The power of relationshipsUsing social network theory andmethodologies to improve familyplanning attitudes and useIrit Sin...
Mali: married women of reproductive age            Knows any      Uses any modern    Has unmet need           modern metho...
Social network analysis: What is it?A theoretical perspective applied to research andprograms• Recognizes that individuals...
The ethnographic sandwich                         Participant observation                         and in-depth interviews ...
1st step in mapping:Obtain a list of all adult men and women inthe village, and assign each a code
2nd step in mapping:Identify from the list all women of reproductiveage, and men married to women of reproductiveage, and ...
Eliciting social networksThink of the people who provide you material assistance. Forexample, someone who loans you money,...
Eliciting social networksSocial network module For women, probe on: husband, mother, mother-in-law, co-wives For men, prob...
Analysis• Use SPSS to obtain descriptive statistics and  cross tabulations, and identify respondent’s  unmet need status• ...
Demographics                          Koutiala           Bandiagara                      Women       Men     Women       M...
Unmet need status                                               Koutiala          Bandiagara                              ...
Unmet need status                                              Koutiala           Bandiagara                              ...
Connectors and Influencers                   Influencers are the most                   nominated individuals in a        ...
Social network maps of villagesKoutiala: more favorable                                      Women                        ...
Social network maps of villagesBandiagara: less favorable                                       Women                     ...
Women: unmet need by network status Bandiagara: Less favorable                                         Unmet need         ...
Does your spouse approve of family planning?   Koutiala: more favorable Bandiagara: less favorable100%                    ...
Husband & wife concordance                                                               Koutiala   BandiagaraOf wives who...
Key results: Social barriers Perceived spousal and community disapproval of  family planning Stigma related to talking p...
Key results: Social networks Women receive material support from husbands and  brothers-in-law, practical support from si...
Programmatic implicationso Working with and through  women’s and men’s  groupso Engaging community-  based religious leade...
sinaii@georetown.edu
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The power of relationships: Using Social Network Theory and methodologies to improve family planning attitudes and use

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The power of relationships: Using Social Network Theory and methodologies to improve family planning attitudes and use

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  • Twenty years of family planning programming efforts in Mali resulted in high levels of knowledge, but contraceptive prevalence remains low.What prevents men and women, who supposedly have an ‘unmet need for family planning’ from using a method?They say they do not want to have a child now,They know there are methods available,They know where to go to get them,Yet they choose to not use a method.We use a social network approach to try to answer this question.
  • Network analysisacknowledgesthatindividualsdon’texist in a vacuum. People interactwith, learnfrom, and get information fromotherindividuals. And this type of analysisis more interested in theserelationships and the characteristics of thoserelationshipsratherthanindividual’sdemographic and socioeconomiccharacteristics.
  • Social network analysis is best done using the ethnographic sandwich.The first ethnographic data collection, which we report on in another presentation, provides the context and language to use when collecting the census data. It consists of participant observation and in-depth interviews.The complete social network map of the community is the focus of this presentationThe second ethnographic study, which is ongoing, consists of in-depth interviews. It ensures that results collected in the earlier phases are correctly interpreted.
  • In this phase of the study enumerators nocked on all doors in the village, to create a complete list of all adults living the village. Individuals did not need to be at home to be recorded – any adult who was home at the time provided this basic information about all adults living in the house/compound.
  • Ask: “What is your relationship with (name of person)? You can mention more than one relationship. For example, a person can be your aunt, and can also be your health provider.” Write the relationships. Relationships can be family relationship (such as mother, husband, sister, co-wife, etc.) or friend, or it can be a different type of relationship, such as shop-keeper, co-worker, health worker, teacher of the respondents children, member of her grin or tontine, etc. It can also be the maribout or religious leader.(c) Ask:”Does (name of person) live in this village, or elsewhere?” If ‘elsewhere’, ask “In what town does (name of person) live?(d) Ask:” How close would you say you are to (name of person)? Very close, close, or not close?” Write the response.(f) ASK: “Does this person influence your decisions about how many children to have and when to have them”?Ask: Would you say that (name of person) approves or disapproves of women using family planning to have fewer children? Mark Yes, No, or Don’t know.PROBES ARE FROM ETHNOGRAPHIC RESULTS
  • Having more children is good Women using FP are immoralWomen using FP seem healthierAvailable methodCouples with fewer children are better offUsing FP is bad for women’s healthAvailable methods are difficult to useOnly God can decide number of childrenFP external influence
  • Having more children is good Women using FP are immoralWomen using FP seem healthierAvailable methodCouples with fewer children are better offUsing FP is bad for women’s healthAvailable methods are difficult to useOnly God can decide number of childrenFP external influence
  • This network of women shows unmet need. The size of the circles = the amount of influence. The green circles are the users, while the read are women with unmet need. What do you see of interest here? How many users are there? Are there enough to bring out about a more favorable environment for FP?\\ How would you use snowball intervention to increase FP use. (User to user)
  • Look at the lightest color on the top of each bar- this represents the men and women who don’t know what their partners think.Especially look at women -- majority don’t know.
  • The power of relationships: Using Social Network Theory and methodologies to improve family planning attitudes and use

    1. 1. The power of relationshipsUsing social network theory andmethodologies to improve familyplanning attitudes and useIrit SinaiSusan IgrasRebecka Lundgren
    2. 2. Mali: married women of reproductive age Knows any Uses any modern Has unmet need modern method method for contraception2006 DHS 85% 6.6% 27.6%1996 DHS 65% 6.7% 27.5%
    3. 3. 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 not more important, than the message itself, and may result in better, more relevant, and perhaps more effective programs.” - Valente & Fosados, 2006
    4. 4. The ethnographic sandwich Participant observation and in-depth interviews • Meaning & value of fertility-related communication • Distribution of social influence within community groups Ethnographic study Ethnographic study In-depth interviews with men and women identified from the census representing different unmet need and social network statuses
    5. 5. 1st step in mapping:Obtain a list of all adult men and women inthe village, and assign each a code
    6. 6. 2nd step in mapping:Identify from the list all women of reproductiveage, and men married to women of reproductiveage, and interview them Response rate: o 92 % in Koutiala o 84% in Bandiagara Interview obtains background information, unmet need status, attitudes toward child spacing, and a social network module
    7. 7. Eliciting social networksThink of the people who provide you material assistance. Forexample, someone who loans you money, someone who buys thingsfor you in the market, or someone who gives you food or clothes.Please tell me the names of three people that you go to for this typeof support. Think of the people who provide you practical assistance. For example, they help you take care of your children, or they can help with household chores, or they can help you with trading or agriculture. Please tell me the names of three people that you go to for this type of support. Think of the people that you can learn from, either because they give you advice or instructions, or because you see what they do and try to do the same. Please tell me the names of three such people. Think of the people who give you emotional support. For example, you can talk to them when you are sad, or when you have an argument with your husband or his mother, or when your children misbehave. Please tell me the names of three people who give you emotional support most often..
    8. 8. Eliciting social networksSocial network module For women, probe on: husband, mother, mother-in-law, co-wives For men, probe on: co-wives, father, male relatives
    9. 9. Analysis• Use SPSS to obtain descriptive statistics and cross tabulations, and identify respondent’s unmet need status• Use UCINET and NetDraw, a special software package designed to analyze network data, to calculate network determinants, create network maps, and organize them by selected variables (e.g., sex, age, family planning attitude and use)
    10. 10. Demographics Koutiala Bandiagara Women Men Women Men (n=217) (n=149) (n=208) (n=152)Age (mean) 27.3 39.5 30.9 41.0No. children (mean) 3.3 5.0 3.8 5.7Formal education 95 97 94 87(% no education)Religion 84 90 100 99(% Moslem)Marital status(% polygamous) 54 37 48 32
    11. 11. Unmet need status Koutiala Bandiagara Women Men Women Men (n=217) (n=149) (n=208) (n=152) Uses modern method 12% 9% 10% 7%NeedMet Uses Traditional method 2% 7% <1% 2% Pregnant 21% 27% 15% 26%No need Desires child this year 17% 30% 17% 22% Breastfeeding or in postpartum 17% 8% 20% 15% amenorrhea Infertile/no sex/ menopause 2% 11% 9% 3%Unmet need 30% 35% 29% 34%
    12. 12. Unmet need status Koutiala Bandiagara More favorable Less favorable Women Men Women Men (n=217) (n=149) (n=208) (n=152) Uses modern method 12% 9% 10% 7%NeedMet Uses Traditional method 2% 7% <1% 2% Pregnant 21% 27% 15% 26%No need Desires child this year 17% 30% 17% 22% Breastfeeding or in postpartum 17% 8% 20% 15% amenorrhea Infertile/no sex/ menopause 2% 11% 9% 3%Unmet need 30% 35% 29% 34%Index of attitudes toward family 0.42 0.56 0.35 0.44planning use (mean)
    13. 13. Connectors and Influencers Influencers are the most nominated individuals in a network. They have direct influence on more people. A high score indicates the opportunity to influence and be influenced directly. Connectors are the individuals with the shortest path to all other individuals. They are gatekeepers, brokers, control the flow, liaise between cliques. A high score Indicates power and access, but also could be a bottleneck.
    14. 14. Social network maps of villagesKoutiala: more favorable Women Women Men Men Size ==Influence Size Influence
    15. 15. Social network maps of villagesBandiagara: less favorable Women Men Size = Influence
    16. 16. Women: unmet need by network status Bandiagara: Less favorable Unmet need FP use No need Size = Influence
    17. 17. Does your spouse approve of family planning? Koutiala: more favorable Bandiagara: less favorable100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% Men Women Men Women Yes No Dont know Yes No Dont know
    18. 18. Husband & wife concordance Koutiala BandiagaraOf wives whose husbands say they approve of family planning Positive attitude: % who believe that women who use FP look better than 64.1% 54.4% those who do not % Believe that couple who use FP are better equipped to 70.5% 47.1% take care of their families Negative attitude: % who believe that women using FP are immoral 24.4% 13.2% % who believe that using FP is bad for women’s health 25.6% 21.6%Of husbands, whose wives say they approve of family planning Positive attitude: % who believe that women who use FP look better than 86.6% 54.3% those who do not % Believe that couple who use FP are better equipped to 86.6% 57.1% take care of their families Negative attitude: % who believe that women using FP are immoral 32.8% 20.0% % who believe that using FP is bad for women’s health 29.9% 22.9%
    19. 19. Key results: Social barriers Perceived spousal and community disapproval of family planning Stigma related to talking publicly about family planning, little discussion Misinformation about family planning Women unable to communicate or make decisions with their husbands about child spacing Disapproval of family planning: religious reasons and because it is a negative, western concept
    20. 20. Key results: Social networks Women receive material support from husbands and brothers-in-law, practical support from sisters-in-law and co-wives and cognitive support from mothers-in-law Men not well-informed, nor linked into discussions on family planning Men and women unaware of what friends and spouses feel about family planning Co-wives, mothers and mothers-in-law are motivated to support family planning use because they would be responsible for looking after the children Rumors and misinformation are spread through networks and represent a key barrier to family planning use Women are not aware of their spouse’s view of family planning Providers not linked into social networks
    21. 21. Programmatic implicationso Working with and through women’s and men’s groupso Engaging community- based religious leaders and their wiveso Bringing home new ideas through migrant workers
    22. 22. sinaii@georetown.edu

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