[Originally posted on HC3’s HealthCOMpass blog here]
When family planning use continues to be relatively low even when resources and information are available, it is vital to determine what is keeping families from using modern contraceptives.
In 2010, a six-year USAID-funded project began in response to persistent low rates of family planning uptake in Benin. Tékponon Jikuagou (2010-2017), which means “doing everything possible to prevent infant mortality” in the local language of Adja, aimed to reduce unmet need for family planning, defined as the number of women and men who do not want a pregnancy but who are sexually active and not using an effective means of contraception, through social network interventions, thereby improving healthy timing and spacing of births.
The project was initially not designed for Benin. Originally set to take place in Mali, the project began with extensive formative research in 2010 and was well on its way to development. The March 2012 coup d’état in Mali forced the project to relocate to Benin after one year. After conducting several small Benin-based studies to confirm similarities and understand differences in networks, attitudes toward fertility, social barriers and unmet need, Tékponon Jikuagou used much of the Mali-based research to design the social network intervention for Benin.
Unmet need remains high in West Africa despite available information and resources. Significant resources for family planning programs over several decades have improved knowledge and services, yet unmet need remains high and sustained use remains elusive. In Benin, for example, the majority of sexually active women and men know of at least one modern method of family planning, yet unmet need increased from 28 percent in 1996 to 33 percent when the project began in 2012 (DHS, 2011-2012).
This project focused attention on why unmet need remains so high and studied other important social influences on women’s health, including family members (mothers-in-law, for example), friends and community leaders. Research shows that it is critical to acknowledge social networks and cultural contexts when addressing unmet need, as gender norms and power relations in particular are key influencers of reproductive health behavior.
The project utilized social network theory, with the hypothesis that once members in a social group began to talk about and adopt family planning methods and develop good experiences using such methods, the social networks containing these individual group members could accelerate diffusion by providing opportunities for social comparison, support and influence — not only for adopting a method but also for continuing or switching to another method.
The intervention’s goal was to foster reflective dialogue and new ideas in existing community groups and formal and informal leaders and then have these individuals – women and men – spread the new ideas through their networks, reducing taboos about discussing such subjects, ultimately creating a social environment that supported couples to act on their desires to space births. The project’s goal was to pilot the approach, adjust it and then retest it under scale-up conditions with additional NGOs integrating the approach into their own development projects.
The latest Spotlight from the Health COMpass describes this project in detail, from concept through evaluation and plans for scale-up.