The Selection of Family Planning Discussion Partners in Nepal

ABSTRACT

There is growing evidence that the information women receive about family planning from their social network is influential in their decisions to use a contraceptive method. Less is known, however, regarding the role individuals play in constructing their social network and, thereby, determining the nature of its influence. This study examined the criteria women use to select their family planning discussion partners and the individual-level factors that promote the addition of a contraceptive user to one's discussion network. Sociometric data were collected in November 1997 and February 1999 from all currently married women aged 15 to 49 years in three villages of Dang District in the Mid-Western Region of Nepal (panel N = 281). Preference for women from one's ethnic group and the strategic selection of contraceptive users was observed. Contraceptive use and attitudes toward family planning were both positively associated with the addition of a contraceptive user to one's discussion network, suggesting that women seek contraceptive users to confirm their existing beliefs and behaviors. Understanding the dynamics of social network formation can assist programs to better utilize the behavior change potential of peer networks.

This research conducted with funding from the United States Agency for International Development (USAID) under Cooperative Agreement DPE-3052-A-00-0014-00.

The authors acknowledge Phyllis Piotrow, Doug Storey, Gary Lewis, Suruchi Sood, and Jane Bertrand, all from the John Hopkins University (JHU) Center for Communication Programs, for their help in designing the study and developing an earlier version of this article. We also acknowledge the work of the Valley Research Group, who toiled to collect the data; three anonymous reviewers for their helpful suggestions; and especially the time and candor of the women of Dang.

Notes

¹The lower response rate in the follow-up survey may be due to the times of the surveys. The baseline survey occurred in November, after much of the agricultural work had been completed, when women may be at their households for a larger part of the day. The follow-up survey occurred in March, when women tend to be more involved in field work away from the household.

²The 1996 Nepal Family Health Survey was the fifth in a series of national, household-level surveys conducted by the Government of Nepal as part of the USAID-funded Demographic and Health Surveys project.

³A multivariate logistic regression measuring the effect of these variables, adjusted for each other, on the odds of being lost to follow-up indicated that having discussed family planning with peers was the only significant factor influencing loss to follow-up.

⁴Possible responses in the Likert scale included: strongly disagree, disagree, agree, strongly agree.

Source: 1997 and 1999 Nepal Social Network Surveys.

*p < 0.05;

***p < 0.001.

**p < 0.01.

Source: 1997 and 1999 Nepal Social Network Surveys.

¹Number of women who added a discussion partner overall, within each specific village or from that specific ethnic group.

² p values calculated using a two-sided binomial test.

³Based on prevalence of use (for addition of users) or prevalence of nonuse (for addition of nonusers) overall, within the specific village or within that specific ethnic group.

⁵For those new discussion partners who had adopted a contraceptive method between 1997 and 1999, it was unclear whether their contraceptive use had preceded or followed the initiation of discussions about family planning. Since individuals who were about to adopt were considered to be as favorable toward family planning as long-term users and because new adopters were few relative to long-term users, discussion partners were considered to use a contraceptive method if they reported use in either the 1997 or the 1999 survey. Similar analyses limited to long-term users did not change the results.

*p < 0.05

**p < 0.01

***p < 0.001.

*p < 0.05

**p < 0.01

***p < 0.001.