Social networks, ideation, and contraceptive behavior in Bangladesh: a longitudinal analysis

TLDR

Ideation, derived from diffusion of innovation and social network theory, explains how a social network approach influences contraceptive behavior. The study estimates the impact of a social network approach to family planning communication and tests a behavior‑change model explaining modern contraceptive adoption among married Bangladeshi women. Field workers were trained to conduct group discussions in opinion leaders' homes at village hubs, implementing the social network approach. Women exposed to the social network approach experienced a five‑fold faster rise in modern contraceptive use and nearly double the effect of conventional visits, while both approaches equally affected ideation, confirming ideation’s role in fertility change.

Abstract

Longitudinal survey data from a panel of married women in Bangladesh is used to estimate the impact of a social network approach to family planning field worker communication and to test a theoretical model of behavior change that explains why women adopt modern contraceptives. Government field workers were trained to organize group discussions with women in the homes of opinion leaders located at central points in each village's social network. A set of intervening variables, referred to collectively as 'ideation', are derived from diffusion of innovation and social network theory to explain how the social network approach affects contraceptive behavior. The rate of increase in modern contraceptive use was found to be five times greater among women in the social network approach than among women who were visited by field workers at home. The impact of the social network approach on modern contraceptive use was almost double that of conventional field worker visits after controlling for the effects of prior contraceptive use and intention, prior home visits, and selected socio-demographic characteristics. Both approaches had the same degree of impact on ideation. The results confirm the influence of ideation on fertility change and suggest that family planning programs would benefit from training field workers to use a social network approach.