Validation of the Fertility Norms Scale and Association with Fertility Intention and Contraceptive Use in India

Abstract

Social norms related to fertility may be driving pregnancy desire, timing and contraceptive use, but measurement has lagged. We validated a 10‐item injunctive Fertility Norms Scale (FNS) and examined its associations with family planning outcomes among 1021 women and 1020 men in India. FNS captured expectations around pronatalism, childbearing early in marriage and community pressure. We assessed reliability and construct validity through Cronbach's alpha and exploratory factor analysis (EFA) respectively, examining associations with childbearing intention and contraceptive use. FNS demonstrated good reliability (α = 0.65–0.71) and differing sub‐constructs by gender. High fertility norm among women was associated with greater likelihood of pregnancy intention [RRR = 2.35 (95% CI: 1.25,4.39); ARRR = 1.53 (95% CI: 0.70,3.30)], lower likelihood of delaying pregnancy [RRR = 0.69 (95% CI: 0.50,0.96); ARRR = 0.72 (95% CI: 0.51,1.02)] and greater ambivalence on delaying pregnancy [RRR = 1.92 (95% CI: 1.18,3.14); ARRR = 1.99 (95% CI: 1.21,3.28)]. Women's higher FNS scores were also associated with higher sterilization [RRR = 2.17 (95% CI: 1.28,3.66); ARRR = 2.24 (95% CI: 1.32,3.83)], but the reverse was noted for men [RRR = 0.61 (95% CI: 0.36,1.04); ARRR = 0.54 (95% CI: 0.32,0.94)]. FNS indicated better predictive value among women compared to men for key reproductive outcomes. This measure may be useful for social norms‐focused evaluations in family planning and warrants cross‐contextual study.

Examining the influence of Mother-in-law on family planning use in South Asia: insights from Bangladesh, India, Nepal, and Pakistan

“…A past small scale qualitative study (Based on 60 MIL, 60 DIL and Sons from same family) conducted in Madhya Pradesh, India conforms this and found that DIL is not comfortable to discuss or disclose about contraceptive use with MIL but they only discuss with husband [13]. Another earlier study also reveal that husband's decision regarding spacing method use is more important than MIL's [34]. In the country, the use of any traditional method of contraception is also high among women co-residing with MIL.…”

Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data

“…While the SRHR Support Index overlaps conceptually with existing indices and scales that capture attitudes towards specific dimensions of SRHR – such as gender equality and women’s empowerment (e.g., SWPER Index [ 23 ], Women and Girls Sexual and Reproductive Empowerment Index (WGE-SRH) [ 26 ], Women’s Agency Scale [ 27 ], the Gender-Equitable Men Scale [ 28 ], the G-NORM scale [ 29 ]) or fertility (e.g., the Fertility Norms Scale [ 30 ]) – its comprehensive approach can help to further improve the understanding and tracking of countries’ progress towards realizing SRHR for all. This Index can in particular be useful to understand and advance SRHR in light of global backlashes and resistance towards sexual and reproductive rights (e.g., abortion and the rights and freedoms of sexual minorities).…”

Introduction to the Special Issue: Indicators in Sexual and Reproductive Health and Rights

“…Two papers go beyond individual knowledge, beliefs, and attitudes to assess the social context in which sexual and reproductive health‐related behaviors are enacted. Bhan and colleagues (2023) present a newly developed 15‐item fertility norms scale and examine its association with several reproductive health outcomes in India. Similarly, Sedlander and colleagues (2023) evaluate measures of gender norms in Nepal and document their association with sexual and reproductive health‐related behavioral outcomes.…”