Translating the Social-Ecological Perspective Into Multilevel Interventions for Family Planning: How Far Are We?

Abstract

Scholars and practitioners frequently make recommendations to develop family planning interventions that are "multilevel." Such interventions take explicit account of the role of environments by incorporating multilevel or social-ecological frameworks into their design and implementation. However, research on how interventions have translated these concepts into practice in the field of family planning-and generally in public health-remains scarce. This article seeks to review the current definitions of multilevel interventions and their operationalization in the field of family planning. First, we highlight the divergent definitions of multilevel interventions and show the persistent ambiguity around this term. We argue that interventions involving activities at several levels but lacking targets (i.e., objectives) to create change on more than one level have not incorporated a social-ecological framework and should therefore not be considered as "multilevel." In a second step, we assess the extent to which family planning interventions have successfully incorporated a social-ecological framework. To this end, the 63 studies featured in Mwaikambo et al.'s systematic review on family planning interventions were reexamined. This assessment indicates that the multilevel or social-ecological perspective has seldom been translated into interventions. Specifically, the majority of interventions involved some form of activity at the community and/or organizational level, yet targeted and measured intrapersonal change as opposed to explicitly targeting/measuring environmental modification.