Despite improvements in economic and social empowerment, women in many countries still have little control over their fertility and reproductive health. A new study from the University of Illinois Urbana-Champaign explores a program that reduces barriers to family planning by providing financial and peer support to women in Uttar Pradesh, India’s most populous state.
Globally, an estimated 270 million women have an unmet need for modern contraception, and this may be even more critical in places like rural Uttar Pradesh where our study takes place. This is a patrilineal and patrilineal society, where women live with their husbands and in-laws and are heavily influenced by social norms around family planning and fertility.”
Catalina Herrera-Almanza, co-author, assistant professor in the Department of Agricultural and Consumer Economics, part of the College of Agricultural, Consumer and Environmental Sciences at Illinois
The study included married women between the ages of 18 and 35 who already had at least one child. One group of participants received vouchers to visit a local family planning clinic. another group received tokens for themselves, plus an additional token they could use to invite a peer to join. A third group served as a control group that did not receive coupons.
These women would not usually travel alone to a clinic and would likely be accompanied by their husband or mother-in-law. By encouraging them to bring another woman of reproductive age, the researchers hoped to provide social support for reproductive choices.
“Research shows that social networks can have a large impact on well-being outcomes, both beneficial and detrimental. Inviting a friend to a family planning clinic can provide encouragement and help women overcome fears of stigma associated with visiting the clinic,” said Herrera-Almanza.
They found that women in the two voucher groups were equally likely to visit the clinic, but women in the bring-a-friend group were more likely to bring a female peer. They often chose a sister-in-law, perhaps because it was more acceptable to their husbands and in-laws if they brought a family member.
Women in the bring-a-friend group were more likely to start using modern contraception and less likely to fear social stigma, suggesting that the opportunity to discuss family planning with peers could lead to stronger reproductive action.
Importantly, there was no backlash when these women informed husbands and mothers-in-law of their decision to go to a clinic. In fact, positive effects were stronger when the mother-in-law was opposed to birth control use prior to the study.
“All the women in the study had at least one child, because social norms suggest that when you get married you immediately have a child to prove fertility, and there is a strong preference for sons. The goal for these women is not necessarily to have fewer children, but to be able to reduce child births,” Herrera-Almanza said.
The results of the study highlight that social mechanisms such as peer support are important in a community with restrictive social norms. The women in the sample had very few peers with whom to discuss reproductive choices, and encouraging them to bring a friend could be a way to expand their social network and build agency.
“Furthermore, it is important to consider the structure of the household. Decisions are not only made between spouses. In this patrilineal, patriarchal society, the mother-in-law is also a very important factor. Husbands often migrate for work and are often absent, giving the mother-in-law even more power in the household and politics.”
The paper, “Bring a Friend: Leveraging Financial and Peer Support to Improve Women’s Reproductive Service in India,” is published in Journal of Development Economics [DOI:10.1016/j.jdeveco.2025.103706]. Authors include S. Anukriti, Catalina Herrera-Almanza and Mahesh Karra.
This study was supported by a Northeastern University Tier-1 grant and the Human Capital Initiative for Research on the Empowerment of Women (POWER) Program through a grant from the William and Flora Hewlett Foundation (Grant 2020-1162). Additional funding was provided by the Center for Global Development Policy and the Institute for Economic Development at Boston University.
Source:
Journal Reference:
