Determinants of family planning use among married women of reproductive age in south Asia: a systematic review and meta-analysis

Background Family Planning (FP) is central to reproductive autonomy; however, structural barriers and restrictive gender norms limit equitable access to modern contraceptive methods in South Asia. We aimed to synthesize the current evidence on determinants of modern contraceptive use among married women of reproductive age in South Asia. Methods We searched Medline, Scopus, Embase, and CINAHL from 1st January, 2015 to 23rd April, 2026. Observational studies from South Asian countries using multivariate analyses to examine determinants of modern contraceptive use among married women of reproductive age (15–49 years) were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool. Generic inverse variance method was used to estimate pooled odds ratios and 95% confidence intervals in RevMan. The review was registered with PROSPERO(CRD42024542764). Findings There were 78 studies with 2,212,823 study participants that met the inclusion criteria and 70 studies were included in the meta-analysis. Women's formal education and employment (OR: 1.35, 95% CI: 1.08–1.70, I 2 = 74; OR: 1.20, 95% CI: 1.01–1.42, I 2 = 0%), spousal involvement in decision-making (OR: 2.79, 95% CI: 1.17–6.65, I 2 = 66%), access to health facility with FP services (OR: 2.13, 95% CI: 1.12–4.05, I 2 = 0%), media exposure (OR: 1.26, 95% CI: 1.10–1.45, I 2 = 0%), and counselling from healthcare workers (OR: 1.57, 95% CI: 1.05–2.35, I 2 = 0%) were associated with higher modern contraceptive use, but some estimates were based on limited studies hence should be interpreted with caution. Interpretation Strengthening women's empowerment, increasing male engagement, and improving access of FP services are essential for equitable access of modern contraceptive methods across South Asia. Funding This study was not funded by any individual or agency.