High-risk fertility behavior and its associated factors among women with recent births in Nepal: evidence from the 2022 Nepal demographic and health survey

Abstract Introduction High-risk fertility behavior (HRFB) is a significant public health issue that can adversely affect maternal and child health, resulting in various health complications. Previous studies in Nepal have examined HRFB and its associated factors using earlier survey rounds and different study populations. This study provides an updated national assessment of HRFB among women with a recent birth, focusing on the prevalence of having at least one HRFB and the factors associated with its presence in this population. Method Data from the most recent Nepal Demographic and Health Survey (2022) were used in the study. The weighted sample of 4,377 women with a recent birth was included in the analysis. To identify the associated factors with high-risk fertility behavior, multivariable binary logistic regression models were fitted. Variables with p-value less than 0.05 were considered statistically significant, and adjusted odds ratio with 95% confidence intervals were reported. Statistical analyses were performed in R (version 4.4.3). Result Out of 4,377 women with a recent birth, 32.3% (95% CI: 30.9% − 33.7%) experienced at least one high-risk fertility behavior. Respondent education was significantly associated with lower odds among those with basic education (AOR: 0.51, 95% CI: 0.42–0.62), secondary (AOR: 0.22, 95% CI: 0.17–0.27), and higher education (AOR: 0.16, 95% CI: 0.09–0.27). Similarly, husband’s education showed a strong association, with lower odds among those with basic (AOR: 0.77, 95% CI: 0.60–0.97) and secondary education (AOR: 0.66, 95% CI: 0.50–0.85). Muslim women had higher odds of HRFB (AOR: 1.52, 95% CI: 1.09–2.11) compared to Hindu women. Women from poor households (AOR: 1.88, 95% CI: 1.55–2.28) and middle households (AOR: 1.38, 95% CI: 1.10–1.74) had higher odds than those from rich households. In addition, women whose healthcare decisions were made by someone else had higher odds of HRFB (AOR: 1.26, 95% CI: 1.02–1.54) compared to those whose decisions were made by themselves. Conclusion High-risk fertility behavior is common among nearly one-third of women of reproductive age in Nepal. It is significantly associated with multiple socio-demographic and reproductive health factors, particularly education, wealth status, religion, women’s decision-making autonomy. The result suggests the need for strategies addressing female and partner education, strengthening reproductive health programs, promoting women’s empowerment to reduce high-risk fertility behavior.