The Influence of Changes in Fertility Related Norms on Contraceptive Use in Egypt, 1995–2005

Abstract

The debate around the relative influence of ideation versus development on fertility reduction has been on-going at least since Cleland & Wilson’s “iconoclastic view” of fertility transition was published in 1987. While there is fairly wide recognition that the diffusion of new behaviors through a community can play an important role in fertility transitions, there is relatively little research on the effect of changes in the normative environment—a predictable consequence of the ideational process—on a woman’s fertility decisions. For the current study, we focus on collective or group norms, which have been defined as “regularities in attitudes and behavior that characterize a social group and differentiate it from other groups.” We infer these regularities in behavior and attitudes by aggregating across individual reports to calculate the objective prevalence of these phenomena within groups. Using multilevel analysis of consecutive 1995, 2000 and 2005 Egypt Demographic and Health Surveys (EDHS), we test the effect of changes in the norms related to the desire for a large family and the use of family planning at parity 0 or 1 on self-reported contraceptive use among married women in Egypt. The analysis included 2432 married women 15–49 years for the 1995–2000 period and 5285 women for the 2000–2005 period. Norms are defined at the cluster level, which serves as our community-level unit of analysis. After controlling for individual and other community factors, including changes in literacy, we found that women residing in communities where the desire for large families increased from 1995–2000 were more than 70% less likely to use a contraceptive method. While the trend was similar, no such effect of desired family size was observed from 2000–2005. Instead, residence in a community where use of family planning after the first child increased from 2000–2005 resulted in a more than three-fold increase in contraceptive use in 2005. Results indicate that changes in norms measured at the collective level affect individual contraceptive use. Specific attitudinal and behavioral changes that influenced individual action, however, changed over time, consistent with shifts in the emphasis of the national family planning program.