The power of relationships: Using Social Network Theory and methodologies to improve family planning attitudes and use

1. The power of relationships
Using social network theory and
methodologies to improve family
planning attitudes and use
Irit Sinai
Susan Igras
Rebecka Lundgren

2. Mali: married women of reproductive age
Knows any Uses any modern Has unmet need
modern method method for contraception
2006 DHS 85% 6.6% 27.6%
1996 DHS 65% 6.7% 27.5%

3. 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 not
more important, than the message itself, and
may result in better, more relevant, and
perhaps more effective programs.”
- Valente & Fosados, 2006

4. The ethnographic sandwich
Participant observation
and in-depth interviews
• Meaning & value of
fertility-related
communication
• Distribution of social
influence within
community groups
Ethnographic study
Ethnographic study In-depth interviews with
men and women identified
from the census
representing different
unmet need and social
network statuses

5. 1st step in mapping:
Obtain a list of all adult men and women in
the village, and assign each a code

6. 2nd step in mapping:
Identify from the list all women of reproductive
age, and men married to women of reproductive
age, and interview them
Response rate:
o 92 % in Koutiala
o 84% in Bandiagara
Interview obtains background
information, unmet need
status, attitudes toward child
spacing, and a social network
module

7. Eliciting social networks
Think of the people who provide you material assistance. For
example, someone who loans you money, someone who buys things
for you in the market, or someone who gives you food or clothes.
Please tell me the names of three people that you go to for this type
of support.
Think of the people who provide you practical assistance. For
example, they help you take care of your children, or they can
help with household chores, or they can help you with trading or
agriculture. Please tell me the names of three people that you
go to for this type of support.
Think of the people that you can learn from, either because
they give you advice or instructions, or because you see
what they do and try to do the same. Please tell me the
names of three such people.
Think of the people who give you emotional support.
For example, you can talk to them when you are sad, or
when you have an argument with your husband or his
mother, or when your children misbehave. Please tell
me the names of three people who give you emotional
support most often.
.

8. Eliciting social networks
Social network module
For women, probe on: husband, mother, mother-in-law, co-wives
For men, probe on: co-wives, father, male relatives

9. Analysis
• Use SPSS to obtain descriptive statistics and
cross tabulations, and identify respondent’s
unmet need status
• Use UCINET and NetDraw, a special software
package designed to analyze network data, to
calculate network determinants, create network
maps, and organize them by selected variables
(e.g., sex, age, family planning attitude and
use)

10. Demographics
Koutiala Bandiagara
Women Men Women Men
(n=217) (n=149) (n=208) (n=152)
Age (mean) 27.3 39.5 30.9 41.0
No. children (mean) 3.3 5.0 3.8 5.7
Formal education 95 97 94 87
(% no education)
Religion 84 90 100 99
(% Moslem)
Marital status
(% polygamous) 54 37 48 32

11. Unmet need status
Koutiala Bandiagara
Women Men Women Men
(n=217) (n=149) (n=208) (n=152)
Uses modern method 12% 9% 10% 7%
Need
Met
Uses Traditional method 2% 7% <1% 2%
Pregnant 21% 27% 15% 26%
No need
Desires child this year 17% 30% 17% 22%
Breastfeeding or in postpartum
17% 8% 20% 15%
amenorrhea
Infertile/no sex/ menopause 2% 11% 9% 3%
Unmet need 30% 35% 29% 34%

12. Unmet need status
Koutiala Bandiagara
More favorable Less favorable
Women Men Women Men
(n=217) (n=149) (n=208) (n=152)
Uses modern method 12% 9% 10% 7%
Need
Met
Uses Traditional method 2% 7% <1% 2%
Pregnant 21% 27% 15% 26%
No need
Desires child this year 17% 30% 17% 22%
Breastfeeding or in postpartum
17% 8% 20% 15%
amenorrhea
Infertile/no sex/ menopause 2% 11% 9% 3%
Unmet need 30% 35% 29% 34%
Index of attitudes toward family
0.42 0.56 0.35 0.44
planning use (mean)

13. Connectors and Influencers
Influencers are the most
nominated individuals in a
network. They have direct
influence on more people. A
high score indicates the
opportunity to influence and
be influenced directly.
Connectors are the individuals
with the shortest path to all
other individuals. They are
gatekeepers, brokers, control
the flow, liaise between
cliques. A high score Indicates
power and access, but also
could be a bottleneck.

14. Social network maps of villages
Koutiala: more favorable
Women
Women
Men
Men
Size ==Influence
Size Influence

15. Social network maps of villages
Bandiagara: less favorable
Women
Men
Size = Influence

16. Women: unmet need by network status
Bandiagara: Less favorable
Unmet need
FP use
No need
Size = Influence

17. Does your spouse approve of family planning?
Koutiala: more favorable Bandiagara: less favorable
100% 100%
80% 80%
60% 60%
40% 40%
20% 20%
0% 0%
Men Women Men Women
Yes No Don't know Yes No Don't know

18. Husband & wife concordance
Koutiala Bandiagara
Of wives whose husbands say they approve of family planning
Positive attitude:
% who believe that women who use FP look better than 64.1% 54.4%
those who do not
% Believe that couple who use FP are better equipped to 70.5% 47.1%
take care of their families
Negative attitude:
% who believe that women using FP are immoral 24.4% 13.2%
% who believe that using FP is bad for women’s health 25.6% 21.6%
Of husbands, whose wives say they approve of family planning
Positive attitude:
% who believe that women who use FP look better than 86.6% 54.3%
those who do not
% Believe that couple who use FP are better equipped to 86.6% 57.1%
take care of their families
Negative attitude:
% who believe that women using FP are immoral 32.8% 20.0%
% who believe that using FP is bad for women’s health 29.9% 22.9%

19. Key results: Social barriers
 Perceived spousal and community disapproval of
family planning
 Stigma related to talking publicly about family
planning, little discussion
 Misinformation about family planning
 Women unable to communicate or make decisions
with their husbands about child spacing
 Disapproval of family planning: religious reasons
and because it is a negative, western concept

20. Key results: Social networks
 Women receive material support from husbands and
brothers-in-law, practical support from sisters-in-law and
co-wives and cognitive support from mothers-in-law
 Men not well-informed, nor linked into discussions on
family planning
 Men and women unaware of what friends and spouses
feel about family planning
 Co-wives, mothers and mothers-in-law are motivated to
support family planning use because they would be
responsible for looking after the children
 Rumors and misinformation are spread through networks
and represent a key barrier to family planning use
 Women are not aware of their spouse’s view of family
planning
 Providers not linked into social networks

21. Programmatic implications
o Working with and through
women’s and men’s
groups
o Engaging community-
based religious leaders
and their wives
o Bringing home new ideas
through migrant workers

22. sinaii@georetown.edu