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.