Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2025 09 15 255 267 EN Rajesh Karki Yeti Health Science Academy, Kathmandu, Nepal Mausam Adhikari Department of Public Health, Yeti Health Science Academy, Purbanchal University, Maharajgunj, Kathmandu, Nepal Roshani Poudel Central Department of Public Health, Institute of Medicine (IOM), Tribhuvan University Maheshor Kaphle Department of Public Health, Peoples Dental College and Hospital, Tribhuvan University 2025 01 13 2025 10 20 Introduction: The unmet need for family planning remains a hurdle to reproductive health equity despite, global efforts to improve access, including in Nepal. This study aimed to assess the prevalence of unmet needs for family planning and associated factors among rural women in Nepal. Methods: In 2023, a cross-sectional study was conducted among married women of reproductive age in a rural municipality in Gandaki Province, Nepal. We recruited 310 participants using consecutive sampling. Data were collected through face-to- face interviews using a structured questionnaire developed from previous literature, validated by experts, and pretested. Descriptive analysis was conducted for categorical variables, and multivariate logistic regression analysis was performed to identify factors associated with unmet needs. Results: The mean age of the respondents was 28.5 ± 5.75 years (range: 17–45 years), and the mean age at marriage was 21.07 ± 3.32 years (range: 14–34 years). More than 80% of the respondents reported having good family planning knowledge, with healthcare workers being the primary source of information (74.8%). The unmet need for family planning was 18.1% (spacing: 16.5%; limiting: 1.6%). The odds of unmet need were higher in Dalit women (AOR 6.66, 95% CI: 1.98–22.40) and women without children (AOR 2.78, 95% CI 1.09–7.13). Conversely, women with a basic education or below (AOR 0.14, 95% CI: 0.03–0.71) and those with husbands who are engaged in business (AOR 0.32, 95% CI 0.12–0.83) had lower odds. Conclusion: This study highlights the significant unmet need for family planning among rural women in Nepal, particularly among adolescents, Dalit women, and those without children. Therefore, targeted interventions are required to address these disparities. Continued efforts should focus on improving family planning access in the study area and similar rural settings, although the findings may not be generalizable to the entire country. https://jbe.tums.ac.ir/index.php/jbe/article/view/1570