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Introduction: Studies show that maternal health in Nepal has improved, but that maternal mortality is still alarmingly high. Nepal is a country heavily controlled by traditions and women are often discriminated. Research shows that patriarchal traditional family structures restrict women's ability to decide for themselves about family planning and pregnancy. This affects both women's and children's health. We, therefore, wanted to study in depth with a qualitative approach, healthcare professionals who work with sexual and reproductive health and their perceptions about socio-cultural factors and barriers within the extended family structure in Nepal that may influence women's decisions regarding their sexual and reproductive health. Objective: To describe the patriarchal traditional family structure in Nepal and its impact on woman’s decision making authority regarding sexual and reproductive health through the healthcare providers’ perceptions. Design: A qualitative approach; semi-structured interviews with 15 healthcare providers with different educational levels, in both rural and urban area and content analysis for analysis of data. Results: The main category was ‘Patriarchal traditional family structure has great impact on women’s decision-making authority. This was divided into two categories: ‘patriarchal traditional family structure - a barrier for decision-making authority regarding reproductive health’ which was divided into five subcategories and ‘patriarchal traditional family structure as a support for decision-making authority regarding reproductive health’ divided into three subcategories. Conclusions: The patriarchal traditional family structure can be both a barrier and a support for women’s decision-making authority regarding sexual and reproductive health. Clinical implications: This knowledge might shed light on causes for birth and pregnancy-related morbidity and mortality. Possibly it can help to scale up interventions to improve women’s health and decision-making authority in Nepal.

Inledning: Studier visar att mödrars hälsa i Nepal har förbättrats, men att mödradödligheten fortfarande är oroväckande hög. Nepal är ett land starkt kontrollerat av traditioner och kvinnor diskrimineras ofta. Forskning visar att patriarkala traditionella familjestrukturer begränsar kvinnors sannolikhet att få bestämma i frågor som rör familjeplanering och graviditet. Detta påverkar både kvinnors och barns hälsa. Syfte: Att beskriva den patriarkala traditionella familjestrukturen i Nepal och dess inverkan på kvinnans beslutsfattande avseende sexuell och reproduktiv hälsa genom vårdgivarens perspektiv. Design: En kvalitativ metod; semistrukturerade intervjuer med 15 vårdgivare samt innehållsanalys för analys av data. Resultat: Huvudtemat som framkom i intervjuerna var, ‘Patriarchal traditional family structure has great impact on women’s decision making authority’ vilket delades upp i två kategorier ‘Patriarchal traditional family structure - a barrier for women’s decision making authority regarding sexual and reproductive health’ med fem subkategorier och ‘Patriarchal traditional family structure - a support for women´s decision making authority regarding sexual and reproductive health’ med tre subkategorier. Slutsatser: Den patriarkala traditionella familjestrukturen kan vara både ett hinder och ett stöd för kvinnans beslutsfattande makt rörande hennes och barnets hälsa. Kliniska implikationer: Denna kunskap kan belysa orsakerna till sjuklighet och dödlighet i samband med graviditet och födelse. Studien kan utgöra underlag i arbetet för att förbättra kvinnors hälsa och beslutsfattande makt i Nepal.