Social Networks, Ideation, and Contraceptive Behavior in Bangladesh

According to Dr. Kincaid, the promotion of contraceptive use in Bangladesh since the 1970s has helped the country slow down the rate of population growth. The average fertility rate had fallen from 6.3 children in 1975 to 3.3 children in 1997. However, the present effort in population control in Bangladesh relies on a cumbersome, though proven, method involving frequent household visits by family planning extension workers. The present study makes a case for a more efficient approach by incorporating recent theoretical elaboration of the diffusion of innovation paradigm.

Published in the January 2000 issue of Social Science & Medicine, this study tests theoretical and methodological hypotheses of diffusion of innovation approach using data from a contraceptive promotion project carried out in Bangladesh. Two specific foci in the study are the extent of contraceptive use growth brought about by a social networks approach and one's ideation (progression of innovation-decision process leading to behaviour change).

Under the study design, interpersonal communication plays a central role in both social network and ideation processes. The social network approach relies on group communication dynamics, while the ideation process is enabled by interpersonal communication, a domain where discussion, negotiation, and approval/disapproval take place.

Evaluation/Research Methodologies:

The study used a one-group, before-after quasi-experimental design to evaluate the impacts of social networking and ideation on contraceptive use. A longitudinal (panel) sample survey of women was conduced in 1994 (baseline) and 1996 (follow-up). The sample was drawn using a snowball sampling method from districts where the social network approach was implemented. The final panel at the end of the 1996 survey consisted of 860 married women age 14-49.

The experimental treatment was women's participation in social network programmes. Each programme involved the following steps:

1. training of field workers on interpersonal communication and group dynamic skills;
2. identification of village communication networks and link persons (opinion leaders who are centrally located in village communication networks) who were satisfied users of family planning and willing to promote it publicly;
3. establishment of rotating peer group gatherings ("jiggashas") involving:
   • meetings at the homes of local link persons at least once a month;
   • discussions of family planning issues;
   • peer group support and influence;
   • counseling facilitated by entertaining audiovisual educational materials; and
   • distribution of contraceptive supplies.

Variables used to analyse the ideation effects included: (1) knowledge of modern contraceptive methods; (2) attitudes towards practicing family planning; (3) discussion of family planning with husband; (4) discussion of family planning with other women; and (5) approval of family planning practice by husband.

Comparisons were made between three groups: (1) women who participated in jiggasha meetings; (2) women who received household visits by family planning field workers but never participated in jiggashas; and (3) women who had no contact with family planning programmes.

Key Findings/Impact:

The author found that the rate of increase in modern contraceptive use between 1994 and 1996 was five times greater among participants in the social network approach than among women who had household visits by family planning field workers. Even after controlling for the effects of prior contraceptive use and intention, the social network approach had almost twice the impact of the home visit approach. Contraceptive use declined substantially between 1994 and 1996 among women who had neither type of family planning communication.

The social network approach and the home visit approach had very similar levels of impact on women's ideation of modern contraceptive use. When measured directly, both approaches explained about 25% of the variance in ideation. However, when variables related to ideation were added to a regression model, the social network approach showed greater impact on contraceptive use than the home visit approach. The author explains that these patterns indicate the existence of indirect effect of the social network approach on ideation. The latter interpretation is consistent with the theoretical design of the social network approach implemented in the present study; it was designed to enhance ideation by increasing discussion of family planning among women, encouraging discussion with spouses, increasing spouse approval for family planning practice, and improving attitudes and increasing levels of contraceptive knowledge.

While acknowledging the greater effectiveness of the social network approach, the author points out that the social network approach faced two challenges. First, the level of jiggasha implementation by the trained field workers was much lower than anticipated. The author suggests that, beyond training field health workers, some type of organisational development for the entire district health centre and community mobilisation may be called for. Second, women's participation in jiggasha meetings was also low. Factors contributing to the low participation included conservative community norms and opposition of spouses and male community leaders, discouraging women's participation in group meetings.