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Social networks, family planning use and unmet need in Mali: Ethnographic research findings from Terikunda Jekulu
1. 1
Social networks, family planning
use and unmet need in Mali
Ferdinand Reus from Arnhem, Holland
Ethnographic research findings from
Terikunda Jékulu
4. 4
After 20 years of investment in Mali…
Unmet need increased from 26% to 31% (1996 to 2006)
DESIRED FERTILITY RATE HAS STAYED THE SAME…
WOMEN, MODERN METHODS
100 Married 2001
90
80
70
60 Married 2006
50
40
2001
30
20 2006 0 5 10
10 Women Men
0
… AND MODERN CPR
REMAINS AT 6%
4
5. 5
Research Questions
● What prevents women (and men) who
supposedly have “unmet need” for FP from using
contraception?
● Can addressing social factors—and not just
women as individuals—increase modern
contraceptive use? For example:
− Involving men?
− Religious leader networks?
● What are promising ways to address these social
factors?
6. Social network analysis: What is it?
A theoretical perspective applied to research and
programs
• Recognizes that individuals interact with, learn from,
and get information from other people
• Focuses on relationships, not individuals
“Who delivers the message, and in what
interpersonal context, may be just as, if no
more important, than the message itself,
and may result in better, more relevant, and
perhaps more effective programs.”
- Valente & Fosados, 2006
7. 7
Why a social network focus?
• Women and men make decisions not as
individuals but as actors in a social
system.
• Social structures are resources to
diffuse and support innovations, and
can include: SOCIE
• Kinship and leadership TY
COMMUNIT
systems Y
RELATIONSHI
• Lineage groups PS
• Trade networks INDIVIDUA
• Other? L
8. Ethnographic research to explore…
• social norms related to fertility and FP
• the meaning & value of fertility-related
communication
• diffusion of information and influence
• social influence
Ferdinand Reus from Arnhem, Holland
9. Study Communities: Characteristics
Koutiala Bandiagara
*More favorable to *Less favorable to
addressing unmet need for addressing unmet need for
family planning family planning
*Higher contraceptive *Lower contraceptive
prevalence prevalence
*Higher unmet need *Lower unmet need
Miniyanka Dogon
Patrilocal, matrlineal Patrilocal, patrlineal
Agricultural economy Seasonal and long-term
(cotton) labor migration
9
10. Research Methods
Method Task Sample Population
Communit • Background Info Village chief & elders
• Mapping of village Association heads
y
checklist • Inventory of community
associations
Focus • Normative/cultural context of -1 group women (18-24 years
old)
Group fertility, FP use & unmet need
-1 group women (25-29 years
Discussio • Meaning and value of fertility- old)
related communication channels -1 group women (30-44 years
ns
and social influence old)
• Social networks & communication -1 group men (18-24 years old)
channels as barriers/facilitators to -1 group men (25-29 years old)
-1 group men (30 years +)
FP use
(8-10 people per group)
Total: up to 30 women & 30
men in each village
11. Research Methods cont.
Method Task Sample Population
In-depth • Assess fertility attitudes, • 8 women 18-24 years old
beliefs, desires, intentions and 4 users & 4 non-users with unmet
interviews with
behaviour need
men & women on • See how attitudes, beliefs, • 8 women 25-29 years old
fertility, FP and desires, etc. are created, 4 users & 4 non-users with unmet
strengthened, challenged & need
social networks
changed by social network • 8 women 35-44 years old
members 4 users & 4 non-users with unmet
• Address the role of spousal need
communication (direct and • 4 men (18-29 years old)
indirect) • 4 men (30-44 years old)
Total: 32 people interviewed (each
village)
In-depth • Understand attitudes and • 2 female leaders
behaviour with regard to • 2 male leaders
interviews with
fertility, FP and especially
community/ unmet need. • 2 health care providers
religious leaders, • Assess role of community
societal institutions & associations in
the transmission of
gatekeepers, info/resources for social
association heads support of FP acquisition and 11
continued use
12. Research Methods cont.
Method Task Sample
Population
Social • Create geographical layout of women’s 1 group of female FP
worlds & key spaces users
mapping
• See how geographical mapping relates to 1 group of female
the transmission of info., support, resources non-users with
for FP use. unmet need
(8-10 people per group)
Network analysis • Women identify members of their 6 female FP users
material, practical, cognitive and (aged 18-24, 25-29, 30-
through pile
emotional network; identify “closeness”; 34)
sorting whether FP has ever been discussed 6 female non-users with
with each member and their reaction; unmet need (aged 18-
and whether network members know 24, 25-29, 30-34)
each other, how well, etc.
12
13. Who are the individuals influential in
spreading information, attitudes and ideas?
• • Husbands • Health
Female kin/friends
Co-wives
Men
• • Older men providers
Community leaders
Mothers-in-law
• Mothers • Employers
• Sisters • Imam’s wife
• Aunts/Cousins
• Friends
• Women
returning from
labor
14. Which groups and organizations are
influential in spreading information,
attitudes and ideas?
“If we discuss FP in
this group it will
• Tontin break up as the
Groups • Agricultural group men will say that
the group is no
• Grin
longer there to
work but to change
women’s ideas and
to put them on a
Organizations • Islamic organization bad path.”
“In my view it is shameful to discuss FP. I have never invited the health
workers here to discuss FP as I don’t think it is compatible with the
spiritual norms of our brotherhood. I would never do this without
authorization of my spiritual leader.”
15. Where do people
and their networks
congregate?
At home or Doing Institutional Health
Events
community chores places system
• In their • Walking to • Madrassa • TBA’s • Parties
homes fields • Chief’s house • Baptisms
• Shady area • At wells house • Retired • Weddings
in dong • Mosque nurse
compound washing • Literacy • Outreach
• “Toguna” • Looking center worker
(older men’s for wood • Health
shady area) in bush system
• Village
shops
16. Social networks influence diffusion
through….
Social learning Social influence
Network members Network members
exchange ideas and follow norms of
gatekeepers to gain
information; and
approval and avoid
evaluate the relative conflict.
benefits of innovation
16
19. Influence of networks and community
norms on family planning use
Negative FP norms Positive FP norms
Large, dense • FP rarely discussed • Catalyze and sustain
networks • Considered inappropriate topic FP use
• Only discussed w/ non-network • Encourage discussion
members • Less opportunities to
• Reinforce rumors/gossip reinforce rumor
• Do not include FP allies • Includes FP allies
Small, open • Facilitate clandestine use
networks • Open to external influence/new
information
22. • Gendered support
network (co-wives,
mothers, mothers-in-
law)
• Men and women are
not aware of their
spouse’s view of FP.
23. 23 Rebecka Lundgren, Sarah Castle,
Kate Cho, Heather Buesseler,
Susan Igras
http://tinyurl.com/terikunda-jekulu
lundgrer@georgetown.edu
Notas del editor
I will be sharing data from a five your project funded by USAID conducted by a consortium of IRH, CARE, CEDPA and ASDAP. The research I will present here today was conducted in Mali. I will present on the first year and a half of the project which focused on formative research. Currently social network interventions are being developed and tested based on these results.
.
Social networks may encourage high fertility because:When women marry, their reproductive rights are transferred to her husband’s household.Support from material and practical networks spreads out the “costs” of raising children Children represent future network support
Walking to and from the field provides an opportunity to discuss FP, esp. as pregnant women could not work but were in charge of leading the donkey. They continued their chats in the evening and during the day in the space where they pounded millet.” “For example, when there is a wedding and a pregnant woman needs to sit down, she can then not get up and dance and we’ll tease her. And that’s how a discussion about fertility starts! If we see that a woman has taken a long time to have her next baby we will remark on it and she’ll pretend to hit us- and you see, there discussion has started.”
It is my sister-in-law who oriented me towards family planning. She really encouraged me to use it during our conversations in our household. I, in turn try to sensitize my co- wife and my other sisters-in-law about the benefits of family planningThere is not one single person in any of my networks who can give me positive information on FP – they are all against it. (32 year old farmer)“I only discuss FP with my friend in the market in Bandigaara-she was the one who told me to stop using the pill as they stack up inside you and make you sterile.”
“I don’t discuss FP with anyone because it is a subject I am ashamed about.”“I don’t know what my wife thinks about family planning because we have never talked about it. In our culture men and women should not talk about these things – this is the reason I have never discussed FP with my wife.”“One day in the market my mother said you must find a way to space their births because I can’t support you having all these children- that’s what really encouraged me to use- I hadn’t taken the radio messages seriously before.”
Similar networks play different roles in high and low prevalence settings:Large, dense networks in low prevalence settings reinforce negative messages and consolidate rumors and misinformationLarge dense networks in high prevalence settings catalyze and sustain FP use
Social networks filter conflicting information, appropriating that in which the network is already inclined to believe. Positive messages are reinforced and negative attitudes consolidated.
Age hierarchies critical: Young people cannot raise topic with elders. Discussions must be initiated by elders. Men must broach subject firstWomen don’t feel they can bring up the topic if husbands aren’t in agreement.
Even if my first co-wife discovered by secret (use) she wouldn’t tell anyone.Interviewer: Why would she help you hide it?Because she helps me bring up my children and if I had a closely spaced pregnancy, it would be her who would have to look after the child. (35 year old woman, charcoal seller, with no education)My co-wife said that using FP really helps- she had closely spaced births but now she uses FP and the children are spaced and she feels free. We talked about it under the shady area in our compound. I like FP but the fact that my co-wife uses it really encouraged me to do the same.It talk about FP with my sisters-in-law. We often chat after dinner. Not one of us is a user but we all speak of its advantages. In one of our chats one sister-in-law said, ”Let’s all take the Pill so we can have sex without fear!!” According to her you can have sex every night without getting pregnant. We women eat alone so we are not embarrassed to talk like that. 34 year old, unemployed woman wit h no education.