The association between men’s family planning networks and contraceptive use among their female partners: an egocentric network study in Madagascar

Abstract

Background Ensuring women have information, support and access to family planning (FP) services will allow women to exercise their reproductive autonomy and reduce maternal mortality, which remains high in countries such as Madagascar. Research shows that women’s social networks - their ties with partners, family members, friends, and providers - affect their contraceptive use. Few studies have considered the role of men’s social networks on women’s contraceptive use. Insofar as women’s contraceptive use may be influenced by their male partners, women’s contraceptive use may also be affected by their partner’s social networks. Men may differ by the types of ties they rely on for information and advice about FP. It is unknown whether differences in the composition of men’s FP networks matter for couples’ contraceptive use. This study assessed the association between men’s FP networks and couples’ contraceptive use. Methods This egocentric network study was conducted among married/partnered men (n = 178) in rural Madagascar. Study participants listed who they relied on for FP information and advice, including health providers and social ties. They provided ties’ gender, age, relationship, and perceived support of contraceptive use. The primary outcome was couples’ contraceptive use, and explanatory variables included FP networks and their composition (no FP network, social-only network, provider-only network, and mixed network of social and provider ties). Analyses used generalized linear models specifying a Poisson distribution, with covariate adjustment and cluster robust standard errors. Results Men who had FP networks were 1.9 times more likely to use modern contraception as a couple compared to men with no FP network (95% confidence interval [CI] 1.64–2.52; p ≤ 0.001). Compared to men with no FP network, men were more likely to use modern contraception if they had a social-only network, relative risk (RR) = 2.10 (95% CI, 1.65–2.68; p ≤ 0.001); a provider-only network, RR = 1.80 (95% CI, 1.54–2.11; p ≤ 0.001); or a mixed network, RR = 2.35 (95% CI, 1.97–2.80; p ≤ 0.001). Conclusions Whether men have a FP network, be it provider or social ties, distinguishes if couples are using contraception. Interventions should focus on reaching men not only through providers but also through their social ties to foster communication and support for contraceptive use.

Social and provider networks and women's contraceptive use: Evidence from Madagascar

“…Our findings provide further evidence that women who rely on health providers as sources of information and advice about contraception are more likely to use contraception. These results are consistent with findings from men in couple in Madagascar [28], yet differ from studies among women in Kenya and Tanzania [18,27]. The positive association between relying on social ties and contraceptive use is consistent with many network studies [12][13][14][15][16][17][18][19][20][21].…”

“…In Tanzania, contraceptive use was associated with relying on interpersonal ties for contraceptive information but not with relying on health providers [27]. In our study among men in partnership in Madagascar, couples' contraceptive use just as high whether men relied on social ties versus provider ties for contraceptive information [28].…”

The role of informational support from women’s social networks on antenatal care initiation: qualitative evidence from pregnant women in Uganda

“…These findings are somewhat similar to evidence in Mozambique and Gambia with women relying on health providers, traditional birth attendants, matrons and community health workers as informational sources about ANC initiation [23,35]. They are consistent with evidence from Madagascar where individuals are just as likely to rely on social ties versus health providers for reproductive health advice and information [43,44]. Yet, these findings may reflect what pregnant women learned during their ANC visit and may not represent the key information sources leading them to first seek ANC.…”

Engaging Community Health Workers to Enhance Modern Contraceptive Uptake Among Young First-Time Parents in Five Cities of Uttar Pradesh

“…Previous studies have documented that meeting with facility-based service providers, as well as women who have been already using a method, is related to higher uptake of contraceptive use. 27 – 29 …”