Power of relationships: Using social network theory and methodologies to improve family planning attitudes and use in Mali

Twenty years of family planning programming efforts in Mali resulted in high levels of knowledge, but contraceptive prevalence remains around 6%. What prevents men and women, who supposedly have an “unmet need for family planning”, from using a method? We used a social-network analysis approach to answer these questions. A complete census of women and men of reproductive age was conducted in two Malian villages. Each individual was asked to name people upon whom they rely for material, practical, cognitive or emotional support. Perceived attitudes towards fertility and current family planning use were explored for each individual named. The result was a complete social networking map, for couples of reproductive age, in each village. Sociometric analysis revealed the relative influence of social interactions on contraceptive use, and the type and density of social connections within study villages. After census-mapping was completed, in-depth interviews conducted with selected individuals representing different unmet-need and social-network status, further illuminated the strength and directions of observed roles and relationships. We found that centers of influence differ by sex, life stage, and marital status. Certain kinds of information are shared more frequently. In addition, individuals who hold formal leadership positions (community leader, head Imam, commercial association head) have numerous, but weak, ties to many community members. Many of these leaders are neutral towards contraceptive use but are perceived as holding negative attitudes. Based on our results, interventions to reduce unmet need for family planning were designed, are being implemented and will be evaluated after 18 months.