Men’s labour migration and attitudes towards women’s sexual autonomy: evidence from the National Family Health Survey 2019–21

Abstract

Background

Male labour migration is common across India and often results in extended periods of spousal separation. This absence changes who holds responsibility and decision-making power at home, and can reshape traditional gender roles and women's autonomy. Sexual autonomy, a woman's ability to control her own body, negotiate safe sex, and make her own reproductive choices, is one part of this shift. Because separation changes spousal dynamics, it can also create different expectations around this autonomy. Our study looks at how male labour migration relates to men's own perceptions of women's sexual autonomy.

Data & methods

We use data from the fifth round of the National Family Health Survey (NFHS-5). The sample includes women aged 15–49 and men aged 15–54. After excluding non-working respondents, the final sample is 82,598 individuals. Migration status is defined as an employment-related absence from the place of residence for at least one month, classified as short-term or long-term migration. We use binary logistic regression to examine the link between migration status and men's perceptions of women's sexual autonomy, adjusting for relevant socioeconomic and demographic factors.

Results

Our study finds that 15.3% of men were temporary migrants (8.9% short-term, 6.4% long-term), confirming migration as a major livelihood strategy in India. In unadjusted models, both short- and long-term migrants, along with men who reported substance use, were significantly more likely to hold negative attitudes toward women's sexual autonomy. After adjusting for sociodemographic factors, the odds of holding negative attitudes were significantly lower among middle-aged men (45–54 years), men from the Scheduled Castes, and men with higher education.

Conclusion

Migration status has a significant role to play in the male perspective on the sexual autonomy of women. Both short- and long-term labour migrants are more likely than non-migrants to hold negative attitudes toward women's sexual autonomy. Our findings point to the need for targeted social and behavioural interventions aimed specifically at younger male migrants who are engaged in substance abuse.

Introduction

Migration is a social and economic force that reshapes family structures, gender relations, and community norms. Male labour migration, especially in low- and middle-income countries, often leads to long spousal separation and shifts how households make decisions [10]. This separation can weaken closeness and intimacy in a marriage [20]. At the same time, it changes what is expected of the wife left behind: she takes on more unpaid labour and domestic duties, but she also gains more room to make decisions in the home. These two outcomes, the added burden and the added autonomy, are distinct. Burden refers to the rise in unpaid work and household duties; autonomy refers to a woman’s actual decision-making power. Male absence makes both possible at once, because it redistributes roles within structural limits that remain firmly in place. In India, women are more likely to have a say in daily cooking decisions, spending on expensive household items, and decisions about their children’s marriage and healthcare when their husbands are away [10]. In Mozambique, women whose husbands have migrated report greater freedom to visit friends and family, look for work, travel to the city or district capital, and get tested for HIV [31]. Across these contexts, men’s migration tends to increase their spouses’ independence and decision-making power [31]. This is a meaningful shift in countries where women have historically held less personal autonomy under patriarchal norms [6], with less access to resources and less control over decisions than men [14, 22, 26]. But this body of research stops at household decision-making

Sexual autonomy refers to a person’s ability to negotiate safer sex, reduce unwanted sexual contact, make informed and voluntary decisions about sexual activity, and exercise control over their own body and reproductive choices [2, 19, 30]. It is widely recognised as a basic human right and a core part of sexual and reproductive health and well-being [12]. Women’s sexual autonomy remains a serious concern in patriarchal settings, where social norms often limit it directly. Studies show that women with greater sexual autonomy are more likely to negotiate condom use, use contraception, and avoid negative reproductive health outcomes such as STIs and unwanted pregnancy [1, 8]

Power dynamics within sexual relationships are shaped by conventional ideas about masculinity, femininity, and gender inequality more broadly [5]. Migration adds another layer to this: some studies find that male out-migration increases women’s autonomy at the household level, but this does not automatically extend to sexual autonomy — patriarchal norms, social surveillance, and economic dependency on the husband can persist regardless of his physical absence [18, 20, 31].

Male labour migration could be associated with male attitudes toward women’s sexual autonomy through several pathways. First, economic mobility and remittances may reinforce a man’s role as provider, strengthening traditional patriarchal authority at home [10]. Second, long spousal separation may also weaken emotional intimacy and communication between partners, which can increase suspicion or a need to control the wife’s sexuality [20]. Third, exposure to urban or destination settings may introduce different gender norms and more liberal attitudes toward women’s decision-making and sexual rights [16]. Fourth, difficult migration experiences, such as poor working conditions and social isolation, may raise stress, alcohol use, and risk-taking, all of which are linked to more controlling and coercive sexual attitudes [13, 21]. Because these pathways pull in opposite directions, the actual effect of migration on attitudes is an open empirical question.

Two competing theoretical frameworks help explain why migration could push attitudes in either direction. Social remittances theory [17] suggests that migrant men bring back new ideas and values from their destination, which can shift them and their households toward more gender-equitable attitudes. Hegemonic masculinity theory suggests migration can deepen patriarchal attitudes if it strengthens a man’s role as economic provider, or if separation creates insecurity about his authority and his wife’s fidelity. These two frameworks predict opposite outcomes, which is part of why this needs empirical testing rather than assumption

Most existing research has examined how male migration affects women’s economic autonomy and household decision-making, as well as the consequences for women left behind. Far less attention has gone to the men themselves: how migration shapes their own gender attitudes, and specifically their attitudes toward women’s sexual autonomy. This matters because men’s attitudes directly interact with sexual negotiation, reproductive health outcomes, and the balance of power within marriage. Studies also treat migration as a single, uniform experience, without separating short-term from long-term absence, so we know little about whether migration duration itself changes these attitudes. Our study addresses that gap. Using nationally representative data from the NFHS-5, we examine the relationship between men’s labour migration and their attitudes toward women’s sexual autonomy in India, distinguishing between short- and long-term migration and accounting for substance use and socio-demographic factors

Methodology

Data sources

This study draws on data from the fifth round of the National Family Health Survey (NFHS-5), carried out between 2019 and 2021. NFHS-5 is a nationally representative, large-scale survey that provides detailed information on population characteristics, family planning, maternal and child health, nutrition, morbidity, and socio-economic and demographic conditions across all states and union territories of India. The survey used a two-stage sampling design in rural areas and a three-stage design in urban areas. Conducted in two phases, it covered 636,699 households and included 724,115 women aged 15–49 and 101,839 men aged 15–54. Full details on the survey methodology are available in the NFHS-5 India report (International Institute for Population Sciences (IIPS) and ICF, 2021).

Study sample

For this study, we use the men’s sample. We first exclude men who were not engaged in any economic activity, since labour migration status is only meaningful for working men. Among the remaining working men, anyone away from home for one month or more was classified as a labour migrant. The full criteria for building the study sample are shown in Fig. 1.

Fig. 1.

Selection criteria for study sample of men (aged 15–54 years) in India, NFHS-5, 2019–21

Outcome variable

The main outcome variable is men’s attitudes toward the sexual autonomy of women. In NFHS-5, men were asked whether, if their wives refuse to have sex, the husband has the right to (a) get angry, (b) refuse financial support, (c) use force for sex, and (d) have sex with another woman. We built the outcome variable by combining responses to these four questions: men who answered positively to at least one was coded as holding a negative attitude (1); all others were coded 0 (scale reliability coefficient: alpha = 0.84).

Main explanatory variables: migration status

NFHS-5 does not ask about migration status directly, but it does ask two related questions. First, respondents were asked whether, in the last 12 months, they had been away from home for one month or more at a time. Those who answered yes were then asked whether they had been away for six months or more at a time. Based on these two questions, we classified respondents into three groups: men who had never been away from home for at least one month were considered non-migrants; those away for at least one month but less than six months were considered short-term or temporary migrants [7, 15] and those away for six months or more were considered long-term or semi-permanent migrants (NSSO, 2010)

Other explanatory variables

Other explanatory variables include respondents’ age (15–24, 25–34, 35–44, and 45–54), education (no education, primary, secondary, and higher), marital status (never married, married, others), occupation (professional, clerical, sales, services, agriculture, production worker, and other), residence (rural, urban), religion (Hindu, Muslim, Christian, and others), social group (Scheduled Castes, Scheduled Tribes, Other Backward Classes, and Others), wealth index (poorer, poor, middle class, rich, and richest), media exposure, smoking behavior, and alcohol use (no, yes).

Methods

Descriptive statistics were used to present the distribution of outcome and explanatory variables. The analysis included a total sample of 82,598 men aged 15–54 years, comprising 70,039 non-migrants, 7,253 short-term migrants, and 5,306 long-term migrants. The outcome variable of the study is men’s attitudes towards women’s sexual autonomy (MASAW),

Statistical methods

We used descriptive statistics to show the distribution of the outcome and explanatory variables across the full sample of 82,598 men aged 15–54, 70,039 non-migrants, 7,253 short-term migrants, and 5,306 long-term migrants. We then ran a bivariate analysis to examine how the outcome variable, men’s attitudes toward women’s sexual autonomy (MASAW), varies by background characteristics, using a chi-square test to assess significance. Finally, we ran a binary logistic regression to examine the association between migration status and MASAW. We report two models as odds ratios (ORs) with 95% confidence intervals (CIs): Model I provides unadjusted estimates (UORs), and Model II provides adjusted estimates (AORs) for migration status after controlling for covariates. All analyses were run in Stata MP 17.

Results

Demographic characteristics of the sample

Among the 82,598 men in the sample, 8.9% were short-term migrants and 6.4% were long-term migrants (Table 1). About 49% of men overall were aged 15–34; but long-term migrants were younger as a group, about 61.5% fell in this age range, compared to 47.6% of non-migrants. Long-term migrants were also more educated, 18.2% had completed high school or above, compared to 15.5% of short-term migrants and 15.7% of non-migrants. About 39.8% of men overall worked in agriculture, with smaller shares in other occupations. Non-migrants had higher shares in agriculture (40.9%) and sales (10.5%) than short-term migrants (35.1%, 8.4%) and long-term migrants (31.1%, 7.7%). Most men lived in rural areas, about 78% of long-term migrants, 79% of short-term migrants, and 74% of non-migrants. Hindu men had a slightly lower share among short-term migrants but a higher share among long-term migrants than Muslim and Christian men. Scheduled Castes and Scheduled Tribes were more represented among short-term migrants than long-term migrants, while Other Backwards Classes were more represented among long-term migrants. Short-term migrants were the poorest group: 26.9% fell in the poorest category, compared to 23.9% of long-term migrants and 19.7% of non-migrants. Men in the richest wealth quintile were the least likely to migrate at all. Long-term migrants had the highest media exposure (77.8%), followed by short-term migrants (74.1%) and non-migrants (73.6%). Both short-term and long-term migrants were more likely to smoke and drink alcohol than non-migrants.

Table 1.

Percentage of men (age 15–54) according to temporary migration status and their background characteristics, National Family Health Survey (NFHS-5), India, 2019–2020

Characteristics	Migration Status			Total
	NM	STM	LTM	%	Number
Total Sample (%)	70,039 (84.80)	7253 (8.78)	5,306 (6.42)	100	82,598
Age
15–24	17.3	24.3	25.1	18.4	15,198
25–34	30.3	34.0	36.4	31.0	25,628
35–44	28.6	25.0	22.9	28.0	23,085
45–54	23.8	16.8	15.6	22.6	18,687
Years of Schooling
No education	14.1	13.3	13.2	13.9	11,507
5 years	13.5	14.9	12.5	13.5	11,179
6—9 years	56.7	56.4	56.1	56.7	46,800
10 years or above	15.7	15.5	18.2	15.9	13,112
Marital Status
Never married	22.8	27.6	31.9	23.8	19,674
Currently married	75.4	70.7	66.5	74.4	31,447
Others	1.8	1.8	1.7	1.8	1,477
Occupation
Agriculture	40.93	35.1	31.12	39.79	32,864
Professional	6.23	6.25	8.48	6.38	5,266
Clerical	1.9	1.81	2.3	1.92	1,587
Sales	10.45	8.4	7.65	10.09	8,334
Services	7.33	8.53	11.1	7.68	6,341
Production worker	28.21	34.14	31.98	28.97	23,930
Others	4.95	5.78	7.37	5.18	4,276
Residence
Rural	73.7	79.2	78.1	74.5	61,537
Urban	26.3	20.8	21.9	25.5	21,061
Religion
Hindu	76.1	73.9	76.3	76.0	62,738
Muslim	11.7	13.4	12.4	11.9	9,810
Christian	7.0	8.1	6.2	7.0	5,818
Others	5.2	4.6	5.1	5.1	4,232
Social Group
Scheduled Castes	18.8	20.5	20.2	19.1	15,739
Scheduled Tribes	19.2	22.0	19.1	19.4	16,057
Other Backward Classes	38.7	35.4	40.7	38.6	31,847
Others	23.3	22.1	20.0	23.0	18,955
Wealth Index
Poorest	19.7	26.9	23.9	20.6	17,033
Poor	22.1	25.1	23.4	22.4	18,524
Middle	21.3	20.4	21.7	21.4	17,529
Rich	19.9	15.6	18.4	19.4	16,044
Richest	17.0	12.1	12.6	16.3	13,468
Media Exposure
No	26.4	26.0	22.2	26.1	21,524
Yes	73.6	74.1	77.8	73.9	61,074
Smoking
No	85.0	79.3	78.4	84.0	69,405
Yes	15.1	20.8	21.6	16.0	13,193
Substance Use
No	70.8	65.4	66.0	70.0	57,832
Yes	29.2	34.6	34.0	30.0	24,766

Figure 2 shows men’s negative attitudes toward women’s sexual autonomy by migration status. “Getting angry” was the most common negative response across all three groups — 19.3% of non-migrants, 21.1% of short-term migrants, and 21.6% of long-term migrants. The belief that a husband can refuse financial support was higher among long-term migrants (16.3%) than among non-migrants and short-term migrants (13.0% each). About 15.6% of long-term migrants justified using force for sex, compared to 12.4% of non-migrants and 11.4% of short-term migrants. Similarly, 15.1% of long-term migrants believed a husband can have sex with another woman if his wife refuses, compared to 12.6% of non-migrants and 13.7% of short-term migrants. Overall, negative attitudes toward women’s sexual autonomy were highest among long-term migrants (33.6%), followed by short-term migrants (30.2%) and non-migrants (27.8%).

Fig. 2.

Prevalence of Men's attitudes towards the sexual autonomy of women by Migration status, NFHS-5, 2019–21

Table 2 shows that long-term migrants (33.6%) and short-term migrants (30.2%) held more negative attitudes than non-migrants (27.8%). Men with more education and higher wealth held fewer negative attitudes than their counterparts. Men in agriculture (30.0%) and services (29.4%) held more negative attitudes than men in most other occupations. Muslim men and men from the Scheduled Castes also held more negative attitudes than their counterparts. Men who smoked held more negative attitudes (33.6%) than non-smokers (27.4%), and men who used substances held more negative attitudes (32.2%) than those who did not (27.0%).

Table 2.

Prevalence of men’s attitudes towards the sexual autonomy of women (MASAW) by their background characteristics, National Family Health Survey (NFHS-5), India, 2019–2020

Characteristics	% (W)		P Value
	Positive Attitude	Negative Attitude
MASAW	71.7	28.3
Migration status
Non-migrants	72.2	27.8	< 0.001
Short-term migrants	69.8	30.2
Long-term migrants	66.4	33.6
Age
15–24	71.6	28.4	< 0.001
25–34	72.0	28.0
35–44	71.2	28.8
45–54	71.8	28.2
Education			0.028
No education	69.7	30.3
Primary	69.3	30.7
Secondary	71.6	28.4
Higher	75.3	24.7	< 0.001
Marital Status
Never married	71.6	28.5
Currently married	71.9	28.1
Others	72.7	27.33
Occupation
Agriculture	70.0	30.03	< 0.001
Professional	74.6	25.4
Clerical	78.8	21.2
Sales	73.5	26.5
Services	70.6	29.4
Production worker	73.2	26.8
Others	64.3	35.7
Residence
Rural	73.0	27.0	0.907
Urban	73.2	26.8
Religion
Hindu	72.6	27.4	< 0.001
Muslim	69.1	30.9
Christian	70.6	29.4
Others	58.7	41.3
Social Group
Scheduled Castes	70.2	29.8	< 0.001
Scheduled Tribes	74.1	25.9
Other Backward Classes	71.4	28.6
Others	72.3	27.7
Wealth Index
Poorest	70.5	29.5	< 0.001
Poor	71.6	28.4
Middle	71.3	28.8
Rich	71.4	28.6
Richest	73.6	26.4
Media Exposure
No	72.3	27.7	0.001
Yes	71.5	28.5
Smoking
No	72.6	27.4	0.001
Yes	66.39	33.6
Substance use
No	73.0	27.0	< 0.001
Yes	67.8	32.2

%(W) Weighted Percentage, MASAW Men’s Attitude towards Sexual Autonomy of Women, SC Scheduled Caste, ST Scheduled Tribes, OBC Other Backwards Classes

a: Includes technical, administrative, and managerial occupations

b: Includes skilled and unskilled manual occupations

Associations between temporary migration status and men’s attitudes towards the sexual autonomy of women

Table 3 shows the estimates of logistic regression to examine the association between temporary migration status and men’s attitudes towards the sexual autonomy of women. Approximately 28.3% of men exhibited negative attitudes towards women’s sexual autonomy. In the unadjusted model, the results show that men who were migrants (both short-term and long-term) were significantly more likely to have negative attitudes towards sexual autonomy. After adjusting for the covariates, Model II shows that short-term migrants (AOR: 1.13; CI: 1.07–1.19) and long-term migrants (AOR: 1.41; CI: 1.32–1.49) were more likely to have negative attitudes than non-migrants. Similarly, men who used substances were 1.16 times more likely (AOR: 1.16; CI: 1.12–1.20) to have negative attitudes. Logistic estimates in Model II further show that men belonging to the older age group (45–54 years), those with higher education, and those belonging to Scheduled Tribes and Other Backward Classes had significantly lower odds of negative attitudes. On the other hand, men belonging to the Muslim religion and those in higher wealth categories had significantly higher odds of having negative attitudes towards the sexual autonomy of women. Compared with those engaged in agriculture (reference category), men working in professional, clerical, sales, service, and production occupations had lower odds of negative attitudes.

Table 3.

Binary logistic estimates showing the associations between temporary migration status and men’s attitudes towards the sexual autonomy of women, National Family Health Survey (NFHS-5), India, 2019–2020

Characteristics	Model 1		Model 2
	UOR	CI (95%)	AOR	CI (95%)
Migration status
Non-migrants®	1	[1.00,1.00]	1	[1.00,1.00]
Short-term migrants	1.12***	[1.06,1.18]	1.13***	[1.07,1.19]
Long-term migrants	1.40***	[1.32,1.49]	1.41***	[1.32,1.49]
Age®
15–24			1	[1.00,1.00]
25–34			0.95**	[0.90,1.00]
35–44			0.93**	[0.87,0.98]
45–54			0.89***	[0.83,0.95]
Education®
No education			1	[1.00,1.00]
Primary			0.92***	[0.86,0.97]
Secondary			0.82***	[0.78,0.86]
Higher			0.69***	[0.64,0.73]
Marital Status®
Never married			1	[1.00,1.00]
Currently married			0.95**	[0.90,1.00]
Others			0.98	[0.86,1.11]
Occupation®
Agriculture			1	[1.00,1.00]
Professional			0.79***	[0.73,0.86]
clerical			0.72***	[0.64,0.81]
sales			0.84***	[0.79,0.89]
services			0.87***	[0.82,0.93]
Production worker			0.78***	[0.75,0.81]
Others			1.16***	[1.08,1.25]
Residence®
Rural			1	[1.00,1.00]
Urban			1	[0.96,1.04]
Religion®
Hindu			1	[1.00,1.00]
Muslim			1.22***	[1.16,1.28]
Christian			1.14***	[1.07,1.22]
Others			2.53***	[2.37,2.70]
Social Group®
SCs			1	[1.00,1.00]
STs			0.73***	[0.69,0.77]
OBCs			0.85***	[0.82,0.89]
Others			0.86***	[0.82,0.91]
Wealth Index®
Poorest			1	[1.00,1.00]
Poor			1	[0.95,1.05]
Middle			1.11***	[1.05,1.17]
Rich			1.17***	[1.10,1.24]
Richest			1.29***	[1.21,1.38]
Media Exposure®
No			1	[1.00,1.00]
Yes			1.08***	[1.03,1.12]
Smoking®
No			1	[1.00,1.00]
Yes			1.15***	[1.10,1.21]
Substance use®
No			1	[1.00,1.00]
Yes			1.16***	[1.12,1.20]

Discussion

This study examined the association between temporary labour migration and men’s attitudes toward women’s sexual autonomy in India. The results demonstrate that, in comparison to non-migrants, migrant men—especially those who have been migrants for a long time—are more likely to have negative opinions about women’s sexual autonomy. This pattern contradicts the widely held theoretical belief that social learning and exposure to diverse social contexts during migration and urbanisation lead to more progressive gender norms [3, 9].

Several interrelated mechanisms may explain this unexpected finding. First, many migration destinations for low- and semi-skilled workers are characterised by economic precarity, informal employment, and male-dominated social networks rather than serving as places of liberal norm diffusion [29]. Migration may strengthen masculine authority and patriarchal expectations in these contexts, especially at times of social fragility and economic strain. In situations where traditional provider roles are challenged, maintaining control over women's sexuality may act as a symbolic declaration of authority [4].

Several mechanisms may explain these findings. First, migration destinations for low- and semi-skilled workers tend to involve economic precarity, informal employment, and male-dominated social networks, rather than offering exposure to more liberal norms [29]. In this kind of setting, migration may actually strengthen masculine authority and patriarchal expectations, especially when migrants face economic strain. When a man’s role as provider is under pressure, controlling his wife’s sexuality may serve as a way of asserting authority elsewhere [4]. Second, in cyclical and short-term migration, the assumption that migrants gain real exposure to egalitarian norms may not hold. Migrants often have limited social integration at their destination and remain within similar peer networks rather than encountering different gender norms [11]. Third, mobile communication dilutes the idea that physical distance reduces a husband’s control over the household decision making. Migrant husbands can stay in constant phone contact, monitoring and directing household decisions from a distance. Therefore, migration does not necessarily reduce control, even when it creates physical separation. Fourth, selection may also play a role. Men who already hold more conservative gender attitudes may be more likely to migrate in the first place, due to structural and economic pressures [25]. This would mean migration is not a neutral experience that changes attitudes, but one that is shaped by the attitudes men already hold before they leave.

Taken together, these findings suggest that the social remittances theory only partly explains what we see in internal labour migration in India. Our results align more closely with hegemonic masculinity theory, which expects male control to persist and adapt even as economic and social circumstances shift, rather than with social remittances theory, which expects migration to liberalise attitudes. The findings also show that age, education, and wealth shape gender attitudes alongside migration status [23]. Younger men held more regressive attitudes than older men, while more education was linked to more gender-equitable attitudes. These findings point to interventions that go beyond the economic side of migration. Programs should include gender-sensitisation efforts and approaches that account for how digital communication can be used to maintain control within migrant households. This is also found in existing evidence that migration affects social norms and family dynamics in gender-structured settings [3, 9]

There are a few limitations to our study. The cross-sectional design means we cannot make causal claims about these relationships. Reporting bias may also affect how men answer attitudinal questions. Future studies using longitudinal designs and more detailed measures of migration experience could help clarify how migration shapes gender attitudes over the life course.

Conclusion

Our study shows that migration is a significant determinant in shaping men’s attitudes toward women’s sexual autonomy in India. Both temporary and long-term migrants are more likely than non-migrants to have negative attitudes toward women's sexual autonomy, defyinthe widespread belief that migration and exposure to metropolitan environments inevitably result in more progressive viewpoints.

Additionally, we find that these attitudes are influenced by important social and economic variables, such as education, income, occupation, and religion, and are associated with substance use. Younger men seem more likely to hold less progressive opinions, whereas men with greater education tend to hold more gender-equitable attitudes. Overall, these results imply that migration may not always improve gender attitudes and, in certain situations, exacerbate existing disparities. This highlights the need for more targeted and context-specific interventions, particularly for migrant men. These include initiatives that directly address enduring patriarchal practices in homes and social networks, as well as gender awareness programs in migrant communities and workplaces.

Authors’ contributions

1. Vikesh Kumar: Conceptualization of the research idea; formal analysis; data curation and data analysis; preparation of tables; writing the data, methods, and results sections; project administration; provision of resources; and overall supervision. 2. Ankit Gupta: Conceptual support in manuscript preparation; drafting the introduction; formatting and visualization of results; identification of potential funding sources; information gathering for publication; and finalization of the manuscript draft for submission. 3. Priti: Writing the discussion section; drafting and revising the manuscript; methodological application; validation of analytical results; and preparation of the original draft. 4. Phanidhar Upadhyaya: Investigation; manuscript review and editorial support; providing recommendations for improving manuscript quality; ethical oversight; and methodological guidance.

Funding

There is no available funding for doing this research. Researchers have done it by self as it is based on the secondary publicly available dataset.

Data availability

The data used in this study were obtained from the National Family Health Survey (NFHS-5), conducted by the Ministry of Health and Family Welfare, Government of India, and coordinated by the International Institute for Population Sciences (IIPS), Mumbai. The dataset is publicly available and can be accessed from the DHS Program website or the ( https://www.iipsdata.ac.in/datacatalog_detail/1 ).

Declarations

Ethics approval and consent to participate

This study is based entirely on secondary data from the publicly available National Family Health Survey (NFHS-5, 2019–21). NFHS-5 data were collected under the supervision of the Ministry of Health and Family Welfare (MoHFW), Government of India, and ethical approvals for the survey were obtained from the Institutional Review Boards (IRB) of the International Institute for Population Sciences (IIPS), Mumbai, and other collaborating institutions. Written informed consent was obtained from all participants by the survey teams before data collection. No separate ethical approval was required for this analysis, as it uses anonymized, publicly available data.

Consent for publication

As NFHS data is a publicly available data on DHS program website and IIPS website too. Anyone who wants to explore or wants to do research they can access data freely, analyse, research and publish it. So, there is no need for the consent of publication.

Competing interests

The authors declare no competing interests.