The Role of Individual and Community Normative Factors: A Multilevel Analysis of Contraceptive Use Among Women in Mali

Abstract

With a gross national income of US$380 per capita in 2005, Mali is one of the poorest and least developed countries in the world. 1 Seventy percent of the population is rural. In 2001, as many as 80% of women had no education, 43% were in polygamous unions and just 4% had access to newspapers, television or radio. Additionally, only about one-half of women had consulted a health professional at least once during their last pregnancy. 2 The country's total fertility rate (TFR) of 6.8 births per woman has remained fairly stable over the past decade and is one of the highest in Africa. 2 With an infant mortality rate of 120 deaths per 1,000 live births in 2005 and a maternal mortality ratio of 1,200 deaths per 100,000 births in 2000, the country faces significant maternal and child health challenges. 3 Family planning was introduced in Mali in the late 1960s. In 1967, the Association Malienne pour la Promotion et la Protection de la Famille began a small family planning pilot project in the capital city, Bamako. However, the government of Mali did not establish an official family planning policy until 1972, when a decree authorizing voluntary birth regulation was issued. 4 Between 1972 and 1990, family planning services were limited to Bamako and other major urban areas. In 1990, however, the government embarked on a family planning promotion campaign. 5 Nationwide campaigns to promote family planning have continued since then. Despite these efforts, contraceptive use in Mali is still very low. For example, the pill, which is the most widely adopted method, is used by only 3% of women in union. Yet, by 2001, 76% of women knew of a modern method of contraception and nearly 29% were considered to have an unmet need for family planning. 2 In addition to reporting Mali's high TFR, the 2001 Demographic and Health Survey (DHS) indicates that only 22% of women in Mali reported an ideal family size of four or fewer children. 2 In light of the widespread desire for large families and other common pronatalist attitudes, understanding why individuals who practice family planning choose to do so is an important area of research. Additionally, understanding the extent to which a pronatalist environment inhibits adoption of contraceptives is critical in efforts to promote family planning in Mali and other low-prevalence countries.There is increased interest in exploring the importance of the environment in health behavior changes. Research on this topic generally seeks to look at the relative influences on health behavior of characteristics of the individuals in a community and the environment in which these individuals reside.A number of theories have been presented to explain

Dual Protection and Contraceptive Method Use among Women in Heterosexual Relationships in Mahikeng, South Africa

“…The findings that women who were employed and have ever discussed condom use with their partners were practicing dual method use are consistent with other reports in South Africa 8,32 . Good socioeconomic status may have contributed to the practicing of dual protection by affecting the ability to use condoms or in conjunction with non-barrier methods of choice.…”

Partner Support for Family Planning and Modern Contraceptive Use in Luanda, Angola

“…Male involvement in family planning IEC could address misperceptions, myths, gender attitudes, and health concerns which make men more likely to oppose family planning and less likely to communicate their approval or voice encouragement, even if they approve. Research suggests that the social networks and larger cultural context shape family planning norms and behaviors 22,38,[40][41][42] . Husbands/partners are pivotal figures in the sexual and reproductive lives of women and contribute to the culture in which women live.…”

“…Les interventions impliquant des campagnes d'information et de communication axées sur les hommes et la promotion de la participation des hommes à la planification familiale pourraient accroître la prévalence des contraceptifs. (Afr J Reprod Health 2017; 21 [2]: [35][36][37][38][39][40][41][42][43][44][45][46][47][48].…”

Association Between Social Network Communities and Health Behavior: An Observational Sociocentric Network Study of Latrine Ownership in Rural India

“…The theory of planned behavior, for instance, includes self-reported measures of reference groups subjectively defined as "people who are important to you." 17---19 Most research surveys (e.g., with outcomes as diverse as the use of contraception 20,21 or adolescent smoking 22 ) have not collected data specific to social norms, requiring researchers instead to create measures of possible norms through the aggregation of existing measures and to infer reference groups from geographic boundaries, such as villages. However, does a valid reference group include (1) just those to whom one is directly connected (friends), (2) those to whom one is more broadly and indirectly connected (e.g., friends of friends), or (3) a still larger aggregation (e.g., the village or town in which one resides)?…”