Abstract

BackgroundNorthwestern 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.MethodsData 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.ResultsKnowledge, 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.ConclusionSBC 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.

Highlights

  • 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

  • This study focuses in particular on several key components of these theories that may be of particular relevance for the design and implementation of behavior change programs in northwestern Nigeria that seek to influence contraceptive use, including interpersonal discussions between couples, approval of family planning, and contraceptive knowledge

  • High fertility and low contraceptive use in northwestern Nigeria are influenced by numerous factors, including social norms for high fertility, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities

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Summary

Introduction

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. The 2018 Nigeria Demographic and Health Survey (NDHS) indicated that the total fertility rate in the northwest of the country was 6.6 live births per woman, and that women aged 40 to 49 years averaged 8.3 births in their reproductive lifetimes [2] This high-fertility situation places women at greater risk of birth complications and maternal mortality. In the 2018 NDHS, only 6.2% of married women in the northwest were currently using any form of modern contraception, and the majority of married women - 68.7% - reported no need for family planning for either spacing or limiting [2] Much of this absence of demand for family planning can be attributed to social norms for high fertility, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities

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