Key Social Norms Take-aways The Sumadhur intervention demonstrated that shifting entrenched fertility and family planning norms—especially around the timing of first births and gendered household decision-making—is possible through intentional engagement of multiple household generations. Although societal norms continue to pressure women into early pregnancy, the intervention catalyzed more gender-equitable attitudes and communication within families, revealing that individual attitudes often diverge from perceived social expectations. Empowering women requires not only education but also the transformation of family and community dynamics to support delayed childbirth, contraceptive use, and reproductive autonomy.
Objectives This study aimed to evaluate the impact of the Sumadhur intervention on social norms and decision-making practices related to fertility and family planning among newly married women, their husbands, and mothers-in-law in rural Nepal.
Methods The researchers used a sequential mixed-methods design, including pre- and post-intervention surveys and in-depth interviews. Quantitative analysis employed nonparametric Wilcoxon Signed-Rank tests, while qualitative data from 45 interviews were thematically analyzed. Norms were assessed using a tailored taxonomy focusing on descriptive and injunctive norms related to fertility and reproductive decision-making.
Intervention Details Sumadhur is a four-month, community-based group intervention involving triads of newly married women, their husbands, and mothers-in-law. Conducted weekly in six villages, the sessions addressed gender norms, nutrition, reproductive health, and intra-household relationships through participatory learning and interactive activities. The goal was to build knowledge, challenge harmful norms, and strengthen family support for reproductive decision-making.
Results Statistically significant improvements were observed in knowledge of family planning, abortion legality, and the benefits of birth spacing across all participant types. Norms around delaying the first pregnancy improved notably among women and mothers-in-law, though less so among husbands. Support for spacing pregnancies increased significantly, and there was a modest shift away from sex preference for children. Newly married women also reported increased contraceptive intentions and greater agency in household decisions. Qualitative findings highlighted improvements in family relationships and growing openness toward women’s educational and reproductive choices, though persistent societal stigma remained a barrier.
Conclusions The Sumadhur intervention effectively improved knowledge and influenced key social norms related to fertility and gender roles within households. Despite continued pressure for early childbirth, family-level support for delayed pregnancy and contraceptive use grew. This study emphasizes the importance of multi-generational, community-level interventions to address reproductive autonomy and suggests Sumadhur should be scaled and adapted for broader implementation in similar contexts.