Comfort Alison B, Harper Cynthia C, Tsai Alexander C, Perkins Jessica M, Moody James, Rasolofomana Justin Ranjalahy, Alperin Cora, Schultz Margaret, Ranjalahy Anja Noeliarivelo, Heriniaina Ravo, Krezanoski Paul J
University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
Opportunity Solutions International, San Francisco, CA, USA.
BMC Public Health. 2021 Jan 25;21(1):209. doi: 10.1186/s12889-021-10180-6.
Ensuring women have information, support and access to family planning (FP) services will allow women to exercise their reproductive autonomy and reduce maternal mortality, which remains high in countries such as Madagascar. Research shows that women's social networks - their ties with partners, family members, friends, and providers - affect their contraceptive use. Few studies have considered the role of men's social networks on women's contraceptive use. Insofar as women's contraceptive use may be influenced by their male partners, women's contraceptive use may also be affected by their partner's social networks. Men may differ by the types of ties they rely on for information and advice about FP. It is unknown whether differences in the composition of men's FP networks matter for couples' contraceptive use. This study assessed the association between men's FP networks and couples' contraceptive use.
This egocentric network study was conducted among married/partnered men (n = 178) in rural Madagascar. Study participants listed who they relied on for FP information and advice, including health providers and social ties. They provided ties' gender, age, relationship, and perceived support of contraceptive use. The primary outcome was couples' contraceptive use, and explanatory variables included FP networks and their composition (no FP network, social-only network, provider-only network, and mixed network of social and provider ties). Analyses used generalized linear models specifying a Poisson distribution, with covariate adjustment and cluster robust standard errors.
Men who had FP networks were 1.9 times more likely to use modern contraception as a couple compared to men with no FP network (95% confidence interval [CI] 1.64-2.52; p ≤ 0.001). Compared to men with no FP network, men were more likely to use modern contraception if they had a social-only network, relative risk (RR) = 2.10 (95% CI, 1.65-2.68; p ≤ 0.001); a provider-only network, RR = 1.80 (95% CI, 1.54-2.11; p ≤ 0.001); or a mixed network, RR = 2.35 (95% CI, 1.97-2.80; p ≤ 0.001).
Whether men have a FP network, be it provider or social ties, distinguishes if couples are using contraception. Interventions should focus on reaching men not only through providers but also through their social ties to foster communication and support for contraceptive use.
确保女性能够获取信息、获得支持并利用计划生育（FP）服务，将使女性能够行使其生殖自主权，并降低孕产妇死亡率，而在马达加斯加等国家，孕产妇死亡率仍然很高。研究表明，女性的社会网络——她们与伴侣、家庭成员、朋友及服务提供者的关系——会影响她们的避孕措施使用情况。很少有研究考虑男性社会网络对女性避孕措施使用的作用。鉴于女性的避孕措施使用可能受到其男性伴侣的影响，女性的避孕措施使用也可能受到其伴侣社会网络的影响。男性在获取计划生育信息和建议所依赖的关系类型上可能存在差异。男性计划生育网络构成的差异是否对夫妻的避孕措施使用有影响尚不清楚。本研究评估了男性计划生育网络与夫妻避孕措施使用之间的关联。
这项自我中心网络研究在马达加斯加农村地区已婚/有伴侣的男性（n = 178）中开展。研究参与者列出他们在计划生育信息和建议方面所依赖的对象，包括医疗服务提供者和社会关系。他们提供了这些关系对象的性别、年龄、关系以及对避孕措施使用的感知支持。主要结局是夫妻的避孕措施使用情况，解释变量包括计划生育网络及其构成（无计划生育网络、仅社会关系网络、仅医疗服务提供者网络以及社会关系和医疗服务提供者关系的混合网络）。分析采用指定泊松分布的广义线性模型，并进行协变量调整和聚类稳健标准误分析。
与没有计划生育网络的男性相比，有计划生育网络的男性夫妻使用现代避孕方法的可能性高1.9倍（95%置信区间[CI] 1.64 - 2.52；p≤0.001）。与没有计划生育网络的男性相比，如果男性有仅社会关系网络，他们使用现代避孕方法的可能性更大，相对风险（RR）= 2.10（95% CI，1.65 - 2.68；p≤0.001）；有仅医疗服务提供者网络，RR = 1.80（95% CI，1.54 - 2.11；p≤0.001）；或有混合网络，RR = 2.35（95% CI，1.97 - 2.80；p≤0.001）。
男性是否拥有计划生育网络，无论是医疗服务提供者网络还是社会关系网络，都能区分夫妻是否使用避孕措施。干预措施不仅应通过医疗服务提供者，还应通过男性的社会关系来接触男性，以促进对避孕措施使用的沟通和支持。
