“All human beings are born free and equal in dignity and rights.”¹

As a 10th grade child wrote: “As a child, I want to grow, dream, and fulfill my potential. I deserve care, love, and attention, not neglect or harm. I need support to explore the world, learn, and become the best version of myself.”

“I want to be seen, heard, and valued for who I am. My dreams matter, and I should be given the chance to explore, create, and reach for the stars.”

“Let me ask questions, make mistakes, and learn at my own pace. Let me be a child—curious, adventurous, and full of wonder. I want to grow into a person who believes in my own worth and potential”

The Convention on the Rights of the Child declares “Recognizing that the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding and with the spirit of peace, dignity, tolerance, freedom, equality and solidarity ².” The Convention further adds “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth”². Parties shall take appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of  the status, activities, expressed opinions, or beliefs of the child’s parents, legal guardians, or family members.. Article 2 clearly mentions that a child must be protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs……¹

Infancy is the age between birth and 2 years of age. Childhood is the age between 2 years to around 12 years. Adolescence starts at the age of around 12 and typically continues until 18 or 21 years depending on the legal and cultural contexts.  Adulthood generally begins at the age of 18 or 21, depending on cultural or legal contexts^3,4,5

In September 2015, Nepal’s Constituent Assembly declared changes in the administrative units and a reclassificied urban and rural areas in the country. Nepal is divided into seven provinces: Koshi Province, Madhesh Province, Bagmati Province, Gandaki Province, Lumbini Province, Karnali Province, and Sudurpashchim Province. Each province is divided into districts, districts into municipalities, municipalities into wards, and wards into sub-wards. Nepal has 77 districts, which include a total of 753 (local level) municipalities. Of the municipalities, 293 are urban and 460 are rural⁶.

The total population of Nepal is 31.1 million⁷. The majority of the people living in Nepal fall under the ages of 15-64 (74.6%), followed by 0-14 (19.5%), and 65 and older (5.85%)⁸. Around 11.6 (39.07%) million of the population fall under the age groups 0-19 years. Around 3 million (10.1%) of the population fall under the age category of 15-19 in Nepal.

Adolescence is a time of significant emotional, psychological, and physical changes, making it sometimes difficult to distinguish between typical teenage behavior and signs of mental health issues. However, there are key warning signs that every parent should be aware of to identify when a teen might be struggling with their mental health. Early recognition and intervention are crucial in helping teens navigate these challenges and access the support they need

The youth is a critical period in the lifespan of a human being where they form social connections, pursue academic success, explore their own identity, develop emotional an, social and cognitive skills which are crucial for and lay the foundation not only for their career that they will embark for their rest of the life but also for the wellbeing that they will enjoy later. Falling into mental health issues at this phase makes it extremely difficult to compromise their career opportunities and achieving other important milestones in life. Mental health issues at this phase of life makes youths more susceptible to risk taking behaviors, self-harm; use of tobacco, alcohol and drugs; risky sexual behaviors, and exposure to and involvement in violence. These effects tend to persist throughout the life and can have a serious implication.

The findings of WHO become very concerning and alarming that youths under this age group of (15-19) are most vulnerable to mental health issues. WHO states “Mental health is a major issue for adolescents: up to half of all mental health conditions start before the age of 14. Poor mental health is the leading cause of disability in young people, and accounts for a large proportion of the global disease burden during adolescence. Suicide is the third leading cause of death in 15-19-year-olds. The mental health issues in youths (10-19 ) year age groups accounts for 13% of the global burden of disease⁹. Globally suicide is the third leading cause of death among 15-29 year-olds¹⁰. Half of all mental health disorders in adulthood start by age 14¹¹.

The suicide related deaths account for 9 per 100,000 population in Nepal, which is worsening since 2018 according to WHO. Some studies have reported suicide deaths as high as This is WHO data; the actual data is much higher as many cases are unreported and unaccounted for.

The problem of suicide is generally more pronounced among men, and particularly severe among women in the 15–29-year age group, where several sources find it to be the leading cause of death.¹²

Substance Use in Youths

Another concerning issue is substance use in adolescents. The probability of dependence becomes high and prognosis poor when substances use is started at an early age. The data shows that worldwide, more than a quarter of all people aged 15–19 years are current drinkers, amounting to 155 million adolescents. Prevalence of heavy episodic drinking among adolescents aged 15­–19 years was 13.6% in 2016, with males most at risk¹³. A survey by the Nepal Health Research Council (NHRC) found that approximately 16% of Nepalese adolescents had engaged in substance use, with alcohol and tobacco being the most prevalent¹⁴. <ahref=”https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf”>Cannabis is the most widely used psychoactive drug among young people with about 4.7% of people aged 15–16 years using it at least once in 2018¹³. Globally in 2018, at least 1 in 10 adolescents aged 13–15 years uses tobacco, although there are areas where this figure is much higher¹⁵.

Cannabis use is rampant in Nepal. It naturally grows everywhere. Moreover, most of the youths regard it as a “herb”. The deity Shiva is portrayed in religion as consuming substances such as cannabis and its derivatives and many followers of Lord Shiva also are religiously inclined to consume cannabis. The author has noted cannabis use very common in students in medical streams and Engineering streams. Some give up on the substance after consuming it for some years, however, others tend consume it for longer term.

Use of cannabis is common worldwide as well where about 4.7% of people aged 15-16 years use it at least once in a study conducted in 2018¹³. Cannabis is particularly associated with neurocognitive alterations and can produce behavioral, emotional, social and academic issues including a Cannabis Induced Anxiety and Psychosis.

Vape (The E-Cigarettes) are very fancy and becoming a way of life among the youths now-a-days. The belief that “vapes” are just vapor and are not unhealthy for the lungs and the fact that doctors encourage smokers to quit smoking by substituting it with vape make them attracted to E-Cigarettes. However, WHO states that evidence is clear that the aerosols from the majority of E-Cigarettes contain toxic chemicals, including nicotine and substances that can cause cancer. E-Cigarettes on their own are associated with increased risk of cardiovascular diseases and lung disorders and adverse effects on the development of the fetus during pregnancy. E-Cigarettes are undoubtedly harmful, should be strictly regulated, and, most importantly, must be kept away from children. Nicotine is highly addictive and found in most e-cigarettes. Both tobacco products and e-cigarettes pose risks to health and the safest approach is not to consume either¹⁶.

Child Mariage

Child marriage is common in Nepal, in fact, highest in Asia¹⁷. In the past children were married at a young age as a cultural practice, however at present most child marriages occur by young children falling in love and eloping with the partner. Parents are then forced to marry the children. However, the cultural practice of marrying their children at a young age is still practiced in rural areas and among marginalized communities. Girl child is still seen as a burden and dowry system is still prevalent in the rural areas of Nepal. Parents still observe the longstanding cultural practice of marrying their children. According to UNICEF approximately 40% of Nepalese women between the ages of 20 and 24 were married before the age of 18, while 7% were married before the age of 15¹⁸. Among Nepalese women aged 20-24, 36.6% reported to have married before the age of 18¹⁷.  Similarly, 11% of males aged 20-24 reported to have married before the age of 18 which is the eighth highest figure in the world. Parents are then forced to marry them off. It is emerging as a significant social as well as legal issue in Nepal¹⁸. Child marriage is illegal and the legal age of marriage in Nepal is 20 years for both males and females. Child marriage, also a human rights violation, restricting children’s choices, changing their course in life, and putting them at significant risk of abuse and violence. The consequences of child marriage are many folds. Teenage pregnancy, Sexually Transmitted Diseases, Infant health risks, child marriage leading mental health issues, separation from family and sometimes from the society, early termination of education leading to economic and job-related difficulties, gender-based violence.

Reference:

1. Child rights and human rights explained | UNICEF [Internet]. [cited 2024 Oct 9]. Available from: https://www.unicef.org/child-rights-convention/children-human-rights-explained
2. OHCHR [Internet]. [cited 2024 Oct 9]. Convention on the Rights of the Child. Available from: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child
3. Children NRC (US) P to R the S of BR on SA, Collins WA. Introduction. In: Development During Middle Childhood: The Years From Six to Twelve [Internet]. National Academies Press (US); 1984 [cited 2024 Oct 8]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK216770/
4. Child development | Definition, Stages, & Facts | Britannica [Internet]. 2024 [cited 2024 Oct 8]. Available from: https://www.britannica.com/science/infancy
5. Dattani S, Roser M. How do statistical organizations define age periods for children? Our World Data [Internet]. 2023 Dec 28 [cited 2024 Oct 9]; Available from: https://ourworldindata.org/how-do-statistical-organizations-define-age-periods-in-children
6. Ministry of Health and Population. Demographic and Health Survey 2022 [Internet]. Ministry of Health and Population; 2022 [cited 2024 Oct 9]. Available from: https://mohp.gov.np/uploads/Resources/Nepal%20Demographic%20and%20Health%20Survey%202022%20Key%20Indicators%20Report.pdf
7. BBC News. Nepal country profile. BBC News [Internet]. 2011 Feb 18 [cited 2024 Oct 8]; Available from: https://www.bbc.com/news/world-south-asia-12511455
8. WHO. Demographics of Nepal [Internet]. [cited 2024 Oct 9]. Available from: https://data.who.int/countries/524
9. New WHO guidelines on promoting mental health among adolescents [Internet]. [cited 2024 Oct 9]. Available from: https://www.who.int/news/item/28-09-2020-new-who-guidelines-on-promoting-mental-health-among-adolescents
10. Mental health of adolescents [Internet]. [cited 2024 Oct 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
11. Adolescent and young adult health [Internet]. [cited 2024 Oct 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
12. Jordans MJ, Kaufman A, Brenman NF, Adhikari RP, Luitel NP, Tol WA, et al. Suicide in South Asia: a scoping review. BMC Psychiatry. 2014 Dec 24;14:358.
13. Adolescent and young adult health [Internet]. [cited 2024 Oct 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
14. Nepal Health Research Coucil (NHRC). Nepal Health Research Council. Survey on adolescent substance use in Nepal. Kathmandu: NHRC-2020 [Internet]. 2020. Available from: https://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adolescents.pdf
15. Ma C, Xi B, Li Z, Wu H, Zhao M, Liang Y, et al. Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the Global Youth Tobacco Surveys. Lancet Child Adolesc Health. 2021 Apr;5(4):245–55.
16. E-cigarettes are harmful to health [Internet]. [cited 2024 Oct 9]. Available from: https://www.who.int/news/item/05-02-2020-e-cigarettes-are-harmful-to-health
17. Ending child marriage in Nepal | UNICEF Nepal [Internet]. 2017 [cited 2024 Oct 9]. Available from: https://www.unicef.org/nepal/reports/ending-child-marriage-nepal
18. Ending child marriage in Nepal | UNICEF Nepal [Internet]. 2017 [cited 2024 Oct 11]. Available from: https://www.unicef.org/nepal/reports/ending-child-marriage-nepal
19. Hardin AP, Hackell JM, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, Simon GR, Boudreau ADA, Baker CN, et al. Age Limit of Pediatrics. Pediatrics. 2017 Sep 1;140(3):e20172151.