It takes a village: Enabling women to space births

Knowledge alone does not change behavior; many people know what they should do, but still do not do it. URMUL, an Indian NGO, has provided family planning to desert communities in Rajasthan for 20 years, yet birth spacing remains low. URMUL used Barrier Analysis (BA), a rapid assessment tool developed by Food for the Hungry, to inform birth spacing communication strategies. In BA, “doers” who adopt a particular behavior and “non-doers” are asked questions based on behavior change theory. Results are tallied and gaps between doers and non-doers identify determinants of behavior change. URMUL interviewed 60 family planning users and 60 non-users about social acceptability, self-efficacy, facilitating and constraining factors and attributes of family planning use. Perceived social acceptability of contraception was the main difference between users and non-users. Users were less likely to believe that their husbands and in-laws disapprove than non-users (23% vs. 77%).The belief that pregnancy is God's will was another constraining factor (74% non-users vs. 13% users). Family approval, husband cooperation and self-efficacy were identified as facilitating factors. Results show few differences in areas often emphasized in communication efforts such as promoting family planning efficacy and safety. Nor did perceived availability of services differ between groups. URMUL adjusted communication activities to focus on increasing women's self-agency, while involving men and families to increase acceptance of contraception. Time series analysis of service statistics six months before and after refocusing messages shows an increase in new adpoters. Implications for use of BA to improve behavior change efforts will be discussed.