Using data from interviews with matched couples recorded in the 2001 Nepal Demographic and Health Survey, this report explores how incorporating both spouses' reports of household decisionmaking may change the understanding of the determinants and consequences of women's autonomy. Results indicate that a substantial proportion of couples disagree about who makes household decisions, but the determinants of women's autonomy are still largely similar according to both spouses' reports. The assessment of the effects of two important sources of autonomy—women's education and employment—differs significantly between spouses, however. When spouses agree that the wife is autonomous, the association between her autonomy and her use of health-care services is found to be substantially stronger than when spouses disagree about her autonomy. This finding suggests that the association between women's autonomy and health-care-service use may be underestimated when only women's reports are considered.