Inter-generational impact: exploring the influence of older sister-in-law’s contraceptive choices on her peer contraception adoption in India

Objective Social network-based reproductive decisions are critical. This study compares the effect of an older peer contraception use on the use of her younger peer, as they share the closest social network within the household, and tend to influence one another for reproductive decisions. In this study we considered peers as two sister-in-law living the same household. Methods We used data from the fifth round of National Family Health Survey which was conducted between 2019 and 2021. We deployed multinomial multivariable logistic regression to find the association between older women contraception use on her younger peer. Also, the first-order Markov chain stochastic process was used to investigate contraceptive clustering in India, and its states. Results The logistic analysis found that all the women in the household used the similar method, but still relied only on the female sterilization as the sole method for their family planning. The multinomial multivariable method found that younger peers were 3.42 times odds more likely to use permanent method if her older peer had used it previously. Also, it was found 11% increase in the any modern contraception use of younger peer if all her older peer will use contraceptives in India. For all the states, the clustering ranged from 5 to 14%, with highest in Himachal (14%). Conclusion Empowering older women as peer educators in contraception workshops can foster informed discussions, dispel myths, and promote the use of modern contraceptive methods among younger peers. Integrating such initiatives into government policies like Mission Parivar Vikas is crucial for improving contraceptive uptake, with ASHA workers and community health volunteers playing a pivotal role in delivering targeted education within households