Factors that determine women’s autonomy to make decisions about sexual and reproductive health and rights in Nepal: A cross-sectional study

Abstract

Women’s autonomy on sexual and reproductive health issues is critical to women’s health and well-being. Women have the right to decide on their fertility and sexuality, be free from coercion and violence, and achieve well-being. This study has identified women’s autonomy regarding decision and exercise of their sexual reproductive health and rights and its association with determining factors in Nepal. Descriptive and analytical statistics such as bivariate and multivariate regression analysis were performed using data from Nepal Demographic and Health Survey 2016. The survey collected data from 12,862 women of reproductive age groups i.e. 15–49 years. However, for this study, we analyzed the data of only ever-married women and they were 9,875 in total. The analysis showed that women’s autonomy in exercising their sexual reproductive health rights is highly associated with media exposure after controlling demographic variables. The frequency of exposure to media (i. less than a week: adjusted odds ratio (AOR):1.383; confidence interval (CI):1.145–1.670, p<0.001, ii. at least once a week: AOR:1.657; CI:1.359–2.021, p<0.001) is positively associated with women’s autonomy. Furthermore, factors like women from Janajati (AOR:1.298; CI:1.071–1.576, p<0.01) and other Terai ethnic groups (AOR:1.471; CI:1.160–1.866, p<0.01), higher education attainment (AOR:1.482; CI:1.164–1.888, p<0.01), richest wealth quintile (AOR:1.527; CI:1.151–2.026, p<0.01), paid work (AOR:1.277; CI:1.045–1.561, p<0.05) and living in Lumbini Province (AOR:0.622; CI:0.486–0.797, p<0.001) and Sudur Paschim Province (AOR:0.723; CI:0.554–0.944, p<0.05) were found to be significantly associated with women’s autonomy in sexual and reproductive health decision making. Similarly, women’s autonomy is also increased with their increased age. In conclusion, women’s exposure to media, improved socio-economic status and increased age influence their autonomy to make decisions about sexual and reproductive health rights in Nepal. Therefore, this study underscores the need to address socio-economic barriers and improve women’s exposure to the media to enhance their autonomy further.

Antenatal care utilisation in Nigeria: assessing disparities between rural and urban areas—analysis of the 2018 Nigeria demographic and health survey

“…Present findings are consistent with our previous research based on the 2013 NDHS [13] and a recent study investigating the association of age differences on the ‘non-use of ANC’ services in Nigeria [14]. Our results also agree with a recent Nepalese study [36], which found that women aged 15-19 years were less likely to be autonomous or able to exercise their sexual and reproductive rights.…”

Association between the person-centered maternity care experience and mental health after delivery in urban and rural Dhading, Nepal: a cross-sectional study

“…This could be because the wealth quintile did not include household income and overseas remittances or because the women got special support. In addition, increased age was one of the determinants of decision-making toward sexual and reproductive health in Nepal [ 51 ].…”

Exploring the link between household structure and women’s household decision-making autonomy in Mauritania

“…For example, Sadhu et al (2020) and Acharya et al (2010) found that in rural Rajasthan and Nepal, as a woman ages, she tends to gain greater autonomy regarding unrestrained movement than a younger woman. Thus, as women age, they gain greater autonomy in household decision-making in polygamous relationships and may acquire additional responsibilities to mentor and guide the decisions of younger women/co-wives (Hanmer and Klugman, 2016;Nepal et al, 2023). In a Southern Ethiopian study about women's autonomy and contraceptive use, the authors found that although women aged 21-30 years were twice as likely to participate in household decisionmaking autonomy, those who were 30 years and older were seven times more likely to participate in decision-making autonomy (Alemayehu and Meskele, 2017) alluding to the importance of age in the power dynamics within a polygamous household.…”