Unmet Need for Family Planning and Spousal Separation in Nepal: A Spatial and Multilevel Analysis.

Abstract

Objectives: In Nepal, where increasing numbers of married couples live apart due to migration, progress in reducing unmet need for family planning (UMN) is stagnant. This study aims to identify spatial patterns of UMN of married women and spousal separation in Nepal and explore associations between UMN and spousal separation at individual- and district-levels. Methods: We used 2016 Nepal Demographic and Health Surveys data to conduct spatial and multilevel logistic analyses. Results: This study shows evidence of similar geographical patterns in UMN of married women and spousal separation. At the individual level, women living with their spouses had 88% (aOR = 0.12, 95% CI 0.11-0.13) decreased odds of experiencing UMN compared to those living apart from their spouses. While not statistically significant, increasing odds of UMN were observed with higher prevalence of spousal separation at the district level. Conclusion: This study contributes to the existing literature by showing similar geographical patterns of UMN and spousal separation across Nepal and demonstrating both individual and contextual effects of spousal separation on UMN among married women. Theoretical and policy implications are discussed.