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Reproductive Health
Published in: Reproductive Health 1/2021

Open Access 01-12-2021 | Research

Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis

Authors: Leah Kenny, Rahma Hassan, Loraine J. Bacchus, Matthew Smith, Bettina Shell-Duncan, Nana Apenem Dagadu, Angela Muriuki, Abdullahi Hussein Aden, Ibrahim Abdirizak Jelle, Beniamino Cislaghi, Mazeda Hossain

Published in: Reproductive Health | Issue 1/2021

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Abstract

Background

To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP).

Methods

Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data.

Results

Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks.

Conclusions

Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women’s wider networks.
Footnotes
1
Where husbands have more children than their wives, this is explained by polygamous relationships.
 
Literature
1.
IRIS. North-Eastern Kenya a prospective analysis. France: IRIS; 2015.
2.
UNFPA. Evaluation of UNFPA support to population and housing census data to inform decision-making and policy formulation 2005–2014, Kenya. New York: UNFPA; 2015.
3.
Scharrer T. “Ambiguous citizens”: Kenyan Somalis and the question of belonging. J East Afr Stud. 2018;12(3):494–513.CrossRef
4.
Humanitarian Policy Group. Pastoralism, demographics, settlement and service provision, in the Horn and East Africa. 2010.
5.
Abebe D, Bushby K, Little P, Mahmoud H, Stites E. Resilience and risk in pastoralist areas: recent trends in diversified and alternative livelihoods. Washington, DC: USAID; 2016.
6.
Carr-Hill R. Missing millions and measuring development progress. World Dev. 2013;46:30–44.CrossRef
7.
Randall S. Where have all the nomads gone? Fifty years of statistical and demographic invisibilities of African mobile pastoralists. Pastoralism. 2015;5(1):22.CrossRef
8.
9.
Kenya National Bureau of Statistics (KNBS). Kenya Demographic and Health Survey 2014. In: Ministry of Health (MoH) and National AIDS Control Council (NACC), editor. 2015.
10.
Sheik-Mohamed A, Velema JP. Where health care has no access: the nomadic populations of sub-Saharan Africa. Trop Med Int Health. 1999;4(10):695–707.PubMedCrossRef
11.
Gammino VM, Diaz MR, Pallas SW, Greenleaf AR, Kurnit MR. Health services uptake among nomadic pastoralist populations in Africa: a systematic review of the literature. PLoS Negl Trop Dis. 2020;14(7):e0008474.PubMedPubMedCentralCrossRef
12.
Haydarov R, Anand S, Frouws B, Toure B, Okiror S, Bhui BR. Evidence-based engagement of the Somali pastoralists of the horn of Africa in polio immunization: overview of tracking, cross-border, operations, and communication strategies. Glob Health Commun. 2016;2(1):11–8.CrossRef
13.
Ali M, Cordero JP, Khan F, Folz R. ‘Leaving no one behind’: a scoping review on the provision of sexual and reproductive health care to nomadic populations. BMC Womens Health. 2019;19(1):161.PubMedPubMedCentralCrossRef
14.
Ag Ahmed MA, Hamelin-Brabant L, Gagnon MP. Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: a qualitative study. BMC Pregnancy Childbirth. 2018;18(1):388.PubMedPubMedCentralCrossRef
15.
Caulfield T, Onyo P, Byrne A, Nduba J, Nyagero J, Morgan A, et al. Factors influencing place of delivery for pastoralist women in Kenya: a qualitative study. BMC Womens Health. 2016;16:52.PubMedPubMedCentralCrossRef
16.
Pike IL, Straight B, Oesterle M, Hilton C, Lanyasunya A. Documenting the health consequences of endemic warfare in three pastoralist communities of northern Kenya: a conceptual framework. Soc Sci Med. 2010;70(1):45–52.PubMedCrossRef
17.
Mugo P, Onsomu E, Munga B, Nafula N, Mbithi J, Owino E. An assessment of healthcare delivery in Kenya under the devolved system. Nairobi: The Kenya Institute for Public Policy Research and Analysis; 2018.
18.
19.
Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M, et al. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC Public Health. 2015;15(1):118.PubMedPubMedCentralCrossRef
20.
Nalwadda G, Mirembe F, Byamugisha J, Faxelid E. Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives. BMC Public Health. 2010;10(1):530.PubMedPubMedCentralCrossRef
21.
Sedgh G, Hussain R. Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Stud Fam Plan. 2014;45:151–69.CrossRef
22.
Mosha I, Ruben R, Kakoko D. Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health. 2013;13(1):523.PubMedPubMedCentralCrossRef
23.
Katende C, Gupta N, Bessinger R. Facility-level reproductive health interventions and contraceptive use in Uganda. Int Fam Plan Perspect. 2003;29(3):130–7.CrossRef
24.
Essendi H, Johnson FA, Madise N, Matthews Z, Falkingham J, Bahaj AS, et al. Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions. Reprod Health. 2015;12:103.PubMedPubMedCentralCrossRef
25.
Costenbader E, Zissette S, Martinez A, LeMasters K, Dagadu NA, Deepan P, et al. Getting to intent: are social norms influencing intentions to use modern contraception in the DRC? PLoS ONE. 2019;14(7):e0219617.PubMedPubMedCentralCrossRef
26.
Kane S, Kok M, Rial M, Matere A, Dieleman M, Broerse JEW. Social norms and family planning decisions in South Sudan. BMC Public Health. 2016;16(1):1183.PubMedPubMedCentralCrossRef
27.
Cislaghi B, Shakya H. Social norms and adolescents’ sexual health: an introduction for practitioners working in low and mid-income African countries. Afr J Reprod Health. 2018;22(1):38–46.PubMed
28.
Mackie G, Moneti F. What are social norms? How are they measured? In: Denny E, Shakya H, editors. UNICEF/UCSD Center on Global Justice Project Cooperation Agreement; 2014.
29.
Paluck EL, Shepherd H. The salience of social referents: a field experiment on collective norms and harassment behavior in a school social network. J Pers Soc Psychol. 2012;103(6):899–915.PubMedCrossRef
30.
31.
Cialdini RB, Demaine LJ, Sagarin BJ, Barrett DW, Rhoads K, Winter PL. Managing social norms for persuasive impact. Soc Influ. 2006;1(1):3–15.CrossRef
32.
Cislaghi B, Manji K, Heise L. Social norms and gender-related harmful practices, learning report 2: theory in support of better practice. London: London School of Hygiene & Tropical Medicine; 2018.
33.
Cislaghi B, Bhatia A, Li M, Lian Q, Baird S, Kayembe P, et al. Socio-developmental factors and changes in the sexual double standard among a cohort of adolescents in Kinshasa Under Review.
34.
Telfer ML, Rowley JT, Walraven GE. Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health. 2002;6:74–83.PubMedCrossRef
35.
Simkhada B, Porter MA, van Teijlingen ER. The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study. BMC Pregnancy Childbirth. 2010;10(1):34.PubMedPubMedCentralCrossRef
36.
Egeh AA, Dugsieh O, Erlandsson K, Osman F. The views of Somali religious leaders on birth spacing—a qualitative study. Sex Reprod Healthc. 2019;20:27–31.PubMedCrossRef
37.
Jones N, Tefera B, Stephenson J, Gupta T, Pereznieto P, Emire G, et al. Early marriage and education: the complex role of social norms in shaping Ethiopian adolescent girls’ lives. London: Overseas Development Institute (ODI); 2014.
38.
White D, Dynes M, Rubardt M, Sissoko K, Stephenson R. The influence of intrafamilial power on maternal health care in Mali: perspectives of women, men and mothers-in-law. Int Perspect Sex Reprod Health. 2013;39(2):58–68.PubMedCrossRef
39.
Upadhyay UD, Karasek D. Women’s empowerment and achievement of desired fertility in Sub-Saharan Africa. Washington, DC: USAID; 2010.
40.
Maro GZ, Nguura PN, Umer JY, Gitimu AM, Haile FS, Kawai D, et al. Understanding nomadic realities. case studies on sexual and reproductive health and rights in East Africa. AMREF/KIT; 2012.
41.
Valente TW, Pitts SR. An appraisal of social network theory and analysis as applied to public health: challenges and opportunities. Annu Rev Public Health. 2017;38(1):103–18.PubMedCrossRef
42.
Marks J, Sanigorski A, Owen B, McGlashan J, Millar L, Nichols M, et al. Networks for prevention in 19 communities at the start of a large-scale community-based obesity prevention initiative. Transl Behav Med. 2018;8(4):575–84.PubMedPubMedCentralCrossRef
43.
44.
Perkins JM, Subramanian SV, Christakis NA. Social networks and health: a systematic review of sociocentric network studies in low- and middle-income countries. Soc Sci Med. 2015;125:60–78.PubMedCrossRef
45.
Tinago CB, Annang Ingram L, Frongillo EA, Simmons D, Blake CE, Engelsmann B. Understanding the social environmental influences on pregnancy and planning for pregnancy for young women in Harare, Zimbabwe. Matern Child Health J. 2019;23(12):1679–85.PubMedCrossRef
46.
Randall S. The demographic consequences of conflict, exile and repatriation: a case study of Malian Tuareg. Eur J Popul Revue Européenne De Démographie. 2005;21(2/3):291–320.CrossRef
47.
Randall S, Giuffrida A. Forced migration, sedentarization and social change: Malian Kel Tamasheq. In: Chatty D, editor. Nomadic societies in the Middle East and North Africa: entering the 21st century. Leiden: Brill; 2006.
48.
(KNBS) KNBoS. 2019 Kenya population and housing census: volume I, population by county and sub-county. Nairobi: National Bureau of Statistics (KNBS); 2019.
49.
Smith SS. A three-step approach to exploring ambiguous networks. J Mixed Methods Res. 2016;10(4):367–83.CrossRef
50.
Kebede GF. Network locations or embedded resources? The effects of entrepreneurs’ social networks on informal enterprise performance in Ethiopia. J Knowl Econ. 2020;11:630–59.CrossRef
51.
Shell-Duncan B, Moreau A, Smith S, Shakya H. Reference guide for data collection: qualitative social network interviews. Evidence to end female genital mutilation/cutting: research to help girls and women thrive. New York: Population Council; 2019.CrossRef
52.
Dominguez S, Hollstein B. Mixed methods social networks research: design and applications. New York: Cambridge University Press; 2014.CrossRef
53.
Moreau A, Shell-Duncan B. Tracing change in female genital mutilation/cutting through social networks: an intersectional analysis of the influence of gender, generation, status and structural inequality. New York: Population Council; 2020.
54.
Shakya HB, Christakis NA, Fowler JH. An exploratory comparison of name generator content: data from rural India. Soc Netw. 2017;48:157–68.CrossRef
55.
Marsden PV. Network data and measurement. Ann Rev Sociol. 1990;16:435–63.CrossRef
56.
Merluzzi J, Burt RS. How many names are enough? Identifying network effects with the least set of listed contacts. Soc Netw. 2013;35(3):331–7.CrossRef
57.
Burt RS, Ronchi D. Measuring a large network quickly. Soc Netw. 1994;16:91–135.CrossRef
58.
McPherson M, Smith JA. A network effects in blau space: imputing social context from survey data. Socius Sociol Res Dyn World. 2019;5:1–21.
59.
Yang H-H, Wu C-I, Lei MK, Yang H-J. How many are good enough for the adolescent social network nomination. WSEAS Trans Math. 2009;8(7):299–308.
60.
Fischer CS. To dwell among friends: personal networks in town and city. Chicago: University of Chicago Press; 1982.
61.
Burt RS. Network items and the general social survey. Soc Netw. 1984;6:293–339.CrossRef
62.
Marsden PV. Core discussion networks of Americans. JSTOR. 1987;52:122–31.
63.
Urbanoski K, Joordens C, Kolla G, Milligan K. Community networks of services for pregnant and parenting women with problematic substance use. PLoS ONE. 2018;13(11):e0206671.PubMedPubMedCentralCrossRef
64.
Hansen D, Shneiderman B, Smith MA. Social network analysis. In: Analyzing social media networks with NodeXL: insights from a connected world. Morgan Kauffman; 2010.
65.
Ebaugh HR, Curry M. Fictive kin as social capital in new immigrant communities. Sociol Perspect. 2000;43(2):189–209.CrossRef
66.
Chatters LM, Taylor RJ, Jayakody RT. Fictive kinship relations in black extended families. J Comp Fam Stud. 1994;25(3):297–312.CrossRef
67.
Gale NK, Heath G, Elaine C, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.PubMedPubMedCentralCrossRef
68.
Croft T, Marshall A, Allen C, Arnold F, Assaf S, Balian S, et al. Guide to DHS statistics. Rockville: ICF; 2018.
69.
Baur M, Benkert M, Brandes U, Cornelsen S, Gaertler M, Köpf B, et al., editors. Visone software for visual social network analysis. Berlin: Springer; 2002.
70.
Csardi G, Nepusz T. The igraph software package for complex network research. InterJournal. 2006;1695(5):1–9.
71.
Borgatti SP, Everett MG, Johnson JC. Analyzing social networks. 2nd ed. Thousand Oaks: Sage; 2018.
72.
Wasserman S, Faust K. Social network analysis: methods and applications. Cambridge: Cambridge University Press; 1994.CrossRef
73.
Costenbader E, Lenzi R, Hershow RB, Ashburn K, McCarraher DR. Measurement of social norms affecting modern contraceptive use: a literature review. Stud Fam Plan. 2017;48(4):377–89.CrossRef
74.
75.
76.
Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM, DeVries R. “It’s up to the Woman’s People”: how social factors influence facility-based delivery in rural Northern Ghana. Matern Child Health J. 2014;18(1):109–19.PubMedCrossRef
77.
Speizer IS, Corroon M, Calhoun LM, Gueye A, Guilkey DK. Association of men’s exposure to family planning programming and reported discussion with partner and family planning use: the case of urban Senegal. PLoS ONE. 2018;13(9):e0204049.PubMedPubMedCentralCrossRef
78.
Schuler SR, Rottach E, Mukiri P. Gender norms and family planning decision-making in Tanzania: a qualitative study. J Public Health Afr. 2011;2(2):25.CrossRef
79.
Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019;16(1):89.PubMedPubMedCentralCrossRef
80.
Ezeanolue EE, Iwelunmor J, Asaolu I, Obiefune MC, Ezeanolue CO, Osuji A, et al. Impact of male partner’s awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria. BMC Public Health. 2015;15(1):879.PubMedPubMedCentralCrossRef
81.
Wegs C, Creanga AA, Galavotti C, Wamalwa E. Community dialogue to shift social norms and enable family planning: an evaluation of the family planning results initiative in Kenya. PLoS ONE. 2016;11(4):e0153907.PubMedPubMedCentralCrossRef
82.
Stephenson R, Bartel D, Rubardt M. Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya. Glob Public Health. 2012;7(6):618–34.PubMedCrossRef
83.
Prata N, Bell S, Fraser A, Carvalho A, Neves I, Nieto-Andrade B. Partner support for family planning and modern contraceptive use in Luanda, Angola. Afr J Reprod Health. 2017;21(2):35–48.PubMedCrossRef
84.
Kisia Malalu P, Alfred K, Too R, Chirchir A. Determinants of use of modern family planning methods: a case of Baringo North District, Kenya. Sci J Public Health. 2014;2(5):424–30.CrossRef
85.
Perry BL, Pescosolido BA, Borgatti SP. Egocentric network analysis: foundations, methods, and models. Cambridge: Cambridge University Press; 2018.CrossRef
86.
Wang DJ, Shi X, McFarland DA, Leskovec J. Measurement error in network data: a re-classification. Soc Netw. 2012;34:396–409.CrossRef
87.
Adams J, Santos T, Williams VN. Strategies for collecting social network data. The Oxford handbook of social networks. Oxford: Oxford University Press; 2020. p. 119.
88.
Homewood K. Ecology of African pastoralist societies. Oxford: James Currey; 2008.
Metadata
Title
Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis
Authors
Leah Kenny
Rahma Hassan
Loraine J. Bacchus
Matthew Smith
Bettina Shell-Duncan
Nana Apenem Dagadu
Angela Muriuki
Abdullahi Hussein Aden
Ibrahim Abdirizak Jelle
Beniamino Cislaghi
Mazeda Hossain
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2021
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-021-01164-1

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