Abstract
BACKGROUND: Women'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. METHODS: This 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. RESULTS: Disparities 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. CONCLUSION: Agency 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.