Boulay, Marc Guy; PhD

                         THE JOHNS HOPKINS UNIVERSITY, 2001

                         HEALTH SCIENCES, PUBLIC HEALTH (0573); SOCIOLOGY, ETHNIC AND RACIAL STUDIES (0631); WOMEN'S STUDIES (0453)
 

                         There is growing evidence that women's social networks regarding family planning are influential in their
                         decisions to use a contraceptive method. It is unclear, however, how discussions with peers facilitate
                         contraceptive use or what role information-seeking strategies may play in determining the composition of
                         these networks. Identifying the reciprocal influences between individuals and their social environment
                         may foster a greater understanding of the process by which innovations diffuse throughout a community
                         and may inform community-based approaches to behavior change. The present study examined
                         changes in the composition of women's family planning discussion networks over time to assess both
                         the role of discussion networks in promoting contraceptive use and the role of individual motivations in
                         constructing one's social environment. Data were collected at two points in time from women living in
                         three villages in Dang District, Nepal using structured surveys (N = 281) and semistructured in-depth
                         interviews (N = 12). Sociometric data were collected to identify discussion networks. Cross-sectional and
                         longitudinal logistic regression models were used to test the research questions. Adoption of family
                         planning was associated with positive changes in the composition of one's social network. Women who
                         added a long-term user or recent contraceptive adopter or who had dropped a non-user from their
                         network were all more likely to have adopted a contraceptive method. The use of these multiple
                         pathways to contraceptive adoption suggested that a number of mechanisms mediate the relationship
                         between social interaction and individuals' behavior. Individual-level characteristics were associated with
                         these changes. Women with low levels of knowledge were more likely to have added long-term users to
                         their network. Women with positive attitudes towards family planning were often more likely to have made
                         positive changes to their network. Perceptions of spousal disapproval and son preference were
                         associated with a lower use of Positive changes strategies. Cognitive dissonance was used to explain
                         the role of these changes as strategies to minimize one's exposure to information dissonant with one's
                         existing attitudes and beliefs. The present findings support current the use of family planning programs
                         focusing on community-based activities aimed at women's empowerment.

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