Knowledge and utilization of family planning and safe abortion services among married women of reproductive age in the Raute community of Nepal: a census-based cross-sectional study

Indigenous and nomadic communities worldwide face disproportionate and persistent barriers to reproductive health services, including family planning and safe abortion. The Raute of Nepal -- one of the country's last nomadic hunter-gatherer groups represent a uniquely marginalized population for whom no prior population-level quantitative reproductive health data exist. This gap prevents health authorities and program implementers from designing evidence-based, culturally appropriate interventions for this community. This census-based cross-sectional study enrolled all 192 eligible married women of reproductive age in the Raute community of Parshuram Municipality, Dadeldhura district, Sudurpaschim Province, Nepal. Data were collected through structured, pre-tested, face-to-face interviews, and analyzed using descriptive statistics, chi-square tests, and binary logistic regression in IBM SPSS version 16. More than half of participants (53.6%) currently used family planning, with injectable contraceptives being the most common method (42.7%), followed by female sterilization (33.0%) and implants (24.3%). Condom use was negligible at 1.0%. Among non-users (46.4%), 97.7% cited lack of interest as the primary reason for non-use. Knowledge of safe abortion services was reported by 61.5% of women, yet only 8.3% had ever accessed such services, and awareness of Nepal's national safe abortion policy, which has been in effect since 2002 was critically low at 10.4%. In bivariate analysis, no socio-demographic or socioeconomic variable was significantly associated with family planning use. The sole significant independent predictor of current family planning utilization in the adjusted logistic regression model was non-utilization of safe abortion services (adjusted odds ratio = 4.275; 95% confidence interval: 1.145-15.954; p = 0.030), suggesting that contraceptive use and abortion service use represent alternative reproductive management strategies in this community. Younger age ([≤]30 years) and urban residence were significantly associated with safe abortion use in bivariate analysis but were attenuated after adjustment, reflecting limited statistical power arising from the small number of outcome events (n = 16). These findings reveal critical gaps in reproductive method diversity, safe abortion policy literacy, and male partner engagement. Community-based mobile outreach tailored to nomadic movement patterns, targeted legal literacy programs in the local language, and structured male involvement strategies are urgently required to improve reproductive health equity in this vulnerable indigenous population.