Fertility intentions and influencing factors among women of reproductive age in Madhesh Province, Nepal: a population-based analysis of the 2022 Nepal demographic health survey

Fertility intentions or desires for future childbearing are necessary variables in understanding reproductive behavior, particularly in transitioning societies like Nepal. Despite a national decline in fertility rates, regional disparities persist, notably in Madhesh Province, where socio-economic and cultural barriers remain entrenched. This study explores the socio-economic and demographic factors influencing fertility intentions among women of reproductive-age in Madhesh Province. A cross-sectional analysis of secondary data from Nepal Demographic Health Survey (NDHS) 2022 was conducted. This study concentrated on women aged 15–49 years and residing in Madhesh, selected through a multistage stratified sampling approach. A weighted sub-sample of 1,643 women was analyzed using descriptive statistics and binary logistic regression to explore the determinants of fertility intentions. Age emerged as the strongest predictor: younger women (15–24 years) exhibited significantly higher fertility intentions than older cohorts. Parity showed a significant negative association with fertility intentions, with higher parity linked to lower desire for more children. Rural women had 33% lower odds of desiring more children compared to urban women. Initial associations with wealth, education, and caste/ethnicity were not significant after adjustment, while media exposure (especially newspapers) inversely correlated with fertility desires. Occupation, religion, and partner's education showed negligible effects. Fertility intentions in Madhesh Province are predominantly shaped by age, parity, rural–urban disparities, and media exposure. Interventions should prioritize the dissemination of reproductive health information through print media and the development of youth-friendly, rural-sensitive family planning programs. This study explores the why women in Madhesh Province, Nepal, decide whether or not they want to have more children. Even though Nepal’s national fertility rate is declining, some areas like Madhesh still shows higher fertility in comparison to other provinces. Understanding why women want more or fewer children can help improve reproductive health services and provincial-level planning. Using data from the Nepal Demographic Health Survey 2022, the study analyzed responses from women aged 1-49 living in Madhesh province. Factors such as age, education, residence (rural or urban), parity (number of living children) and media exposure were examined to see how they influence fertility intentions. The results showed that younger women and those with fewer children were more likely to want more children, while rural women and those exposed to print media (like newspaper) were less likely. Fertility intention declined with increasing number of children, being highest among women with 1–2 children and lowest among those with five or more. These findings highlight the need for youth-centered and rural targeted reproductive health programs and for using accessible media to promote informed family planning choices in Madhesh Province. These results suggest that health programs in Madhesh should focus more on young women and rural communities. Also, using print media like newspapers to share information about family planning could help more women make informed decisions about their reproductive health.