The role of individual and community normative factors: a multilevel analysis of contraceptive use among women in union in Mali.

CONTEXT Unlike in other African countries, the fertility rate in Mali has remained at a relatively high rate of 6.8 births per woman. Little research exists on the role that community norms play in use of family planning, particularly in low-prevalence countries. METHODS Data on 7,671 women in union from the 2001 Mali Demographic and Health Survey were analyzed using multilevel modeling techniques to assess the effects of individual and community factors on the adoption of modern contraceptive methods. RESULTS Only 5% of women in union were using a modern contraceptive method in 2001. The odds of contraceptive use were elevated among women in the highest wealth quintile, women who approved and whose partner approved of family planning, those who had had recent discussions on family planning with their partner or others and those exposed to family planning messages (odds ratios, 1.4-2.7). At the community level, the odds of modern contraceptive use rose with the proportion of women who were exposed to family planning messages (5.5), and decreased as the mean number of births per woman rose (0.7). In the final model, which included both individual- and community-level factors, the community factors were no longer significant. CONCLUSIONS Because approval of family planning and discussion of family planning with partners were shown to be the factors most strongly associated with modern contraceptive use in the multilevel model, programs that seek to increase individual approval and those that teach communication between partners could be particularly helpful to increasing contraceptive use in Mali.