Contraception Use and Tolerant Attitudes toward Violence against Women: How Media Use and Collective Norms are Jointly Associated with Attitudes and Behaviors among Ethiopian and Tanzanian Women

Background: 68% of Ethiopian and 58% of Tanzanian women believe a husband is justified in beating his wife in at least one of five specified circumstances (e.g., overcooking the food). 29% of currently married women in Ethiopia and 38% in Tanzania are using contraception. Use of any method of contraception decreases with the increase in the number of reasons that a woman thinks wife beating is justified. Objective: Our objective is to test the following hypotheses. Hypothesis1: Collective norms are associated with individual attitudes about violence against women and use of contraception. Hypothesis 2: Media use will attenuate the relationship between collective norms and individual attitudes and behaviors. Methods: Data come from the 2011 Ethiopian DHS (N=15, 913) and from the 2016 Tanzanian DHS (N= 13,208), nationally representative surveys of women. Each enumeration area (similar to a zip code) was taken as a separate community (total Ethiopian communities=650 & total Tanzanian communities = 608). Collective norms were classified as low, medium, or high on contraception use and tolerance for violence (CU-TFV) measures based on values at the community level. Regressions were run to predict individual level CU-TFV from collective norms for CU-TFV, media use, and their interaction, controlling for age, wealth, education and urban versus rural. Findings: Collective CU-TFV norms were significant predictors of individual-level CU-TFV, respectively (all Ps\u3c.001). Media use was significant for CU (all Ps \u3c.05) but only significant for TFV among Ethiopian women (P= \u3c0.01). Significant interactions between collective CU-TFV norms and media (all Ps\u3c.05 except TFV in Tanzania) showed that when collective norms were high, media use did not differentially predict CU-TFV. But when CU-TFV was low, media use was positively associated with higher individual CU-TFV in all regressions except TFV in Tanzanian women. Conclusion: Media’s influences appear to be a function of community characteristics. Findings suggest that collective norms are powerful and impact individual CU-TFV but that media can attenuate this relationship in most cases. External media are more consequential among communities with low CU-TFV. For communities that are already engaged in higher contraception use and low tolerance for violence, media use is not as consequential

Shifting Beliefs and Practices around Family Planning in Rural Ethiopia

Background: Over the last ten years Ethiopia has substantially increased uptake of family planning methods. As a result, most regions of the country experienced a decrease in fertility. The aims of this study are to: (1) Describe the current family planning beliefs in one rural district in Ethiopia; (2) Identify which beliefs promote or hinder the uptake of family planning; (3) Acquire insights into how these beliefs may be changing through time; and, (4) Specify the social influences involved in the diffusion of information and ideas related to fertility and family planning. Methods: In July 2016, in collaboration with our Ethiopian research partners, we conducted five focus groups and twelve individual interviews (n = 59) with adolescents, men, women and key informants in Oromia, Ethiopia. We used a random sampling protocol to recruit participants. Focus group and interview questions covered childbearing, gender roles, decision-making, and modern contraceptive use. We analyzed data using thematic analysis and Nvivo v.11 qualitative software. Results: All participants knew of and accepted modern contraception to space childbirth. Adults considered it a positive change within their community and adolescents considered it a common part of the community for married women. We also found that there are two decision-making networks in regards to family planning: (1) one that pertains to basic decisions about having children, which remains patriarchal; and (2) a second network that pertains to family size and spacing decisions which includes the Government Health Extension Workers who are perceived as trusted community members who helped bring family planning methods and health education to the community. Adolescents described use of contraception among married women as commonplace but did not discuss it for themselves. Some key informants reported a need for improved adolescent sexual health services. Conclusion: While marriage and initial childbearing remain patriarchal, Government Health Workers have helped to increase contraception uptake among married women who space births after their first birth. Focusing efforts on spacing after first birth among married women could be an effective first step to increase contraception uptake within a community