Harassment is a form of discrimination that includes any unwanted physical or verbal behavior that offends or humiliates you [1]. Harassment is a problem that exists globally both in an open and hidden way and is a serious problem [2-5]. It is a problem for not only developing countries but developed countries as well [6]. Harassment is known to affect men; primarily, it affects women [7-9] they are being victimized in public places, workplaces, homes, transport, etc. [7]. Women are afraid to raise their voices against abuse and accept harassment to resolve conflict [8]. They have been accepting and tolerating harassment for many decades [9]. Nepal is among the countries where women are facing problems of physical, verbal, sexual, and psychological harassment [9].

Nepal’s Sexual Harassment Prevention Act 2015, Section 4 states that: Physical contact and advances; showing or displaying pornographic materials; expressing sexual motives by way of written, verbal, or non-verbal means; demand or proposal for sexual favors and flirting or harassing with a sexual motive [10]. Various types of harassment are encountered by adult females among them are physical harassment, verbal, non-verbal, personal harassment, discriminatory harassment, psychological harassment, sexual harassment, and third-party harassment [11]. Harassment in public vehicles is a significant problem, yet it is largely invisible, making it simple to ignore [12].

Kathmandu Valley of Nepal consists of Kathmandu, Lalitpur, and Bhaktapur districts [13]. In Kathmandu Valley, Motorbikes account for 79.1%, private vehicles (cars, vans, and jeeps) come in second at 12.42%, heavy-duty vehicles come in fourth at 4%, public vehicles come in sixth at 2.67%, and so on. The overall annual growth rate is 14%. Large buses only make up 6% of all public vehicles; the majority, or 94%, are low-occupancy vehicles, such as microbuses and minibuses [14].

A study conducted among Jimma University female students revealed that the prevalence of psychological distress among students who had experienced sexual harassment was 63.0% [15]. A study conducted in 2018 among female health science students found the prevalence of sexual harassment in public vehicles was 79.6% [16]. Another study conducted in 2019, found 78.21% of female students experienced sexual harassment in Kathmandu Valley [5]. In Nepal, most of the studies predominantly focused on the prevalence of public vehicle harassment and types of harassment [17,18]. However, data assessing the psychological distress among those who experienced public vehicle harassment is scarce. Thus, this study was designed to assess the prevalence of public vehicle harassment, types, and psychological distress among women aged 15-24 years traveling in Public Vehicles in Lalitpur district, Kathmandu Valley, Nepal.

Study design

This was a quantitative, cross-sectional study conducted among young women of the age group 15-24 years who traveled in public vehicles of Lalitpur district, Kathmandu Valley, Nepal in 2019.

Study setting

Lagankhel and Chapagaun Bus parks in the Lalitpur district of Kathmandu Valley were two clusters that were selected; these are the bus stations that most people frequently use for traveling. From these stations, women in the age group 15-24 years were selected by purposive sampling.

Participants

The study population consisted of young women between the ages of 15 and 24. Young women who have given informed consent and have been regular users of public transport in the past one-year were included in this study. However, this study did not include women who were younger than 15 or older than 24 years old, who were travelling in their personal vehicles, or who refused to give informed permission.

Variables

The main outcome variable of this study was the experience of harassment (yes/no). We operationally defined Harassment as Physical contact and advances; showing or displaying pornographic materials; expressing sexual motives by way of written, verbal, or non-verbal means; demand or proposal for sexual favors and flirting or harassing with a sexual motive. A semi-structured questionnaire consisting of four parts was prepared after a review of relevant literature. The first part of the questionnaire was related to the socio-demographic characteristics of the study participants, the second was related to the types of vehicles and travel characteristics, the third part was related to the types of harassment, intensity, reaction, and perceived factors and the fourth, Screening was done by asking questions with the help of a questionnaire, and fifth part was related to the psychological distress and its severity after harassment.

 Tools

The Kessler-6 (K6) Psychological Distress Scale was used to measure distress symptoms, and standardized and validated screening tools for non-specific psychological distress, including depression and anxiety, were used [19]. The scale was available in the Nepali version and has been used previously in Nepal as well as in a variety of cultural settings in different parts of the world. The K6 uses a Likert scale to establish how often an individual has experienced psychological distress over the preceding 30 days. Scores range from 0-24 with higher scores indicating worst outcomes. A K6 score of greater or equal to 13 has been defined as indicating high psychological distress [20]. A psychological distress assessment was performed at the time of data collection. The K6 scale was used to assess the psychological distress among women travelling in public vehicles.

Study size

We used a single proportion formula for sample size calculation i.e. z²pq/d². Using this formula and taking the reference of the prevalence of sexual harassment in public vehicles in Kathmandu, Nepal, p = 79.6% [16], q = 1-p =20.4%, error (d)=5%, and z = 1.96 at 95% CI, the calculated sample size was 249.42, and by adding a 10% non-response rate total sample size for this study was 274. However, we approached 281 respondents for the final sample size.

Variables

Socio-demographic characteristics consist of the age of respondents, marital status, occupation, residence, and educational status. Travel characteristics consist of frequency of travel which includes 5-7 times per week, 3-4 times per week, 2 times or less a week, once in 15 days, and less than once a month. The third part of the questionnaire include types of harassment that are physical, verbal, and non-verbal. Ethnicity was categorized into Brahmin/Chhetri and others, religion into Hindu and Non-Hindu, Marital status into Unmarried and Married, Occupation into students and others, and place of residence into urban and rural. Educational status was categorized into two groups: below high school level and above.

Statistical methods

Data was collected using a paper-based questionnaire. The collected data was checked daily for completeness and consistency before data processing and analysis. The collected data was checked and analyzed by using a computer and data was entered and analyzed in SPSS version 16. Both descriptive and statistical inferences were used to analyze the data. Descriptive statistics like frequency, percentage, and mean were used to describe the socio-demographic characteristics, vehicle and travel characteristics, types of harassment, intensity and reaction, and psychological distress. Parametric numerical variables were presented as mean and standard deviation, while categorical variables were expressed as frequencies and percentages. The normality of data distribution was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. The chi-square test was employed for categorical variables. The results were presented using crude odds ratios (COR), along with their 95% confidence intervals and p-values. All tests were conducted at a 95% confidence level, and p-values less than 0.05 were deemed.

Ethical clearance

Before conducting the statistically significant study, ethical clearance was obtained from the Ethical Review Board of Nepal Health Research Council (Reference number: 76-3268). For each study participant, the purpose of the study was stated by the researcher before the collection of data. In addition, participants were informed that they had the full right to refuse to participate in the study and could interrupt the interview if not comfortable with it. Written informed consent was obtained from all participants before their enrolment. Throughout the study, the confidentiality and anonymity of the participants were rigorously maintained and ensured.

This study was conducted in two bus parks of Lalitpur districts i.e. Lagankhel Bus Park and Chapagaun Bus Park to assess public vehicle harassment and psychological distress. A total of 281 young women were assessed among them the mean age was 19.70 years with a standard deviation of 2.52, the maximum age was 24, and the minimum age was 15 years. The majority (87.9%) of the women were unmarried, and 84.7% were students. Nearly two-thirds, 63.7% of women reside in urban areas and 47.7% have an education up to college level (Table 1).

Almost half that is 49.1% of women travel in public vehicles 5–7 times per week with 45.6% preferring buses as the means of transportation. The majority of women (84.0%) spend less than one hour time per day in public vehicles. Daytime (79.0%) was the major time for traveling and the major purpose (54.1%) was for going to school/college (Table 2).

More than two-thirds (66.5%) of women experience harassment in public vehicles with 62.6% feeling harassed 1-2 times. Of the major perpetrators, 78.6% were passengers sitting nearby and 40.1% were women, who experienced physical harassment. More than two-thirds of women (70.1%) experienced public vehicle harassment while wearing clothes other than school uniforms. The majority (30.5%) of women felt that the most common factor causing public vehicle harassment was bus overcrowding followed by a male-dominated society. Almost one-third of women (35.9%) reported implementing rules properly is the way to prevent harassment (Table 3).

Table 4 illustrates that significant association between educational status and psychological distress with harassment indicating p-values 0.014 and 0.001 respectively.

Table 5 shows the results of the Crude odds ratio. Women who experience public vehicle harassment are 1.70 (95% CI= 1.52 – 1.89) times more likely to have psychological distress. Additionally, women who have completed high school only are 2.19 (95% CI= 1.16 - 4.14) times more likely to experience public vehicle harassment than women who have completed higher education.

The overall findings of this study revealed the prevalence of public vehicle harassment was found to be 66.5% and the most common harassment was physical 75 (40.1%) which was similar to the study done by Mishra and Lamichhane [16] in female health science students of Kathmandu Valley where physical harassment was the most prominent type of harassment with 67.1% followed by verbal and non-verbal. A similar quantitative study conducted in Pampanga municipality of the Philippines among 385 individuals revealed that 99.0% of women had ever been sexually harassed in a public vehicle [21]. Passengers traveling in the same vehicles and sitting or standing nearby were found to be the most common harasser (78.6%) followed by the conductor and driver. This finding was also similar to the study of Mishra and Lamichhane where fellow passengers were responsible for 92.4% of harassment [16]. A repeated cross-sectional survey conducted over 500 women to assess the changes in sexual harassment between September 2016 and September 2018 revealed reduced levels of the most egregious form of sexual harassment but increased levels of gender harassment in 2018 [22]. A similar study conducted in Karachi, Pakistan shows similar results where major culprits are fellow passengers (75%) followed by bus conductors (20%) and sometimes even bus driver [23]. Another study conducted in Nepal among adolescents to find out the perpetrator and commonplace of sexual harassment found that sexual harassment occurred from males who were strangers, neighbors, relatives, instructors, and peers. The frequency of sexual harassment that is verbal or gestural involves touching or pinching and is more common among male peers [24]. The similarity in findings between the study done in Karachi and the present study might be due to passengers remaining in close contact with fellow passengers rather than driver and conductor so there is a high chance of being harassed by fellow passengers. Another reason might be drivers and conductors remain busy inside vehicles while passengers aren’t so during the period of travel. Fellow passengers harass more than bus operators.

This study shows the major factor behind public vehicle harassment was bus overcrowding (31%), recent study conducted in 2023 in Dhaka city of Bangladesh, revealed similar findings where 18.43% of sexual harassment was due to overcrowding of buses [25]. A Systematic review conducted against women in public transport environments showed overcrowding may allow perpetrators to carry out their actions unnoticed and without consequence [7]. On the other hand, bus overcrowding is the major factor in this study. This could be due to the increasing population of Lalitpur metropolitan city, available vehicles are not sufficient for this increasing population. Studies showed that during the COVID-19 pandemic, due to travel restrictions, public vehicle usage was reduced by 50% worldwide and by 50-60% in Asian countries [26]. Public transport harassment during the pandemic had also diminished due to fear of transmission [27]; however, this situation might be restored because of the reduced effect of the pandemic. A study conducted in India at the end of 2022 found that more than two-thirds of women faced sexual harassment during public transport [28].

Harassment is most common during the day time with 64.7% followed by 33.2% at night time [5]. Daytime is the busiest time when people travel frequently as compared to night, so the majority of people travel mostly in the day time, so harassment occurs. The majority of respondents (48.7%) keep silent after being harassed and only 28.9% of respondents scold harassers after being harassed. This study shows that respondents experienced harassment more in other dress (70.1%) than in college uniforms but in contrast, the findings reported by another study [16] reveal harassment was more common in college uniforms (69.9%) followed by 55.9% in Jeans/t-shirt. The tentative age of the harasser was found to be a maximum of 36 years with a minimum age of 15 years.

Public vehicle harassment is not directly associated with ethnicity, religion, marital status, occupation, and place of residence. However, it is directly related to educational status, women who have educational qualifications below high school experience harassment 2.19 times more than women with higher educational qualifications. One-third of the respondents in this study believe that implementing rules properly can help to prevent harassment in the coming days. This may be due to the current situation of public vehicles where anyone can do anything. There is no provision of punishment for harassers, so making rules and implementing them strictly will reduce harassment shortly. This crude odds ratio reveals women are 1.70 times more likely to get psychological distress after public vehicle harassment. Findings were similar to the study conducted in Northeast India, where 58% of participants had perceived severe stress after harassment [29].

This study was undertaken in 2019. Since then, COVID-19 significantly disrupted social interactions [30]. Therefore, it is relevant to consider the effect of COVID-19 on the prevalence of public vehicle harassment. A study conducted among adolescent girls and young women aged 18-24 years in Nepal to examine the prevalence and correlates of violence and sexual and reproductive health service disruption among girls and young women during COVID-19 restrictions and lockdown found no significant difference in the prevalence of violence before and after pandemic [31]. Education was found to be protective against the experience of both physical and sexual violence after the pandemic [31]. A qualitative study conducted in Province -2 of Nepal to explore community perceptions of COVID-19 and their experience towards health service utilization during the pandemic using semi-structured interviews revealed that most participants expressed concerns about COVID-19, citing a lack of knowledge, misinformation, and stigma as significant factors in its spread. Maternity services, immunization, and the supply of essential medicines were identified as the most impacted areas of healthcare during the lockdown. Participants attributed interruptions in health services primarily to local healthcare facility closures, limited affordability, increased private sector involvement, fears of COVID-19 transmission among healthcare workers and within facilities, and disrupted transportation services [32]. Another study conducted in three cities of Bangladesh to assess the harassment and challenges faced by public transport users found that the proportion of female respondents in each of the three cities was much more significant than males also around 1/3^rd of the harassment happened inside the public vehicles which were similar in three cities namely Dhaka, Rajshahi, and Mymensingh [33].

Our study found that nearly half of the respondents believe that effectively implemented rules and increased seats designated for women in public vehicles will reduce harassment in public vehicles. A similar study in Kerala, India also showed that at least three priority public transportation seats for women and girls are effective [28]. Findings from other literature show that there are persistent inequalities in access to public transport in both rural and urban settings [34], so harassment levels may be different. Additionally, it was found that the strategy as mentioned earlier helps to protect females and gives them the power to speak and fight against the perpetrator [35,36]. Thus, to address incidents of public vehicle harassment, the government of Nepal should pay more attention to creating policies, operations, and enforcement that would help to control harassment.

The present study assessed public vehicle harassment and its psychological distress which has filled the research gap, in addition, prevalence and associated factors have also been identified. This study was conducted among women traveling in public vehicles of Lalitpur district, Kathmandu Valley findings can be generalized within Kathmandu Valley only. The analysis was done with cross-sectional data and thus no causal statement can be made. Data in this study was based on self-report and no clinical assessment was done to find psychological distress.

Our study concludes the prevalence of public vehicle harassment was significantly high (more than two-thirds) in Kathmandu Valley. Low educational qualification and psychological distress were associated with public vehicle harassment. It is recommended that law enforcement agencies and researchers work together to investigate victim hesitation to report and to create programs that encourage victims to come forward. Alternative forms of punishment for harassers as well as proactive educational initiatives need to be implemented. Organizations and employers need to set up effective reporting systems, training initiatives, and preventive actions. Implementing effective awareness campaigns, robust legal measures, and a streamlined, supportive judicial system is crucial to reducing sexual harassment and psychological distress among young women traveling in public vehicles.

The author declared that they have no conflicts of interest.

The data used to generate the findings of this study will be available from the corresponding author with the reasoned requests.

We did not receive any kind of funds to conduct this research. No incentives were provided to the participants.

We would like to express our thanks to all bus park administration, bus drivers, and helpers for providing permission to collect the data. Our sincere thanks also extend to the Nepal Health Research Council Institutional Review Board for providing ethical clearance. Additionally, we would like to thank all the participants for their valuable time.

DA and GJ developed the study concept, design, and data curation. DA and MK analyzed and interpreted the data. MK conducted statistical data analysis. DA and NR drafted the manuscript, MK and NR reviewed the draft manuscript, and all authors contributed intellectual content. The study was supervised by MK. All authors read and approved the final manuscript.