Indigenous young people's participation in health promotion in their community: a participatory action research of the Early Marriage and Early Pregnancy Prevention [EMEP] Project of Nepal
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Indigenous peoples of Nepal constitute more than one third of the total population, yet they experience marginalization and inequalities in relation to health, education and political participation. Early marriage is one of the traditional practices of Nepali indigenous communities contributing to poverty and the poor health of young people. In some indigenous communities, more than two third of young girls are married before the age of 15 years. The aim of the study was to investigate young people’s participation in the early marriage and early pregnancy prevention (EMEP) project in the highly marginalized Thami indigenous community. The EMEP has been implemented since 2009 with young people as a key stakeholder. Using participatory action research (PAR) the study asked a group of Thami young men and women about their experiences of participating in the project and it explored their recommendations for enhanced participation in future. PAR is a research methodology which involves collaboration with representatives of the population under investigation, with the goal of intervention into a problem. Thami youth in this study viewed their participation in the EMEP project as mostly limited to being recipients of information campaigns. Barriers to participation included high workloads and pressures of work away from home (including migrant work outside Nepal); the delivery of the project mainly through schools; and the lack of priority of the project in the lives of Thami youth, were poverty and lack of education are the major problems they face. Their recommendations for enhanced participation included: provision of financial incentives and skills development and training; and participation of youth in needs’ assessment and project design. Implications for health policy is that marginalised youth such as the Thami have a valuable contribution to make to development, and that it is vital that their needs and views are taken into account when developing strategies. In particular, they stress the importance of addressing the social determinants of their health especially poverty and lack of education. 9 In April 2015 Nepal experienced a devastating earthquake which will have a profound effect on development in future. Youth participation will still be an important issue, perhaps more so in face of the changes that will occur as a result of the crisis.