Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms supporting high fertility, male-dominated decision-making, and contraceptive myths strongly shape family planning behaviors in this setting. Interventions must go beyond individual-level change to also address relational dynamics, especially fostering joint decision-making and male engagement, and create enabling environments that support women’s autonomy and challenge entrenched gender roles.
Objectives This study examines the drivers of high fertility and low contraceptive use in northwestern Nigeria, aiming to understand how social and behavioral change (SBC) programs can effectively improve family planning outcomes by targeting key psychosocial and social factors such as knowledge, spousal communication, approval, and social influences.
Methods The study used a cross-sectional household survey of 3,000 women aged 15–49 with a child under two, conducted in three Nigerian states. Using the ideational framework of behavior change, the researchers applied mixed-effects logistic regression analyses to explore associations between cognitive, emotional, and social ideational factors and outcomes like contraceptive use, intentions, spousal discussions, and approval.
Intervention Details While this was not an intervention evaluation, the study was conducted as part of the baseline assessment for the USAID-funded Breakthrough ACTION/Nigeria SBC program. This program includes advocacy outreach, community engagement through household visits and dialogues, and integrated SBC messaging via mass and mobile media to address family planning, malaria, and maternal-child health.
Results Approval of family planning, spousal communication, and contraceptive knowledge were the strongest predictors of modern contraceptive use and intentions. Women who approved of contraception were nearly three times more likely to use modern methods and six times more likely to intend to start. Joint decision-making with husbands was associated with significantly better outcomes than unilateral decisions by either partner. Dispelling myths and increasing accurate knowledge also significantly improved approval and communication.
Conclusions SBC programs can achieve meaningful gains in contraceptive use even without large-scale socioeconomic changes by focusing on improving knowledge, challenging myths, promoting spousal discussions, and increasing approval of family planning. Engaging both women and men is critical to maximizing impact.
Norms Addressed
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