I will be sharing data from a five your project funded by USAID conducted by a consortium of IRH, CARE, CEDPA and ASDAP. The research I will present here today was conducted in Mali. I will present on the first year and a half of the project which focused on formative research. Currently social network interventions are being developed and tested based on these results.
Social networks may encourage high fertility because:When women marry, their reproductive rights are transferred to her husband’s household.Support from material and practical networks spreads out the “costs” of raising children Children represent future network support
Walking to and from the field provides an opportunity to discuss FP, esp. as pregnant women could not work but were in charge of leading the donkey. They continued their chats in the evening and during the day in the space where they pounded millet.” “For example, when there is a wedding and a pregnant woman needs to sit down, she can then not get up and dance and we’ll tease her. And that’s how a discussion about fertility starts! If we see that a woman has taken a long time to have her next baby we will remark on it and she’ll pretend to hit us- and you see, there discussion has started.”
It is my sister-in-law who oriented me towards family planning. She really encouraged me to use it during our conversations in our household. I, in turn try to sensitize my co- wife and my other sisters-in-law about the benefits of family planningThere is not one single person in any of my networks who can give me positive information on FP – they are all against it. (32 year old farmer)“I only discuss FP with my friend in the market in Bandigaara-she was the one who told me to stop using the pill as they stack up inside you and make you sterile.”
“I don’t discuss FP with anyone because it is a subject I am ashamed about.”“I don’t know what my wife thinks about family planning because we have never talked about it. In our culture men and women should not talk about these things – this is the reason I have never discussed FP with my wife.”“One day in the market my mother said you must find a way to space their births because I can’t support you having all these children- that’s what really encouraged me to use- I hadn’t taken the radio messages seriously before.”
Similar networks play different roles in high and low prevalence settings:Large, dense networks in low prevalence settings reinforce negative messages and consolidate rumors and misinformationLarge dense networks in high prevalence settings catalyze and sustain FP use
Social networks filter conflicting information, appropriating that in which the network is already inclined to believe. Positive messages are reinforced and negative attitudes consolidated.
Age hierarchies critical: Young people cannot raise topic with elders. Discussions must be initiated by elders. Men must broach subject firstWomen don’t feel they can bring up the topic if husbands aren’t in agreement.
Even if my first co-wife discovered by secret (use) she wouldn’t tell anyone.Interviewer: Why would she help you hide it?Because she helps me bring up my children and if I had a closely spaced pregnancy, it would be her who would have to look after the child. (35 year old woman, charcoal seller, with no education)My co-wife said that using FP really helps- she had closely spaced births but now she uses FP and the children are spaced and she feels free. We talked about it under the shady area in our compound. I like FP but the fact that my co-wife uses it really encouraged me to do the same.It talk about FP with my sisters-in-law. We often chat after dinner. Not one of us is a user but we all speak of its advantages. In one of our chats one sister-in-law said, ”Let’s all take the Pill so we can have sex without fear!!” According to her you can have sex every night without getting pregnant. We women eat alone so we are not embarrassed to talk like that. 34 year old, unemployed woman wit h no education.
Open floor for discussion
Social networks, family planning use and unmet need in Mali: Ethnographic research findings from Terikunda Jekulu
1 Social networks, family planning use and unmet need in Mali Ferdinand Reus from Arnhem, Holland Ethnographic research findings from Terikunda Jékulu
Presenter Disclosures Rebecka Lundgren No relationships to disclose.
4 After 20 years of investment in Mali… Unmet need increased from 26% to 31% (1996 to 2006) DESIRED FERTILITY RATE HAS STAYED THE SAME… WOMEN, MODERN METHODS 100 Married 2001 90 80 70 60 Married 2006 50 40 2001 30 20 2006 0 5 10 10 Women Men 0 … AND MODERN CPR REMAINS AT 6% 4
5 Research Questions ● What prevents women (and men) who supposedly have “unmet need” for FP from using contraception? ● Can addressing social factors—and not just women as individuals—increase modern contraceptive use? For example: − Involving men? − Religious leader networks? ● What are promising ways to address these social factors?
Social network analysis: What is it?A theoretical perspective applied to research andprograms• Recognizes that individuals interact with, learn from, and get information from other people• Focuses on relationships, not individuals “Who delivers the message, and in what interpersonal context, may be just as, if no more important, than the message itself, and may result in better, more relevant, and perhaps more effective programs.” - Valente & Fosados, 2006
7 Why a social network focus? • Women and men make decisions not as individuals but as actors in a social system. • Social structures are resources to diffuse and support innovations, and can include: SOCIE • Kinship and leadership TY COMMUNIT systems Y RELATIONSHI • Lineage groups PS • Trade networks INDIVIDUA • Other? L
Ethnographic research to explore…• social norms related to fertility and FP• the meaning & value of fertility-related communication• diffusion of information and influence• social influence Ferdinand Reus from Arnhem, Holland
Study Communities: CharacteristicsKoutiala Bandiagara*More favorable to *Less favorable toaddressing unmet need for addressing unmet need forfamily planning family planning*Higher contraceptive *Lower contraceptiveprevalence prevalence*Higher unmet need *Lower unmet needMiniyanka DogonPatrilocal, matrlineal Patrilocal, patrlinealAgricultural economy Seasonal and long-term(cotton) labor migration 9
Research MethodsMethod Task Sample PopulationCommunit • Background Info Village chief & elders • Mapping of village Association headsychecklist • Inventory of community associationsFocus • Normative/cultural context of -1 group women (18-24 years old)Group fertility, FP use & unmet need -1 group women (25-29 yearsDiscussio • Meaning and value of fertility- old) related communication channels -1 group women (30-44 yearsns and social influence old) • Social networks & communication -1 group men (18-24 years old) channels as barriers/facilitators to -1 group men (25-29 years old) -1 group men (30 years +) FP use (8-10 people per group) Total: up to 30 women & 30 men in each village
Research Methods cont.Method Task Sample PopulationIn-depth • Assess fertility attitudes, • 8 women 18-24 years old beliefs, desires, intentions and 4 users & 4 non-users with unmetinterviews with behaviour needmen & women on • See how attitudes, beliefs, • 8 women 25-29 years oldfertility, FP and desires, etc. are created, 4 users & 4 non-users with unmet strengthened, challenged & needsocial networks changed by social network • 8 women 35-44 years old members 4 users & 4 non-users with unmet • Address the role of spousal need communication (direct and • 4 men (18-29 years old) indirect) • 4 men (30-44 years old) Total: 32 people interviewed (each village)In-depth • Understand attitudes and • 2 female leaders behaviour with regard to • 2 male leadersinterviews with fertility, FP and especiallycommunity/ unmet need. • 2 health care providersreligious leaders, • Assess role of communitysocietal institutions & associations in the transmission ofgatekeepers, info/resources for socialassociation heads support of FP acquisition and 11 continued use
Research Methods cont.Method Task Sample PopulationSocial • Create geographical layout of women’s 1 group of female FP worlds & key spaces usersmapping • See how geographical mapping relates to 1 group of female the transmission of info., support, resources non-users with for FP use. unmet need (8-10 people per group)Network analysis • Women identify members of their 6 female FP users material, practical, cognitive and (aged 18-24, 25-29, 30-through pile emotional network; identify “closeness”; 34)sorting whether FP has ever been discussed 6 female non-users with with each member and their reaction; unmet need (aged 18- and whether network members know 24, 25-29, 30-34) each other, how well, etc. 12
Who are the individuals influential in spreading information, attitudes and ideas? • • Husbands • HealthFemale kin/friends Co-wives Men • • Older men providers Community leaders Mothers-in-law • Mothers • Employers • Sisters • Imam’s wife • Aunts/Cousins • Friends • Women returning from labor
Which groups and organizations are influential in spreading information, attitudes and ideas? “If we discuss FP in this group it will • Tontin break up as the Groups • Agricultural group men will say that the group is no • Grin longer there to work but to change women’s ideas and to put them on aOrganizations • Islamic organization bad path.” “In my view it is shameful to discuss FP. I have never invited the health workers here to discuss FP as I don’t think it is compatible with the spiritual norms of our brotherhood. I would never do this without authorization of my spiritual leader.”
Where do peopleand their networkscongregate? At home or Doing Institutional Health Events community chores places system• In their • Walking to • Madrassa • TBA’s • Parties homes fields • Chief’s house • Baptisms• Shady area • At wells house • Retired • Weddings in dong • Mosque nurse compound washing • Literacy • Outreach• “Toguna” • Looking center worker (older men’s for wood • Health shady area) in bush system • Village shops
Social networks influence diffusion through….Social learning Social influenceNetwork members Network membersexchange ideas and follow norms of gatekeepers to gaininformation; and approval and avoidevaluate the relative conflict.benefits of innovation 16
Influence of networks and community norms on family planning use Negative FP norms Positive FP normsLarge, dense • FP rarely discussed • Catalyze and sustainnetworks • Considered inappropriate topic FP use • Only discussed w/ non-network • Encourage discussion members • Less opportunities to • Reinforce rumors/gossip reinforce rumor • Do not include FP allies • Includes FP alliesSmall, open • Facilitate clandestine usenetworks • Open to external influence/new information