Abstract / Summary
Women’s empowerment is a global development priority that serves as both an independent goal and a critical determinant of maternal and newborn health (MNH) outcomes. This study aimed to assess the association between women’s empowerment and utilization of MNH services from pregnancy throughout postpartum, including the continuum of care (CoC) among married women in Nepal. This cross-sectional study analyzed data from the 2022 Nepal Demographic and Health Survey, including 1,876 women (15–49 years) with children under two years. Women’s empowerment was measured using the validated survey-based Women’s emPowERment (SWPER) index. MNH utilization outcomes included ≥ 4 antenatal care visits, health facility delivery, postnatal care within 48 h for mother and newborn, and CoC. Multivariable logistic regression was used to estimate the prevalence odds ratio (PrOR) for the association between empowerment domains and MNH service utilization, stratified by place of residence. Overall, 81.7% of women reported high empowerment regarding attitudes towards violence (urban: 83.4% vs. rural: 78.6%); 36.1% for social independence (urban: 39.7% vs. rural: 29.2%); and 32.6% for household decision-making (urban: 32.1% vs. rural: 33.7%). Women with high social independence had higher odds of completing the MNH continuum of care compared to those with low independence (PrOR: 1.61; 95% CI: 1.10–2.36). This association remained significant in urban (PrOR: 1.70; 95% CI: 1.01–2.84) but not rural settings (PrOR: 1.52; 95% CI: 0.87–2.65). Household decision-making was not significantly associated with most MNH services; however, rural women with high decision-making status were significantly less likely to complete ≥ 4 ANC visits (PrOR: 0.44; 95% CI: 0.23–0.85). Similarly, in rural settings, women with high empowerment regarding attitudes towards violence were less likely to deliver in a health facility (PrOR: 0.21; 95% CI: 0.06–0.66) compared to those with low empowerment in the same domain. Higher social independence is associated with greater utilization of MNH services, particularly in urban settings, whereas in rural Nepal, empowerment alone appears insufficient to overcome health system and geographic barriers to access services. Public health interventions should move beyond individual empowerment to adopt cross-sectoral strategies that simultaneously address structural constraints and improve service accessibility in remote regions.