Cycle 9 (2020 Deadline)
Young wives: an exploratory study of married women below twenty and the socio-cultural determinants of their contraceptive behavior in low resource settings in India
PI: Sudipta Mondal (smondal@pciglobal.in), Project Concern International, India
U.S. Partner: Cristine Legare, The University of Texas at Austin
Project Dates: March 2022 - April 2024
Project Overview:
 | | Group photograph with Prof. Legare and the team. |  | | Interviewer explains the study to a household in Dharmoshala (Dhubri) |  | | Woman busy with daily chores in a Muslim household in Dighi (Godda) |  | | Village of Baghmara (Godda) |
Family planning (FP) is a public health priority in India, with a target fertility rate of 2.1% by 2025. However, FP in India has focused more on female sterilization than delaying births, despite the fact that delaying births is more relevant for young women who are in the process of building a family [Muttreja & Singh, 2018]. This is especially true for states that lag behind in demographic transitioning and other development indices. This project will focus on two such states, namely Jharkhand and Assam, known for higher proportions of underage marriage and tribal populations. More than 30% of women aged 20-24 in Assam and 37% in Jharkhand got married before the age of 18. Moreover, 33% of young married women (15-19) in Assam and 27% in Jharkhand became pregnant within a year of marriage (Indian National Family Health Survey 4). While interventions and policies are in place, it is important to focus simultaneously on understanding and addressing the socio-cultural norms and gender roles at work in order to effectively delay the first pregnancies of young already married women.
The project team will focus on women aged 15-19 years who have been married for at least a year and separate them into two groups: (1) those who have delayed the first pregnancy a year or more after marriage using modern methods (adopters); and (2) those who conceived prior to a year of marriage, or conceived later but did not use any modern method (non-adopters). The intent is to identify the extent to which the FP beliefs and behaviors of these two groups vary, despite navigating similar complex and diverse socio-cultural environments. The main project objective is to identify predictors of FP adoption by studying the complex cultural ecologies of health, particularly fertility-related beliefs and gender norms, and how they interact with the FP decisions of young couples. This study will draw complementary insights from both qualitative and quantitative methods to address data gaps, since these constructs often elude large-scale surveys. The merit of the study lies in its ability to generate context-specific evidence crucial for designing better interventions which will enable young couples to successfully navigate complex socio-cultural norms and make good FP decisions that protect their well-being. The research team will proceed on the basis of their central hypothesis that without an attention to the prevailing socio-cultural values and norms, and without viewing the issue from a family systems perspective, conventional approaches to FP programming will continue to falter.
Despite the fact that the general determinants of family planning behaviors of Indian couples are broadly known, this is not adequate for governments to plan effective interventions. Most national surveys do not provide a thorough understanding of the complex social norms and gender roles concerning fertility that people navigate and that ultimately lead to higher incidences of early marriage and conception. More than 30 million women in India who want to avoid pregnancy are not using modern FP methods. The proposed research will generate knowledge required for designing interventions to achieve this desired behavior.
Project results and potential impact
1. There are significant challenges and gaps in family planning among young wives and their husbands. These challenges take the shape of restrictions in their mobility and decision-making power, which limits their access to resources and ownership of assets. 2. Communication about family planning between spouses is lacking, with husbands often making the final decision on contraceptive methods. 3. Misconceptions about family planning methods are common, and access to information and counseling is limited for both young wives and husbands. 4. There is a significant unmet need for family planning among young wives, with many not using any method or relying on traditional methods. 5. Early pregnancies are prevalent among young wives, which highlights the need for special attention to address these issues. 6. Regressive social norms related to fertility are a hindrance to higher uptake of contraceptives among newly married young couples in rural areas. Impact of the Study: According to Dr. Sudipta, the most important impact of the stydy is that it informs us about the appropriate policy and programmatic responses, such as the following: To improve family planning programs, it is crucial to focus on improving communication, addressing misconceptions, and increasing access to information and counseling to empower young couples to make informed decisions about their reproductive health. Social norms and gender roles are two critical elements that need immediate attention from the FP programs targeted to young wives. To make the use of modern family planning a norm, programs need to break the ‘silence’ around topics related to FP usage by promoting increased discourse at the family and community level. Norms-conscious programming: This refers to programming that acknowledges the importance of norms. The intended interactions between frontline health workers and the newlywed couples – the most dominant factor for influencing contraceptive use behavior among YWs, will not witness a significant rise unless normative barriers are simultaneously addressed along with other predictors. Norm conscious programming in FP emphasizes understanding and respecting the cultural, social, and religious norms surrounding reproductive health. Programs can thus tailor their approaches to be more acceptable and effective within communities. Engagement with all: Normalizing the contraceptive use among young newly married couples need all-round efforts involving the family members, community influencers and frontline health workers. Engaging not just young wives, but also their families, frontline workers, and community influencers widens the scope of influence. Family members play significant roles in decision-making regarding reproductive health, so engaging them in discussions and education can lead to more informed choices. Frontline workers, such as healthcare providers and community health workers, are often trusted sources of information within communities. By involving them in family planning initiatives, their knowledge and support can help bridge gaps in understanding and acceptance. Community influencers, such as religious leaders or respected elders, hold sway over community attitudes and behaviors. Including them in family planning efforts can help change perceptions and foster acceptance within communities. Group-based interactions: Encouraging group-based interactions within community can promote open dialogue and end the silence surrounding family planning. When individuals participate in group discussions, they create a supportive environment where they can share experiences, concerns, and knowledge, leading to increased awareness and acceptance. Utilizing existing platforms like Self-Help Groups (SHGs) leverages established community networks and infrastructure. SHGs often serve as platforms for social and economic empowerment, making them ideal for integrating family planning discussions and activities. Better use of digital resources: Reshaping information dissemination through digital channels capitalizes on the widespread use of technology for communication. This could involve using social media, mobile apps, or online platforms to provide accurate information, dispel myths, and reach a broader audience, especially younger generations who are more digitally connected. Refocusing the FP programming: the project team recommend that Family Planning initiatives should extend their focus beyond solely measuring the total fertility rate (TFR). It's imperative to prioritize the timing of starting the family-building journey, ensuring sufficient spacing between births, and most importantly, these programs should actively contribute to the increasing social and economic ambitions of the youth, particularly young women in India.
The study focused on understanding of family planning behaviors and choices of young couples and the role of social norms in determining those. Findings of the study have the potential to be used as an input for the redesigning of IEC strategies, messages and materials targeted at young couples in rural settings in order to reduce the unmet need and improve the uptake of modern FP methods. The research project was just recently completed, and the findings are yet to be applied for the said purpose. Back to PEER Cycle 9 Grant Recipients
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