A longitudinal study examining how self-injection social norms are associated with contraceptive self-injectable interest and use in rural Uganda
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study demonstrates that social norms specific to contraceptive self-injection play a measurable and influential role in shaping both women’s interest in and actual uptake of self-injectable contraception. Importantly, it shows that beyond awareness and access, supportive descriptive and injunctive norms are critical for enabling women to act on their preferences. The findings highlight that shifting social norms should be a central component of family planning programs, as norms influence perceived acceptability, confidence, and agency in adopting self-care technologies.
Objectives The study aimed to (1) develop a composite measure of self-injection social norms, and (2) assess whether these norms are associated with women’s interest in self-injecting contraception and subsequent self-injection use over time among women in rural Uganda.
Methods This longitudinal study analyzed data from 2,170 sexually active women of reproductive age in rural Uganda who were not self-injecting at baseline. Data were collected at baseline and six-month follow-up as part of the ICAN cohort study. Researchers constructed a self-injection social norms scale using exploratory factor analysis based on items capturing descriptive norms (perceived prevalence), injunctive norms (perceived acceptability), and social sanctions. Logistic regression models (both unadjusted and adjusted) were used to examine associations between social norms scores and outcomes of interest, controlling for sociodemographic factors.
Results A four-item, single-factor self-injection social norms scale with good internal consistency (α=0.78) was developed. Higher social norms scores—indicating more supportive norms—were significantly associated with increased odds of both interest in self-injection at baseline (AOR: 1.92) and actual self-injection use at six-month follow-up (AOR: 1.55). These findings suggest that women who perceive self-injection as more common and socially acceptable are more likely to consider and adopt this contraceptive method.
Conclusions The study concludes that self-injection social norms are a key determinant of contraceptive decision-making and behavior. Interventions aiming to increase uptake of self-injectable contraception should go beyond improving access and awareness to actively promote supportive social norms. The newly developed social norms scale also provides a practical tool for measuring and tracking norms in future research and programs.
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