Do education and use of family planning methods empower women? Evidence from the Nepal Demographic Health Survey (NDHS) 2016 and 2022.

Objectives: To assess how education and the use of family planning methods intersect to influence women's empowerment among currently married women of reproductive age in Nepal.

Design setting and participants: The study analysed a combined weighted sample of 21 023 currently married women in the age group (15-49 years) using data sets of two cross-sectional Nepal Demographic and Health Survey (NDHS). A weighted analysis of the samples was carried out, accounting for the complex survey design. In NDHS 2016, the sample size was 9,868, and in NDHS 2022, it was 11, 155. Thirteen indicators that have been used in previous studies were employed to measure women's empowerment. To examine the relationship between education, family planning use and women's empowerment, a multivariate binary logistic regression analysis was conducted, taking into account cluster and survey weights.

Outcome measures: Women's empowerment is the primary outcome measure, which was assessed using a composite index of 13 indicators based on previous studies. The indicators encompassed sexual and reproductive autonomy, participation in household decision-making, control over financial decisions and attitudes towards wife-beating.

Results: The results indicate that women with higher education and those who use family planning methods are significantly more empowered, with adjusted ORs of 3.764 (95% CI 2.894 to 4.895) in 2016 and 4.541 (95% CI 2.914 to 7.079) in 2022 compared with women without education and family planning use. This consistent pattern across both surveys highlights a significant association between education, family planning use and women's empowerment.

Conclusion: The study suggests the importance of advocating for education and family planning use as interlinked pathways to empower women. To fulfil Sustainable Development Goal 5-achieving gender equality and empowering all women and girls-government must ensure intersectional strategies that remove barriers to education and reproductive autonomy.