The association between men’s family planning networks and contraceptive use among their female partners: an egocentric network study in Madagascar

listen audio

Study Justification:
– The study aims to address the high maternal mortality rate in countries like Madagascar by examining the association between men’s family planning networks and contraceptive use among their female partners.
– Previous research has shown that women’s social networks influence their contraceptive use, but few studies have considered the role of men’s social networks in this context.
– Understanding the composition of men’s family planning networks and their impact on couples’ contraceptive use can inform interventions and strategies to improve reproductive health outcomes.
Study Highlights:
– The study was conducted among married/partnered men in rural Madagascar.
– Participants listed who they relied on for family planning information and advice, including health providers and social ties.
– The primary outcome was couples’ contraceptive use, and the explanatory variables included family planning networks and their composition.
– The results showed that men with family planning networks were 1.9 times more likely to use modern contraception as a couple compared to men with no network.
– Men with social-only networks, provider-only networks, or mixed networks were more likely to use modern contraception compared to men with no network.
– The findings suggest that reaching men through both providers and social ties is important for promoting communication and support for contraceptive use.
Recommendations:
– Interventions should focus on reaching men through their social networks and health providers to promote contraceptive use.
– Strategies should be developed to foster communication and support for family planning within couples.
– Education and awareness programs should be implemented to increase knowledge about modern contraception among men and their social networks.
Key Role Players:
– Health providers: They play a crucial role in providing accurate information and counseling about family planning.
– Community health workers: They can serve as intermediaries between health providers and men’s social networks, providing education and support.
– Local leaders and community influencers: They can help disseminate information and promote positive attitudes towards family planning.
– Non-governmental organizations (NGOs): They can collaborate with local stakeholders to implement interventions and programs targeting men and their social networks.
Cost Items for Planning Recommendations:
– Training and capacity building for health providers and community health workers.
– Development and dissemination of educational materials and resources.
– Outreach and awareness campaigns targeting men and their social networks.
– Monitoring and evaluation of interventions.
– Collaboration and coordination efforts among stakeholders.
– Research and data collection to assess the impact of interventions and inform future strategies.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it presents a clear research question, methodology, and results. The study sample was recruited from a representative sample of villages, and data was collected using a structured survey. The analysis used appropriate statistical methods and adjusted for relevant covariates. The results show a significant association between men’s family planning networks and couples’ contraceptive use. To improve the evidence, the abstract could provide more information on the limitations of the study, such as potential biases or generalizability issues. Additionally, it would be helpful to include the effect sizes and confidence intervals for the associations found.

Background: Ensuring women have information, support and access to family planning (FP) services will allow women to exercise their reproductive autonomy and reduce maternal mortality, which remains high in countries such as Madagascar. Research shows that women’s social networks – their ties with partners, family members, friends, and providers – affect their contraceptive use. Few studies have considered the role of men’s social networks on women’s contraceptive use. Insofar as women’s contraceptive use may be influenced by their male partners, women’s contraceptive use may also be affected by their partner’s social networks. Men may differ by the types of ties they rely on for information and advice about FP. It is unknown whether differences in the composition of men’s FP networks matter for couples’ contraceptive use. This study assessed the association between men’s FP networks and couples’ contraceptive use. Methods: This egocentric network study was conducted among married/partnered men (n = 178) in rural Madagascar. Study participants listed who they relied on for FP information and advice, including health providers and social ties. They provided ties’ gender, age, relationship, and perceived support of contraceptive use. The primary outcome was couples’ contraceptive use, and explanatory variables included FP networks and their composition (no FP network, social-only network, provider-only network, and mixed network of social and provider ties). Analyses used generalized linear models specifying a Poisson distribution, with covariate adjustment and cluster robust standard errors. Results: Men who had FP networks were 1.9 times more likely to use modern contraception as a couple compared to men with no FP network (95% confidence interval [CI] 1.64–2.52; p ≤ 0.001). Compared to men with no FP network, men were more likely to use modern contraception if they had a social-only network, relative risk (RR) = 2.10 (95% CI, 1.65–2.68; p ≤ 0.001); a provider-only network, RR = 1.80 (95% CI, 1.54–2.11; p ≤ 0.001); or a mixed network, RR = 2.35 (95% CI, 1.97–2.80; p ≤ 0.001). Conclusions: Whether men have a FP network, be it provider or social ties, distinguishes if couples are using contraception. Interventions should focus on reaching men not only through providers but also through their social ties to foster communication and support for contraceptive use.

The study sample was recruited from 27 villages randomly selected from the 80 villages within a 5 km radius of the semi-urban town of Ambalavao in Fianarantsoa Province, Madagascar. Data collectors enumerated all households by village and then used random number draws to identify households for study participation. The total sample chosen from each village was proportionate to the number of households in the village, with a minimum of 5 households per village. Within each selected household, the data collector enumerated all men ages 18 years and older who were willing to answer questions about FP, and then randomly selected one man. Surveys were conducted in the local language (Malagasy) by male data collectors in order to facilitate study recruitment and elicit candid answers about reproductive health topics. Prior to data collection, written informed consent was obtained, with verbal informed consent permitted for participants who could not read and write. All men who were randomly chosen within a household consented to participate, yielding a study sample of 208 men. Men who were not in partnership (that is, who were either divorced, widowed, or single; n = 17) and men whose partners were pregnant (n = 13) were excluded from this study. Thus, the final analytical sample included 178 study participants. Participants were provided with a small gift for their time and participation in the form of a lamba, a cloth used locally for multiple purposes. The study received approval from the National Ethics Committee in Madagascar and the University of California San Francisco Institutional Review Board. Cross-sectional data were collected from June to July 2019. The primary outcome was a binary measure of whether the participant reported that their partner is currently using modern contraception. We hereafter interpret this variable as the couple using modern contraception though it is understood that the measure is based on the male partner’s perception of his partner’s contraceptive use. We defined modern contraception to include injectables, the pill (oral contraceptives), implants, intra-uterine devices (IUD) and external condoms (i.e., male condoms). Participants were also asked if they knew anyone else using these modern methods, which was recorded as a dichotomous yes or no. Male and female sterilization were excluded as forms of modern contraception because of data validity issues. In our data, 15% of men reported using sterilization. For reference, in national surveys among reproductive age women in Madagascar, 4% report using female sterilization and 0.3% report that men were sterilized [45]. This discrepancy was likely due to a misunderstanding of the question, so we excluded reports of sterilization as a form of modern contraception. Participants were also asked about their desire for pregnancy as a couple in the last 4 weeks (with answer categories for wanted to become pregnant, did not want to, or was not certain). Participants also reported who, within the couple, made decisions about contraceptive use (participant, his partner, or together as a couple). The number of births that the female partner had experienced was also elicited from participants. The number of births was used to reflect fertility, given high infant and child mortality in Madagascar [46]. Other data recorded included age, whether the participant was married and/or living with the partner or has partner but not living together, number of household members, whether attended school and highest grade attained, current occupation, estimated household earnings in the past month, and whether the household had electricity. Missingness for these variables is < 3% except for pregnancy desires (12%), contraceptive use decision-making (20%), and number of births (11%). To collect network data, we adapted the people network survey developed by Brunson (2013) [47, 48] to ask about FP. We asked participants (egos) to list the individuals (alters) from whom they obtain information, advice, and/or guidance about FP.1 The question was worded as follows: “The purpose of these next questions is to gather accurate information about your people network; in other words, the people from whom you obtain information, advice and/or guidance about your use of family planning. Please take a moment to think about who these people might be. Please provide the first names of the people who have influenced your use of family planning.” Interviewers then prompted participants to review if they had forgotten any alters, prompting them to consider whether they wished to include their partner(s), siblings, parents, CHWs, and other health providers to ensure completeness. The maximum number of alters elicited from any study participant was 3. For each alter that was listed, name interpreter questions elicited alter age and gender, nature of the ego’s relationship with that alter, and the ego’s perception of that alter’s support of modern contraceptive use (categorized as supportive of modern contraceptive use vs. not supportive). Several network measures were used as explanatory variables in separate analyses. The first explanatory variable was a dichotomous variable for whether the study participant named at least one individual in his FP network. The second was a categorical variable that included four mutually exclusive categories to represent network composition: 1) having no FP ties and thus no FP network, 2) all FP ties were composed of social relations only, including partner, other family members, and/or friends (hereafter referred to as social-only FP network); 3) all FP ties were composed of providers only, including CHWs, health educators, nurses, mid-wives or doctors (hereafter referred to as provider-only FP network); and 4) FP ties were composed of a combination of social and provider ties (hereafter referred to as a mixed FP network). The size of the FP network was categorized as 0 alters, 1 alter, or ≥ 2 alters. There were no differences in contraceptive use or network composition by missingness of baseline covariates. If observations had missing covariates, then they were not included in the analysis. However, missingness of covariates was significant at p = 0.051 level, for differences in FP network composition. Men with no FP network were more likely to have missing covariates and therefore were not included in the analysis: 26% of men with missing covariates had no FP network compared to 16% of men with non-missing covariates. We fitted a generalized linear model specifying a Poisson distribution with robust standard errors, interpreting the estimated incidence rate ratios as relative risk ratios (RR) [49]. In all analyses, the individual-level characteristics included age, number of births by partner, living together status, primary school completion, and household earnings. To avoid model over-specification, other individual characteristics were not included because of limited variation (electricity, occupation as farmer). Household size was included instead of number of births because of higher missingness rates (results are similar when births is included instead). Models also included fixed effects by sub-districts (the Malagasy Fokontany, which represents groups of villages). Analyses were conducted at the ego-level using robust standard errors clustered by sub-district. Additional analyses were conducted at the alter-level only using data from men with a FP network to examine the association between alter characteristics (gender, age, perceived support for contraceptive use, and type of relationship (e.g. CHW) and couple’s use of contraception, with robust standard errors clustered by sub-district. Alternative specifications included adjusting for: 1) couples’ pregnancy desire and 2) couples’ contraceptive decision-making. These covariates were not included in the main model because of higher missingness rates. In other specifications, we explored: 3) including both network composition and knowledge of contraceptive users variables, and 4) excluding partners as sources of advice in the network since the outcome simultaneously measures partners’ use of contraception. We also conducted an e-value sensitivity analysis to estimate how large the relative risk ratio of an unobserved confounder would need to be associated with both contraceptive use and men’s social networks in order to completely explain the associations in the study [50, 51].

Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Male Engagement Programs: Develop programs that specifically target men and aim to increase their knowledge and involvement in family planning and maternal health. These programs can include educational campaigns, workshops, and community outreach activities to raise awareness and promote positive attitudes towards contraception and maternal health.

2. Social Network Interventions: Implement interventions that leverage men’s social networks to promote contraceptive use and maternal health. This can involve identifying influential individuals within men’s networks and training them to disseminate accurate information and provide support for family planning. Peer-to-peer communication and support can be powerful in changing attitudes and behaviors.

3. Provider Training: Enhance the training of healthcare providers to ensure they have the knowledge and skills to effectively engage men in discussions about family planning and maternal health. This can include training on effective communication strategies, cultural sensitivity, and addressing men’s concerns and misconceptions.

4. Integrated Services: Improve access to maternal health services by integrating family planning services with other healthcare services. This can involve providing family planning counseling and contraceptive methods during antenatal and postnatal care visits, as well as integrating family planning services with other reproductive health services.

5. Mobile Health (mHealth) Solutions: Utilize mobile technology to deliver information and services related to maternal health and family planning. This can include mobile apps, SMS messaging, and telemedicine services that provide educational resources, reminders for contraceptive use, and access to healthcare providers for consultations.

6. Community-Based Approaches: Implement community-based interventions that involve community leaders, religious leaders, and local organizations to promote family planning and maternal health. This can include community education sessions, support groups, and community-led initiatives to address barriers and promote positive norms around family planning.

7. Male-Friendly Healthcare Facilities: Create healthcare facilities that are welcoming and accommodating to men, providing a comfortable environment for them to seek information and services related to family planning and maternal health. This can involve training healthcare staff to be sensitive to men’s needs and preferences, as well as providing male-friendly waiting areas and educational materials.

These innovations can help improve access to maternal health by engaging men, leveraging social networks, enhancing provider training, integrating services, utilizing technology, and involving communities in promoting positive attitudes and behaviors towards family planning and maternal health.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the study is to focus on reaching men through their social networks in addition to healthcare providers. The study found that men who had family planning (FP) networks were 1.9 times more likely to use modern contraception as a couple compared to men with no FP network. Men with social-only networks, provider-only networks, or mixed networks of social and provider ties were all more likely to use modern contraception compared to men with no FP network.

Therefore, interventions should aim to engage men not only through healthcare providers but also through their social ties. This can be done by implementing community-based programs that involve men’s social networks, such as peer education and support groups. These programs can provide accurate information about family planning, address misconceptions, and promote communication and support for contraceptive use within couples. By involving men’s social networks, the innovation can help create a supportive environment for women to exercise their reproductive autonomy and improve access to maternal health services.
AI Innovations Methodology
The study titled “The association between men’s family planning networks and contraceptive use among their female partners: an egocentric network study in Madagascar” explores the impact of men’s social networks on couples’ contraceptive use in rural Madagascar. The study aims to understand whether the composition of men’s family planning (FP) networks affects couples’ contraceptive use and to provide insights for interventions to improve access to maternal health.

The methodology used in this study is an egocentric network study. The study sample consisted of married/partnered men in rural Madagascar. Data collectors enumerated households in selected villages and randomly selected one man from each household. Surveys were conducted in the local language, and written or verbal informed consent was obtained from participants. The final analytical sample included 178 men.

To collect network data, participants were asked to list individuals from whom they obtain information, advice, and/or guidance about family planning. Participants provided the names of these individuals, their age, gender, nature of the relationship with the participant, and their perceived support of modern contraceptive use. Network measures, such as the presence of FP ties, network composition (social-only, provider-only, mixed), and network size, were used as explanatory variables.

The primary outcome of the study was whether the participant reported that their partner is currently using modern contraception. Other variables, such as desire for pregnancy, contraceptive decision-making, number of births, age, marital status, education, occupation, household earnings, and household characteristics, were also collected.

The data analysis involved fitting generalized linear models with a Poisson distribution and robust standard errors. The estimated incidence rate ratios were interpreted as relative risk ratios. The models included individual-level characteristics and fixed effects by sub-districts. Additional analyses were conducted at the alter-level to examine the association between alter characteristics and couples’ contraceptive use.

The study found that men with FP networks were more likely to use modern contraception as a couple compared to men with no FP network. Men with social-only networks, provider-only networks, or mixed networks were also more likely to use modern contraception. These findings suggest that interventions should focus on reaching men not only through providers but also through their social ties to foster communication and support for contraceptive use.

In summary, the study used an egocentric network study design to assess the association between men’s FP networks and couples’ contraceptive use in rural Madagascar. The methodology involved data collection through surveys, network mapping, and statistical analysis using generalized linear models. The findings highlight the importance of men’s social networks in influencing couples’ contraceptive use and provide insights for interventions to improve access to maternal health.

Partagez ceci :
Facebook
Twitter
LinkedIn
WhatsApp
Email