Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors

Abstract

Background Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. Methods Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants. Results Knowledge, approval of family planning, and social influences, particularly from husbands, were all associated with improved family planning outcomes. Approval of family planning was critical – women who personally approve of family planning were nearly three times more likely to be currently using modern contraception and nearly six times more likely to intend to start use in the next 6 m. Husband’s influence was also critical. Women who had ever talked about family planning with their husbands were three times more likely both to be currently using modern contraception and to intend to start in the next 6 m. Conclusion SBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use—even without large-scale changes in socio-economic and health services factors—by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Uncertainty about the time-order of influencers and outcomes however precludes inferences about the existence of causal relationships and the potential for impact from interventions.

Collective norms and modern contraceptive use in men and women: A multilevel analysis of DHS Program data in Nigeria and Zambia

“…This study uses nationally representative data from Nigeria and Zambia to explore associations between collective norms and individual modern contraceptive use and how these differ for men and women. Previous studies in both countries have shown that socio-cultural factors play a significant role in forming norms that impact fertility-related behavior, including norms related to gender, desire for larger families, and broader religious/cultural influences 16,[23][24][25][26][27][28] . Gender norms associated with modern contraceptive use include gender-equitable attitudes towards household decision-making, couples' family planning decisions, and community-level family planning self-efficacy in Nigeria 16 and higher mean age at first birth, community justification for domestic violence, the ratio of men's to women's employment in Zambia 15,29 .…”

Multimodal resources in the ‘Get It Together’ reproductive health campaign in Nigeria

“…Out of a total of more than 170 countries, Nigeria is among the 20 countries with the highest fertility rates in the world (Niger has the highest rate, with an average of seven children per woman (Hutchinson et al, 2021; World Bank, 2020). The resulting unsustainable population growth has a significant negative impact on people’s lives and on society at large.…”

“…With 814 deaths per 100,000 live births (World Health Organization, 2018), Nigerian women have a 1 in 22 life-time risk of dying during pregnancy, childbirth, postpartum or post-abortion and are 500 times more likely to lose their life in childbirth than their counterparts in the most advanced nations of the world ( Daily Trust Report , 2021). Although the degree of the risk varies across the six geopolitical regions of the country, maternal mortality poses a great risk to the health and well-being of Nigerian women and infants (see Hutchinson et al, 2021; National Population Commission and ICF (2019)).…”

ZIKV-Related Ideations and Modern Contraceptive Use: Cross-Sectional Evidence from the Dominican Republic, El Salvador, Honduras, and Guatemala

“…27 , 28 The ideational model has been used to successfully examine and develop health communication campaigns to address HIV, 29 malaria, 30 pandemic influenza, 31 pneumonia, 32 and even contraceptive use. 33 , 34 …”