Social influence on women's contraceptive use: Population-based, sociocentric network study in rural Uganda

Myriad barriers impede women's access to contraception in Uganda and affect their reproductive autonomy. Almost half of married women of reproductive age in Uganda want to avoid pregnancy and one-third are undecided, yet only 38% use modern contraception. Interventions harnessing the influence of women's social networks may help to overcome these barriers and support desired contraceptive use. Using population-based longitudinal, socio-centric network data from household surveys across 8 villages in Uganda, we examined the role of social influence on contraceptive use among partnered, reproductive-age women. We fitted a stochastic actor-oriented model using three waves of data to estimate changes in social tie formation and contraceptive use over time as a function of contraceptive use among women's social ties while adjusting for ego-level characteristics. We found that partnered women were 1.25 times more likely to choose contraceptive methods that were already popular in the network compared to methods that were less popular (p < 0.001). We identified a direct social influence effect on contraceptive use: women were 1.23 times more likely to choose a particular contraceptive method for each additional social tie who was using that same method (p < 0.05). Our findings fill a key evidence gap by being able to separate social ties' tendencies to have similar contraceptive behaviors (i.e., homophily) in order to estimate the direct contribution of social influence on contraceptive use. These findings suggest that peer-based interventions focused on supporting contraceptive decision-making may be especially effective in overcoming barriers to contraception.