This document describes a study analyzing how family planning communication programs in Nepal influence the composition and behavior of social networks related to family planning. The study found that (1) addition of contraceptive users to a woman's discussion network was associated with her own adoption of contraceptives; (2) program exposure did not directly lead to formation of networks more favorable to family planning; and (3) the interaction between a woman's program exposure and discussion with a contraceptive user facilitated contraceptive use.

1. Program-stimulated change in
network composition and
behavior related to family
planning in Ghana Nepal
Marc Boulay​
​
Dynamics of Networks and Behavior Symposium ​
XXIV International Social Network Conference​
Portoroz, Slovenia​
May 11, 2004

2. Social Networks and FP
• Widely believed that social networks
exert a strong influence on contraceptive
behavior​
• This influence can be positive or
negative​
□ Favorable networks consistently
associated with contraceptive adoption​
□ Survey and anecdotal evidence has linked
non-use to negative information women
learn from peers

3. FP communication programs
• Often promote discussions about FP as
one mechanism for behavior change​
• Evaluations consistently show an
association between exposure and FP
discussion​
• Unclear whether these
program-stimulated discussions result in a
network favorable to contraceptive use

4. Other factors that may also influence
composition of FP discussion network
• Proximity​
□ Likelihood of interaction​
• Ethnic Homophily​
□ Similarity in language​
• Contraceptive use status​
□ Information from expert sources​
□ Confirmation/Dissonance reduction​

5. Research Questions
• What factors influence the selection of
FP discussion partners within the study
villages?​
□ Ethnic homophily, contraceptive use ​
□ Does program exposure influence selection,
particularly of contraceptive users?​
• Is a positive change in network
composition associated with contraceptive
adoption?

6. Nepal Radio Communication
Project (RCP)
• USAID-funded project to promote FP
among couples in Nepal​
• Weekly radio drama​
□ Residents of fictional village modeled
interpersonal communication regarding FP​
• Broadcast between 1995-2000

7. Study Design
• Site: 3 villages in Dang District, Nepal​
• Sample: Nearly all CMWRA (15-49 years)
in November 1997 & March 1999​
□ Wave 1: n = 350 (response rate = 98.6%)​
□ Wave 2: n = 337 (response rate = 83.0%)​
□ Present in both surveys: n = 281 ​
• Collected sociometric data​
□ Women living in your village with whom you
have discussed FP during the past six months​

8. Description of the study
villages

9. Analysis plan for change in
network composition
• Description of change in networks​
​
• Bivariate examination of change using
binomial test​
​
• Multivariate analysis using SIENA​

10. Change in FP discussion
networks

11. Odds ratios for addition of a FP
discussion partner to network
Source: 1997 and 1999 Nepal Social Network Surveys​
*p<0.05​
Adjusted for age, education, parity, village of residence, and ethnic
group​
H-W standard errors accounting for within-village correlation

12. Observed and expected addition of
Tharus to network, by ethnicity of ego

13. Observed and expected addition of
contraceptive users to network, by
contraceptive use of ego

14. Observed and expected addition of
contraceptive users to network, by
program exposure of ego

15. SIENA Analysis
• Allowed for changing composition of
networks​
• Assumed a constant rate function​
• Stepwise addition of variables into
objective function​
• Final models confirmed using an
independent run (initial parameter
estimates = 0)

16. Variables in SIENA Analysis
• Network effects​
• Ethnic similarity​
□ Dichotomous variable (Tharu, non-Tharu) ​
• Contraceptive Use in 1997​
□ Ego use, alter use, similarity​
• Program Exposure in 1997​
□ Ego exposure, alter exposure, ​
• Ego Exposure X Alter FP Use Interaction​
□ Dyadic covariate (= 1 if i exposed and j using
FP, otherwise = 0)

17. Final SIENA Models

18. Analysis plan for adoption of
FP between 1997 and 1999
• Analysis restricted to 170 non-users in
1997 interviewed in both survey waves​
​
• Huber-White standard errors used to
account for interdependence of
observations ​
□ Interdependence based on shared
membership in a weakly-connected
component​
□ 216 connected components identified

19. Percent of adopters by
presence of a contraceptive
user in discussion network
Source: 1997 and 1999 Nepal Social Network
Surveys

20. Adjusted coefficients from a
logistic regression model
predicting adoption of a FP method
Source: 1997 and 1999 Nepal Social Network Surveys​
N=170​
*p<0.05​
Adjusted for age, education, parity, village of residence, and ethnic
group​
H-W standard errors accounting for within-component correlation

21. Conclusions
• Effect of contraceptive use and program
exposure on network change varies​
• No evidence that program exposure
directly promotes network composition
favorable to FP​
• Addition of a FP user to network appears
to facilitate contraceptive use

22. Limitations
• Small number of networks limits ability
to assess differences across networks​
• Underreporting of FP discussion
partners​
• Time between measures was fairly long​
• With only 2 waves, it is still difficult to
establish time order between addition of
FP user to network and FP adoption

23. Next steps
• Rerun analyses with Ghana data when
available​
□ lower prevalence of FP Use​
□ greater number of networks (9)​
• Explore role of community group
participation on network change