International Institute for Population Sciences
Deemed to be University (An Autonomous Organization of Ministry of Health & Family Welfare, Government of India)

Abstract Introduction In a patrilocal society, family structure plays a pivotal role in shaping women's involvement in decision-making. This study examines the relationship between household structure and women's decision-making within households across four South Asian countries: India, Nepal, Bangladesh, and Pakistan. Methods Data from nationally representative DHS surveys were analysed across four domains of women’s decision-making: health, purchases, mobility, and financial expenditures. Descriptive and multivariable logistic regression models were used to examine how household typologies influence women's autonomy. Results Women's decision-making autonomy varies significantly by family structure. Female-headed nuclear families demonstrate the highest autonomy, especially in Pakistan (OR=5.52 for spending) and India (OR=1.89 for health). Conversely, male-headed joint families restrict autonomy, reducing health decisions by 41% and purchases by 57% in Pakistan. Male-headed complex households further limit women’s participation, with 7–33% lower odds across domains. In Bangladesh, male-headed nuclear families decrease purchase decision-making by 31% and visit decisions by 43%. Higher education increases autonomy up to fivefold, while urban residence boosts participation by 15–20 percentage points. Discussion Our findings indicate that family structure shapes women's decision-making. The limited involvement of women in decision-making in this region highlights the need to address systematic barriers and the intersectional factors of socio-economic conditions. Urbanization policies enhancing rural women’s mobility and education reforms targeting intergenerational gender norms can dismantle household-level barriers. Keywords: Women's Autonomy, Family Structure, Decision-Making, South Asia, DHS