Pari Adhikari, Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal. Barsha Luitel, Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal. Lirisha Tuladhar, Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal; Department of Social Work, University of Kentucky, Lexington, KY 40506, United States. Pratistha Dhakal, School of Medical Sciences, Kathmandu University, Dhulikhel, Kavrepalanchowk 45200, Nepal. Amit Timilsina, Program Development Advisory Unit, Research and Community Development Centre, Budhanilkantha, Kathmandu 44600, Nepal. Author contribution Pabitra Neupane (Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Validation, Writing—original draft, Writing—review & editing), Pari Adhikari (Data curation, Formal analysis, Validation, Visualization, Writing—original draft, Writing—review & editing), Barsha Luitel (Conceptualization, Data curation, Investigation, Writing—original draft, Writing—review & editing), Lirisha Tuladhar (Conceptualization, Data curation, Investigation, Writing—original draft, Writing—review & editing), Pratistha Dhakal (Conceptualization, Data curation, Investigation, Writing—original draft, Writing—review & editing), and Amit Timilsina (Conceptualization, Formal analysis, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review & editing) Funding Asian-Pacific Resource and Research Centre for Women (ARROW) supported the data collection of the study; however, no funding has been received for the publication of this study. Conflicts of interest None declared. Data availability All the supporting data are within the manuscript. References Acharya  A. Influence of youth engagement on Nepal's political evolution: an analysis of emerging youth-led movements. Interdiscip J Manage Soc Sci  2024;5:1–13. 10.3126/ijmss.v5i2.69438 [ DOI ] [ Google Scholar ] Bauml  M, Smith  VD, Blevins  B. “Who cares?” young adolescents’ perceived barriers to civic action. In: Dialogues in Middle Level Education Research Volume 3. Abingdon, Oxon; New York, NY: Routledge, 2024, 179–210. [ Google Scholar ] Campbell  S, Greenwood  M, Prior  S, et al.  Purposive sampling: complex or simple? Research case examples. J Res Nurs  2020;25:652–61. 10.1177/1744987120927206 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Clarke  V, Braun  V. Thematic analysis. J Posit Psychol  2017;12:297–8. 10.1080/17439760.2016.1262613 [ DOI ] [ Google Scholar ] Creswell  JW. Qualitative Inquiry and Research Design: Choosing Among Five Approaches . 3rd edn. Thousand Oaks, CA: Sage Publications, 2013. Dlamini  B, Tagoola  F, Mutalya  K, et al.  The sexual reproductive health and rights Status of young people in Uganda: the rationale for continued youth focused investment. J AIDS Clin Res  2019;10:800. [ Google Scholar ] Fry  D, Zask  A. Applying the Ottawa charter to inform health promotion programme design. Health Promot Int  2017;32:901–12. 10.1093/heapro/daw022 [ DOI ] [ PubMed ] [ Google Scholar ] Fusch  P, Ness  L. Are we there yet? Data saturation in qualitative research. Qual Rep  2015;20:1408–16. 10.46743/2160-3715/2015.2281 [ DOI ] [ Google Scholar ] George  AS, Amin  A, de Abreu Lopes  CM, et al.  Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health. BMJ  2020;368:l6985. 10.1136/bmj.l6985 [ DOI ] [ Google Scholar ] Ghimire  J, Lal  BK, Karki  S, et al.  An estimate of abortion incidence and unintended pregnancies. J Nepal Health Res Counc  2024;22:50–7. 10.33314/jnhrc.v22i01.4945 [ DOI ] [ PubMed ] [ Google Scholar ] Government of Nepal . Constitution of NEPAL 2015. Kathmandu: Constituent Assembly Secretariat, 2015, 19, 505. [ Google Scholar ] Maharjan  B, Rishal  P, Svanemyr  J. Factors influencing the use of reproductive health care services among married adolescent girls in Dang District, Nepal: a qualitative study. BMC Pregnancy Childbirth  2019;19:152. 10.1186/s12884-019-2298-3 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mainali  J. Navigating Global Influence: A Qualitative Exploration of Funding Dynamics and Stakeholder Engagement in Sexual and Reproductive Health Organizations in Nepal [Internet] . James Madison University, 2024. https://commons.lib.jmu.edu/masters202029/260/ Maistrellis  E, Juma  K, Khanal  A, et al.  Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal. BMJ Glob Health  2022;7:e008752. 10.1136/bmjgh-2022-008752 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Mallik  R, Kismodi  E, Ravindran  TS. The dynamics of funding for sexual and reproductive health and rights (SRHR) advocacy and movement building. Sex Reprod Health Matters  2023;31:2352251. 10.1080/26410397.2024.2352251 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Melles  MO, Ricker  CL. Youth participation in HIV and sexual and reproductive health decision-making, policies, programmes: perspectives from the field. Int J Adolesc Youth  2018;23:159–67. 10.1080/02673843.2017.1317642 [ DOI ] [ Google Scholar ] Meyer  R. Development Advocate Nepal [Internet]. Kathmandu: UNDP Nepal, 2019 [cited 2025 Dec]. https://files.acquia.undp.org/public/migration/np/Development_Advocate_2019.pdf Ministry of Health and Population . National Adolescent Health and Development Strategy 2075 [Internet] . Ministry of Health and Population, 2019a. https://publichealthupdate.com/national-adolescent-development-and-health-strategy-2075/ (24 December 2025, date last accessed) Ministry of Health and Population . National Health Policy 2019 [Internet] . Ministry of Health and Population, 2019b. Accessed on 5th January 2026. Retrieved from http://climate.mohp.gov.np/downloads/National_Health_Policy_2076.pdf (5 January 2026, date last accessed) Ministry of Health and Population . Nepal Demographic and Health Survey 2022: Key Indicators Report . Ministry of Health and Population, 2022. https://dhsprogram.com/pubs/pdf/PR142/PR142.pdf (13 December 2025, date last accessed) Ministry of Youth and Sports . National Youth Policy 2072 . Ministry of Youth and Sports, 2015. https://www.moys.gov.np/sites/default/files/nitiheru/National%20Youth%20Policy%202072_2.pdf (13 December 2025, date last accessed) Natil  I. Introducing barriers to effective civil society organisations. In: Barriers to Effective Civil Society Organisations. Abingdon, UK; New York, NY: Routledge, 2020, 9–19. 10.4324/9781003053040 [ DOI ] [ Google Scholar ] National Statistics Office. National Population and Housing Census 2021 National Report . Kathmandu, Nepal: Government of Nepal, National Statistics Office, 2021. Available from: https://censusnepal.cbs.gov.np/results/files/result-folder/National%20Report_English.pdf Nepal  A, Dangol  SK, Karki  S, et al.  Factors that determine women’s autonomy to make decisions about sexual and reproductive health and rights in Nepal: a cross-sectional study. PLOS Glob Public Health  2023;3:e0000832. 10.1371/journal.pgph.0000832 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Nepal Law Comission.  2018. The Right to Safe Motherhood and Reproductive Health Act 2075. Nepal Law Commission Retrieved from https://nepal.unfpa.org/sites/default/files/pub-pdf/The%20Right%20to%20Safe%20Motherhood%20and%20Reproductive%20Health%20Act%202075.pdf Olajubu  AO, Olowokere  AE, Naanyu  V. Barriers to utilization of sexual and reproductive health services among young people in Nigeria: a qualitative exploration using the socioecological model. Glob Qual Nurs Res  2025;12:23333936241310186. 10.1177/23333936241310186 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Pant  RK. Nepal’s performance in achieving sustainable development goals: a critical evaluation. Kaumodaki  2024;4:164–76. 10.3126/kdk.v4i1.64576 [ DOI ] [ Google Scholar ] Peterson  A, Drake  P, Tat  S, et al. Youth Engagement in Sexual Health Programs and Services: Findings from the Youth Engagement Network's Environmental Scan . ETR Associates, 2020. https://pages.etr.org/hubfs/YEN/ETR_YEN%20Environmental%20Scan%20Full%20Report_2020.pdf Pozniakovska  N, Sysoieva  I, Mikluha  O, et al.  ASSESSMENT OF THE EFFICIENCY OF CIVIL SOCIETY ORGANISATIONS IN IMPLEMENTING THE CONCEPT OF SUSTAINABLE DEVELOPMENT. Manage Theory Stud Rural Business Infrastructure Dev  2025;47:225–37. 10.15544/mts.2025.17 [ DOI ] [ Google Scholar ] Ross L.  Understanding reproductive justice. In: McCann CR, Kim SK, Ergun E (eds.), Feminist Theory Reader: Local and Global Perspectives. Abingdon, UK; New York, NY: Routledge, 2021, 77–82. 10.4324/9780367430801 [ DOI ] [ Google Scholar ] Saadati  F, Nadrian  H, Golkar  MH, et al.  Indices and indicators developed to evaluate the “strengthening community actions” mechanism of the Ottawa charter for health promotion: a scoping review. Am J Health Promot  2022;36:881–93. 10.1177/08901171211069130 [ DOI ] [ PubMed ] [ Google Scholar ] Seibel  W. Successful failure: functions and dysfunctions of civil society organizations. In: Civil Society: Concepts, Challenges, Contexts: Essays in Honor of Helmut K. Anheier. Cham, Switzerland: Springer International Publishing, 2022, 69–81. 10.1007/978-3-030-98008-5_5 [ DOI ] [ Google Scholar ] Shrestha  S, Wærdahl  R. Girls’ access to adolescent friendly sexual and reproductive health services in Kaski, Nepal. Asia Pac Policy Stud  2020;7:278–92. 10.1002/app5.305 [ DOI ] [ Google Scholar ] Sidamo  NB, Kerbo  AA, Gidebo  KD, et al.  Socio-ecological analysis of barriers to access and utilization of adolescent sexual and reproductive health services in sub-saharan Africa: a qualitative systematic review. Open Access J Contracept  2023:103–18. 10.2147/OAJC.S411924 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Szymuś  K, Manaboriboon  N, Mohammed  FEA, et al.  Meaningful youth engagement in sexual and reproductive health and rights decision making. Lancet Glob Health  2024;12:e20–1. 10.1016/S2214-109X(23)00493-X [ DOI ] [ PubMed ] [ Google Scholar ] Tamang  J, Khanal  A, Tamang  A, et al.  Foreign ideology vs. national priority: impacts of the US global gag rule on Nepal’s sexual and reproductive healthcare system. Sex Reprod Health Matters  2020;28:5–22. 10.1080/26410397.2020.1831717 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Thomas  SL, Kickbusch  I, Kökény  M, et al.  40 Years of the Ottawa Charter for Health Promotion-Reaffirming Health for All, Vol. 40. Oxford, UK: Oxford University Press, 2025, daaf143. 10.1093/heapro/daaf143 [ DOI ] [ PubMed ] [ Google Scholar ] Timilsina  A, Rijal  G, Neupane  P, et al.  Comprehensive reproductive health care services during COVID19 in Nepal: an ethical analysis through reproductive justice framework. Health Prospect  2022;21:13–8. 10.3126/hprospect.v21i2.42738 [ DOI ] [ Google Scholar ] Tiwari  A, Wu  W-J, Citrin  D, et al.  Our mothers do not tell us”: a qualitative study of adolescent girls’ perspectives on sexual and reproductive health in rural Nepal. Sex Reprod Health Matters  2022;29:2068211. 10.1080/26410397.2022.2068211 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Van Wessel  M, Naz  F, Sahoo  S. Complementarities in CSO collaborations: how working with diversity produces advantages. Voluntas  2021;32:717–30. 10.1007/s11266-020-00227-4 [ DOI ] [ Google Scholar ] Villa-Torres  L, Svanemyr  J. Ensuring youth's right to participation and promotion of youth leadership in the development of sexual and reproductive health policies and programs. J Adolescent Health  2015;56:S51–7. 10.1016/j.jadohealth.2014.07.022 [ DOI ] [ PubMed ] [ Google Scholar ] Vohra-Gupta  S, Petruzzi  L, Jones  C, et al.  An intersectional approach to understanding barriers to healthcare for women. J Community Health  2023;48:89–98. 10.1007/s10900-022-01147-8 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Wilberg  A, Saboga-Nunes  L, Stock  C. Are we there yet? Use of the Ottawa charter action areas in the perspective of European health promotion professionals. J Public Health  2021;29:1–7. 10.1007/s10389-019-01108-x [ DOI ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement All the supporting data are within the manuscript. 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