The Marma buddhist community is an indigenous community living in Bangladesh's Chittagong Hill Tracts (CHT) who are facing social and cultural difficulties. Although marma women are integral to community leadership and cultural preservation, little research exists documenting their contributions and challenges. Analyze roles, challenges and solutions of Marma women in community leadership and cultural preservation tasks. This cross-sectional study was carried out in the Bandarban, Khagrachari, and Rangamati districts of the CHT from January 2020 to December 2022. A purposive sampling was used to select 318 Marma women aged 18 years and older. Abstract Global, national, and local regulatory frameworks aimed at public health have historically focused on alcohol distribution, availability, marketing, and consumption. Descriptive statistics, chi-square tests and logistic regression were used to analyze the quantitative data. In contrast qualitative data were thematically analyzed to identify Marma women̋s leadership roles, cultural preservation, and challenges. Results: Showed that 64% of the participants had leadership roles in their local government or community organizations, statistically significant correlation between educational limitation and leadership role (p < 0.01). 78% of the women participated in cultural preservation activities (like traditional festivals and rituals), and there was a positive relationship between age and cultural participation (p = 0.02). In addition, 53% of the participants were engaged in educational activities to relay Marma language and cultures to younger generations, and the relationship with education and leadership roles was significant (p value = 0.03). 45% reported challenges including gender inequality and limited access to resources, with resource accessibility notably related to leadership participation (p < 0.05). Conclusions: Marma women are playing an indispensable role in community leadership and cultural conservation in the CHT. Their contributions are thus essential for the cultural continuity of the Marma people, yet they encounter strong forces that inhibit their participation in this respect. Fostering gender equity and facilitating access to resources is essential for empowering Marma women in their leadership and cultural preservation efforts.