Background: Maternal mortality is a major public health problem in low- and middle-income countries. Most of the maternal deaths could be prevented if there is adequate and timely use of maternal health care services by women. Decision making power of women is one of the essential factors which have influence on maternal health care service utilization.

This study aims to assess the association between women s autonomy and maternal health care utilization among Nepalese women.

Methods: This study was based on Nepal Demographic Health Survey (NDHS), 2011 which is a nationally representative, population based household survey. The total of 4,148 women was analyzed in this study. Utilization of maternal health care services was measured in terms of number of ANC visits, timing of start of ANC visit, skilled attendants during ANC visits, place of delivery and skilled attendants during delivery. Similarly, women s autonomy was assessed in terms of decision making regarding health care, large household purchases, visiting friends or relatives and spending money earned by husbands. The association of various socio-demographic variables, women s autonomy and maternal health care utilization was analyzed using Pearson s chi-square test and binary and multiple logistic regressions.

Results: About half of the studied women attended more than three times ANC visits. Almost 61% women had home delivery and only 36 % birth deliveries were attended by skilled health professionals. One fourth of women had higher level of women s autonomy and majority had medium level of autonomy. Women who had autonomy in their health care were significantly more likely to have ?3 ANC visits (OR=1.69, 95% CI= 1.41-2.03) and were also more likely to give birth at health facility (OR=1.44, 95% CI=1.26-1.64). Various socio-demographic factors such as age, education, employment and wealth quintile were also significantly associated with the utilization of maternal health care services.

Conclusion: Utilization of maternal health care services was found to be low among Nepalese women. Higher autonomy of women was associated with higher utilization of maternal health care services. Participation of women in decision making process regarding health care and household matters should be increased for the better use of maternal health care services in Nepal.