Key Social Norms Take-aways This study reveals how patriarchal and extended family norms continue to shape young women’s reproductive health experiences in Nepal, particularly when their husbands migrate for work. Despite gaining more autonomy in some areas, women with migrant husbands still navigate deeply entrenched norms around spousal absence, fertility expectations, and decision-making power controlled by in-laws. However, these women also report feeling less social pressure to conform to community expectations related to family planning and fertility—suggesting that migration disrupts traditional norms and opens limited space for individual agency.

Objectives To examine how male labor migration impacts young married women’s family planning use, fertility awareness, relationship dynamics, and decision-making autonomy in Nepal, particularly comparing women with migrant husbands to those with co-resident spouses.

Methods A cross-sectional baseline survey was conducted with 2,430 participants aged 15–24 across five diverse districts of Nepal in 2016, as part of the USAID-funded Fertility Awareness Community Transformation (FACT) Project. This sub-analysis focused on 1,123 married women, including 485 with migrant husbands. The study employed standardized questionnaires and social norms scales to assess fertility knowledge, autonomy, and social pressure related to reproductive health behaviors.

Results Women with migrant husbands were significantly less likely to use modern family planning methods (9.3% vs. 30.3%) and more likely to intend pregnancy within the next year, despite lower fertility awareness and less spousal communication. They had higher rates of full autonomy in decisions regarding health and mobility, yet also showed lower relationship satisfaction. Social norms analysis revealed they experienced significantly less pressure from family and community to use family planning, delay first birth, or bear sons compared to women with resident husbands.

Conclusions Married women with migrant husbands represent a distinct demographic with unique reproductive health needs. While they may experience slightly greater autonomy, they face knowledge gaps and limited spousal communication that hinder informed family planning. Interventions targeting this group should focus on increasing fertility awareness, promoting preconception counseling, and improving couple communication—particularly timed to coincide with migrant husbands’ home visits. Programs should also engage in-laws and broader community structures to address persisting normative constraints.