Impact of Sumadhur intervention on fertility and family planning decision-making norms: A mixed methods study

Abstract

Background Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making. Methods In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired t-tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically. Results Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges. Conclusions Entrenched social norms surrounding fertility and family planning contrasted with participants’ personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

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

“…Nearly one-fifth of the women have unmet need for limiting [40], which has increased in recent times; which suggest the need for expanding the basket of choices in the program to address the need of the women. Additionally, promising interventions such as Sumadhur i.e., intervention for triads (wives, husbands, and mothers-in-law) including inequitable gender norms and practices, fertility planning and contraception, and couples and household relationship dynamics, which has been proved beneficial in improving fertility and family planning decision-making norms among newlyweds should be scaled up [41].…”

Individual empowerment and community norm effects of engaging young husbands in reproductive health in rural India: findings from a pilot study

“…contraceptives) to delay pregnancy decreased signi cantly (23% decrease among newly married women and 17% decrease among mothers-in-law). (13) This pattern was not observed among husbands, with their opposition to family planning methods increasing after being administered the intervention. This contradictory nding among the husbands indicates that further research needs to be conducted to uncover the limitations and barriers to family planning acceptance among husbands.…”

Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial

“…Despite this recognition, there remains a notable gap in the literature. While a handful of studies have addressed the involvement of key household members, such as mothers-in-law and husbands, in efforts to enhance contraception uptake and promote women’s empowerment,51–53 such interventions are scarce, particularly in the context of South Asia. This highlights a significant gap in the current research landscape, as more comprehensive approaches involving these influential household members are essential for effectively addressing barriers to family planning and advancing women’s reproductive health and empowerment in the region.…”