Association of collective attitudes and contraceptive practice in nine sub-Saharan African countries
Outcomes: Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Community-level gender norms—specifically permissive attitudes toward premarital sex and accepting attitudes toward wife-beating—significantly influence contraceptive use and demand satisfaction among women in sub-Saharan Africa. Permissive norms are associated with greater contraceptive use, while norms accepting wife-beating are linked to lower use. Addressing these norms is key to improving reproductive health outcomes.
Objectives To assess how community-level gender norms affect individual contraceptive use and demand for contraception among women in nine sub-Saharan African countries.
Methods The study analyzed cross-sectional data from Demographic and Health Surveys (2005–2009) using multilevel logistic regression. It included 73,090 sexually active, fecund women aged 15–49 years. Gender norms were proxied through aggregated community-level attitudes toward premarital sex and wife-beating. Analyses controlled for individual sociodemographic factors and community indicators of women’s empowerment (education, early marriage, employment).
Social Norms Measures and Methods Norms were measured as “collective attitudinal norms” derived from community-level aggregation of individual responses. These included permissive attitudes toward premarital sex and acceptance of wife-beating, stratified by age and sex (adolescent peers vs. adults). The Theory of Normative Spectrum guided the interpretation of how such norms shape behavior through visibility, sanctions, and relevance.
Results A one standard deviation increase in collective permissive attitudes toward premarital sex was associated with an 8–11% increase in contraceptive use. Conversely, a similar increase in collective acceptance of wife-beating correlated with a 10% decrease. These associations held after adjusting for individual attitudes and empowerment factors. Community-level norms explained 26% of the variation in contraceptive use, with education-related empowerment accounting for an additional 41%. Country-specific analyses showed the strongest normative effects in Nigeria and Benin.
Conclusions This study is among the first to quantify the impact of gender norms on contraceptive behaviors at a community level. Norms supporting women’s sexual agency promote contraceptive use, while those tolerating gender-based violence undermine it. Efforts to improve family planning outcomes should incorporate norm-shifting strategies alongside empowerment initiatives, particularly in contexts where community influence is strong.
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