Bring a Friend: Strengthening Women’s Social Networks and Reproductive Autonomy in India

Social networks are a key ingredient in the process of economic development. A large literature has established that social networks influence individual behavior and outcomes in myriad ways, but the bulk of this literature has focused on social interactions in the context of microfinance groups. To date, little is known about how social networks can be expanded and leveraged to achieve specific impacts in other domains such as public health.

In a new working paper published by the World Bank, Mahesh Karra and colleagues evaluate a novel intervention that utilizes financial incentives to expand social networks and strengthen social ties and, in turn, improve well-being. The study focuses on married women aged 18-30 from 28 villages of the rural Jaunpur district in India’s most populous state, Uttar Pradesh, a population that not only tends to be socially isolated relative to other women, but also for whom peer support may be especially valuable. Specifically, the researchers examine women’s networks and well-being in the domain of family planning and reproductive health, where peers can help women overcome intrahousehold and social constraints.

The authors provided a randomly selected group of women with a voucher package for subsidized family planning services at a local clinic for their own use, as well as for any peers other than their husbands who accompanied them to the clinic at least once (the “Bring-a-Friend” voucher group). To separately identify the additional effect of enabling women to seek peer support from the effect of having a voucher for one’s own use, a randomly selected group of women were provided the voucher package only for their own use and not for their peers (the “Own” voucher group).

Main findings:

• Both vouchers significantly increased women’s likelihood of visiting a clinic for family services overall, as well as without their husbands or mothers-in-law (i.e., either alone or with female peers), relative to control group women. However, the Bring-a-Friend voucher was significantly more effective than the Own voucher in increasing clinic visits for women who faced greater opposition to family planning use from their mothers-in-law at baseline.
• Modern contraceptive use increased by 56 percent for both voucher groups relative to the control group. However, only the Bring-a-Friend voucher significantly increased modern method use for women who faced social barriers to family use at baseline.
• The Bring-a-Friend voucher expanded women’s social networks. Specifically, a woman’s number of close peers in the village increased by 21 percent for the Bring-a-Friend group relative to the control group and significantly more so than the Own voucher group.

Taken together, the results suggest that although offering women a voucher for their own use, a commonly used policy tool, may improve women’s family planning outcomes on average, such an intervention may be ineffective for women who are socially isolated, mobility constrained and face intrahousehold opposition to family planning use. Only when a voucher for a woman’s own use is combined with a voucher that encourages a woman’s peers to participate are there improvements in family outcomes for socially constrained women. In sum, the study is unique in showing that vouchers and peer connections can be leveraged to improve women’s reproductive autonomy by overcoming the constraints imposed by mothers-in-law in patrilocal societies.