Tipping Point: Using Social Network Theory to Accelerate Scale and Impact

Situation or Background
As of 2012, Niger had the highest prevalence of child marriage and adolescent fertility in the world, with 79% of women aged 20-24 married by the time they are 18, and 186 births per 1,000 adolescents. Although there are many social and behavioral interventions to address family planning (FP) uptake and reduce adolescent fertility, there is little evidence on the critical roles of social networks, and the social norms held within these networks, on the impact and implementation of FP interventions especially in low and middle-income country settings.

Our Goal or What We’re Doing
Drs. Holly (Shakya) Baker and Jay Silverman, in partnership with Save the Children US, GRADE Africa, and GEH co-investigator Rebecka Lundgren, are conducting a 4.5-year study to develop and evaluate the effectiveness and scalability of a social network-based vs. standard intervention to improve FP uptake among married adolescent girls and young women in rural Maradi, Niger. This work builds on the previous work of Drs. (Shakya) Baker and Silverman’s evaluation of Pathfinder’s Reaching Married Adolescents (RMA) intervention in Dosso, Niger, and their pilot social network assessment and analysis in this same context, which indicated the diffusion of the benefits of RMA through the social networks of direct recipients of the program.

Approach or Methodology
To assess the relative effectiveness of the social network-informed approach, a three-arm cluster randomized controlled trial will be conducted among low parity women and girls (ages 15-24 years) in 51 villages in Maradi.

Impact and What We’re Learning
This study is the first large-scale field experiment to test the utility of social norms and social network theory for maximizing the impact of a reproductive health intervention. If the social network-based approach is found to be more effective, and no more difficult to scale, than the standard program (i.e. no less feasible, cost-effective, acceptable, faithful), this approach will scale across a larger geography and population in Niger, with concurrent assessment of scaling success.