261671 Social networks, family planning use, and unmet need in Mali: Ethnographic research findings from “Terikunda Jékulu”

Monday, October 29, 2012 : 2:30 PM - 2:45 PM

Rebecka Lundgren, MPH , Institute for Reproductive Health, Georgetown University, Washington, DC
Sarah Castle, PhD , Institute for Reproductive Health, Independent Consultant, Bamako, Mali
N. Kate Cho, MPH , Institute for Reproductive Health, Georgetown University, Washington, DC
Heather Buesseler, MPH , Institute for Reproductive Health, Georgetown University, Washington, DC
Susan Igras, MPH , Institute for Reproductive Health, Georgetown University, Washington, DC, DC
Background: Unmet need for family planning (FP) in Mali continues to increase, despite high rates of FP knowledge and numerous efforts to increase access. The Terikunda Jékulu project is testing an innovative approach to reduce unmet need for FP by leveraging social networks to influence attitudes, beliefs, and social norms around fertility and FP. This study was conducted to understand the dynamics between network size, function, composition, and density and the diffusion of ideas about FP and fertility. Methods: Ethnographic research was conducted in two villages with contrasting levels of FP use and unmet need for FP. Qualitative research activities included focus group discussions, in-depth interviews, social mapping, and network analysis via pile sorting. Results: In the village with low CPR and low unmet need, large, dense networks reinforced negative messages and misinformation about FP. FP users in this community had small, open networks that enabled them to use secretly. In the village with higher CPR and unmet need, both users and non-users' networks were small and dense. For users, this served to catalyze and sustain their use, and female marital kin helped some overcome spousal disapproval. In both settings, age hierarchies directed the flow of information and few couples had discussed FP. Conclusions: Similar kinds of social networks play different roles in different contexts. Among FP users, networks strengthened positive messages, but among those with unmet need, networks reinforced negative attitudes. This impacts individual-level behavior change by engendering facilitating factors or barriers, respectively, in adopting innovations.

Learning Areas:
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Explain the key elements of social network analysis Identify three reasons why addressing social factors—and not just individual behaviors—can increase family planning use Describe the importance of focusing on unmet need, rather than contraceptive prevalence rate (CPR).

Keywords: International Family Planning, Network Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.