The Role of Interpersonal Communication in Preventing Unsafe Abortion in Communities: The Dialogues for Life Project in Nepal

Figures & data

Table 1. Primary research questions, data-collection tools, and measures

1. How effectively are dialogue group members able to negotiate pregnancy-related decisions that are likely to result in either avoiding unwanted pregnancy through the use of family planning and emergency contraception or choosing safe abortion as the solution for terminating an unwanted pregnancy?
2. How effectively are dialogue group members able to communicate with and influence other community members' knowledge, communication, and access with regard to family planning, safe abortion, and other reproductive health issues?
Data-collection tool	Purpose	Measure or indicator
Process evaluation
Facilitator session summary form	To summarize dialogue group session activities	Overall impressions of the session Stories of changes in attitudes, new behaviors, or influences
Community event log	To observe how dialogue groups can serve as catalysts in their communities through sponsored venues	Completed for each community event in which dialogue group members participate throughout the evaluation period: – Who organized the event? – Purpose – Theme/topics covered – Questions asked – Insights for planning future activities
Outcomes evaluation
Dialogue group participant: Anonymous group-based assessment	To assess knowledge and skills gained in the following: – Reproductive biology – Abortion law – Safe abortion practice recommendations – Family planning/emergency contraception	Group-based pretest and posttest conducted among the same dialogue group members at beginning and end of evaluation
Dialogue group participant: individual survey	To assess knowledge and skills gained in the following: – Attitudes such as perceptions of risk/benefits of different abortion options, stigma surrounding abortion practices, ideal family size, and influencers – Social connections and communication efficacy within social networks around different reproductive health topics – Behaviors such as current contraceptive use, recent pregnancy history and outcome (posttest only), and as communication social-change agents	All enrolled participants were interviewed by a facilitator or their supervisor during the first or second dialogue group meeting and as the last activity at the end of the intervention
Session attendance log	To assess participant session attendance, exposure to dialogue group intervention, and group attendance totals	Facilitator recorded participant attendance at each session

Table 2. Demographic summary of dialogue group participants (N = 478) from knowledge, attitudes, and practices survey interviews

Selected background characteristics	%
Age (years)
15–19	20
20–24	17
25–29	17
30–34	14
35–39	12
40–44	9
45 and older	11
M (range)	29.6 (18–70)
M number of living children (range)	2.6 (0–10)
Gender
Male	8
Female	92
Have ever been married	67
Ethnicity/caste
Newar	20
Chettrei	15
Bahun	13
Brahmin	10
Tharu	7
Other	22
Missing	13
Primary language spoken at home
Nepali	63
Newari	13
Bhojpuri	18
Tharu	2
Other	4
Years in school
None	18
1–6	17
7–9	18
10	17
More than 10	30
Percentage who bring in a cash income	29
Belong to other groups (in addition to Dialogues for Life)
No other group membership	88
1–2	10
More than 2	2

Table 3. Summary of group participant assessment (Bead Game) knowledge indicators ^a

	Percentage who answered correctly
Selected indicators	Pretest (n = 478)	Posttest (n = 426)	Percentage change %
Knowledge about reproductive biology
1. A woman cannot get pregnant the first time she has sex. (false)	48	57	+9
2. Women have eggs, and men have sperm. The sperm must fertilize the egg in the woman's uterus for a woman to become pregnant. (true)	90	93	+3
3. A woman cannot get pregnant if the man withdraws before ejaculation. (false)	30	38	+8
Knowledge about family planning and emergency contraception
4. A sterilization operation is a more reliable contraceptive method than withdrawal. (true)	93	93	0
5. A condom can be used more than one time and still prevent a pregnancy. (false)	57	88	+31
6. There is a pill that a woman can take to prevent pregnancy after sex (emergency contraception). (true)	65	87	+22
Knowledge about abortion
7. It is legal for a woman to have an abortion in Nepal. (true)	77	90	+13
8. A woman must have the consent of her husband to have a legal abortion. (true)	33	79	+46
9. Any doctor can perform a safe abortion. (false)	69	90	+21

Table 4. Who participants trust the most in discussing sensitive topics: Communication efficacy ^a

	Who do you trust the most (to discuss this topic with)? ^b
Topic	Pretest	Posttest
Family planning methods	Female friend (48%)	Spouse/partner (47%)
	Spouse/partner (16%)	Female friend (7%)
	(n = 330)	(n = 370)
Pregnancy-related concerns	Female friend (49%)	Spouse/partner (42%)
	Own sister (13%)	Own sister (11%)
	(n = 272)	(n = 331)
Unwanted pregnancy concerns	Female friend (51%)	Spouse/partner (43%)
	Spouse/partner (15%)	Own sister (14%)
	(n = 193)	(n = 259)
Men's health concerns	Female friend (36%)	Spouse/partner (71%)
	Own sister (29%)	Own sister (5%)
	(n = 172)	(n = 273)
Abortion-related topics	Female friend (49%)	Spouse/partner (48%)
	Own sister (12%)	Own sister (9%)
	(n = 116)	(n = 319)

Table 5. Selected family planning indicators and social change agent indicators ^a

Indicator	p	Pretest	Posttest	Measured change during program ^a
Desired family size (n = 408) (average) ^b	.000*	2.0	1.75	118 (30%) who wanted more children at pretest now wanted fewer children at posttest.61 (15%) who wanted fewer children at pretest wanted more children at posttest.229 (56%) reported no change in their views.
Married participants who are currently using modern contraceptive methods (n = 277).	.001*	146 (56%)	176 (65%)	58 (23%) noncontraceptive users at pretest survey reported using contraceptives at posttest.26 (10%) contraceptive users at pretest reported “no” at posttest (discontinued use of contraception).
Actions taken as social change agents
Participants who have advised anyone to use contraceptives or visit a family planning clinic in the past 6 months (n = 408).	.001**	222 (54%)	261 (64%)	79 (19%) ^c
Female participants who reported that someone has sought their advice about an unwanted pregnancy (n = 408).	.001**	149 (37%)	209 (51%)	101 (25%) ^c
Female participants who reported that someone has sought their advice about abortions/pregnancy termination (n = 408).	.001**	154 (38%)	195 (48%)	85 (21%) ^c

Table 6. Outcomes of participants who reported a pregnancy event during project (n = 408) ^a

Indicator	Total
Did you or your spouse become pregnant since joining the Dialogues for Life program?
Male participants who reported “yes”	1 (<1%)
Female participants who reported “yes”	12 (3%)
No pregnancy event reported	384 (94%)
Not sure	11 (3%)
How did you feel at the time?
I (my spouse) wanted to become pregnant	3
I (my spouse) wanted to wait	5
I (my spouse) did not want to have anymore children	2
Was your pregnancy because of “galti” (mistake), sudden, or accidental?	3
Was your pregnancy because no family planning methods were used?	9
Was your pregnancy due to a failure of family planning methods?	1
Before you were pregnant, did you have an understanding with your husband to have another child?	9
Pregnancy outcome
Live birth	6
Miscarriage	0
Stillbirth	0
Induced abortion	2
Currently pregnant	5
Abortion services
Family Planning Association of Nepal	1
Marie Stopes	1