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

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.