Key Social Norms Take-aways Gender roles, particularly those that support shared responsibility for child-rearing, play a significant role in contraceptive use among rural couples in Nepal. While mutual spousal decision-making is often assumed to influence contraceptive uptake, this study found limited direct association. Instead, more equitable gender norms—such as men contributing to childcare and not assuming women are the sole caregivers—were more strongly associated with both current and ever use of contraception. These findings suggest that social norms around gender roles may indirectly shape family planning behaviours and should be a central focus of reproductive health interventions.

Objectives To examine the influence of gender roles and decision-making on contraceptive use among rural couples in Nepal, and to identify associated demographic and socio-economic factors.

Methods This study conducted a secondary analysis of a 2012–2013 cross-sectional survey of 440 couples in four rural villages in Nepal’s Syangja district. Data were collected via structured questionnaires from either partner in each couple, capturing demographic, socio-economic, gender role, and decision-making variables. Logistic regression was used to explore associations with current and ever use of contraception, adjusting for confounders.

Intervention Details This was not an intervention study, but the findings inform future programming by identifying the importance of gender roles in influencing contraceptive behaviours.

Results Forty percent of participants reported current contraceptive use, and 65.5% reported ever using contraception. Gender roles—particularly shared childcare responsibilities and rejecting the notion that only women should care for children—were significantly associated with contraceptive use. Decision-making variables (e.g., who decided on family size or pregnancy timing) were largely not associated with contraceptive use after adjusting for other factors. Women with secondary education were surprisingly less likely to report current use than those with less education. Men were more likely than women to report contraceptive use, and couples in nuclear families were more likely to use contraception than those in joint families.

Conclusions Gender norms play a more significant role in contraceptive use than decision-making structures per se. Programs should prioritize engaging both men and women in family planning efforts and aim to shift underlying gender norms—particularly around shared responsibilities in parenting and household roles—to enhance contraceptive uptake.