ArticleBMC women's health2025
Determinants of agency in family planning among marginalized and non-marginalized women: an analysis of the Nepal demographic and health survey 2022.
Article in BMC women's health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWomen's agency in family planning, as reflected in informed decision-making, negotiation, and cognitive control over their reproductive choices, is vital for sexual and reproductive health and rights. This study examined the prevalence of these dimensions of agency and their socio-demographic, economic, and relational determinants across marginalized and non-marginalized groups, an area that has received limited scholarly attention.
methodsThis study utilized nationally representative data from the 2022 Nepal Demographic and Health Survey. The analysis included 4,769 currently married women aged 15-49 years (3,357 marginalized and 1,412 non-marginalized) who were using modern contraception. Women's agency in family planning, assessed through decision-making on contraceptive use, condom negotiation, and cognitive autonomy, served as the outcome variable, whereas socio-demographic, economic, and household decision-making factors were considered exposure variables. Associations were examined using bivariate and multivariable logistic regression.
resultsDisparities existed between marginalized (66%) and non-marginalized (79%) women, with a lower proportion among the former. Higher education was strongly linked to increased agency in family planning in both marginalized [AOR = 19.40, (95% CI: 2.61-144.33)] and non-marginalized [AOR: 4.44, (95% CI: 2.05-9.62)] groups. The other determining variables, such as age, caste/ethnicity, wealth index, and mobile/telephone ownership, were significant determinants for the marginalized group, while occupation and pressure from husband or family members were specific determinants for the non-marginalized group.
conclusionAgency in family planning appeared more limited among marginalized women compared to non-marginalized women. Education, especially higher education, stands out as the strongest predictor of agency in family planning in both groups. Still, age, caste/ethnicity, wealth, and technology access are crucial for marginalized women, while occupation and familial pressure are significant for non-marginalized women.
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