Even as many countries have made measurable progress in women’s education and economic participation, control over fertility remains uneven, deeply contextual, and shaped by social norms. Patriarchal structures continue to influence women’s reproductive choices—often in subtle but powerful ways.
A team led by a researcher from the University of Illinois Urbana-Champaign experimented with a social intervention in Uttar Pradesh, India’s most populous state, where even a visit to a family planning clinic is often shaped not by medical access or financial capacity alone, but by household hierarchies and community expectations. For many women, reproductive decisions were negotiated under the watchful authority of husbands, mothers-in-law, and extended families, with the fear of social judgment looming large, noted the researchers.
To understand whether social support could shift these dynamics, they undertook a modest social intervention—combining financial assistance with peer support—to see if this can help women navigate these constraints and exercise greater agency over their reproductive health.
The researchers focused on married women aged 18 to 35 who had at least one child. Globally, an estimated 270 million women have an unmet need for modern contraception.
“In such societies, women typically live with their husbands’ families and are strongly influenced by household hierarchies and norms around fertility,” said co-author Catalina Herrera-Almanza, Assistant Professor at the University of Illinois. “Decisions about family planning are rarely made by women alone.”
Researchers divided participants into three groups. One group received vouchers to visit a local family planning clinic. A second group received vouchers not only for themselves but also an additional voucher that allowed them to bring a peer—another woman of childbearing age—to the clinic. A third group served as a control and received no vouchers.
The idea was simple but significant. Women in these communities rarely travel alone for healthcare, and visits to family planning clinics are often accompanied by husbands or mothers-in-law. By encouraging women to bring a peer instead, the programme sought to create a socially acceptable form of support while reducing isolation and fear.
The findings were telling. While women in both voucher groups were equally likely to visit the clinic, those in the “bring-a-friend” group were far more likely to arrive with another woman. Most chose sisters-in-law—a choice that balanced companionship with acceptability within the household.
More importantly, women who brought a peer were more likely to adopt modern contraceptive methods and reported lower fear of social stigma. Conversations with peers appeared to normalize family planning, helping women articulate and act on their reproductive preferences.
“Social networks can significantly influence welfare outcomes,” Herrera-Almanza said. “Inviting a friend to the clinic can provide reassurance and help women overcome the stigma associated with being seen there.”
Crucially, the study found no evidence of backlash when women informed husbands or mothers-in-law of their clinic visits. In fact, the positive effects were strongest in households where mothers-in-law had initially opposed contraception, suggesting that peer-supported choices may carry greater legitimacy.
The study also sheds light on the nuanced goals of reproductive agency. In many cases, women were not seeking to limit family size but to space pregnancies—a critical factor for maternal and child health. Social norms strongly favor early childbirth and male offspring, making spacing a delicate negotiation rather than a purely medical choice.
Researchers S. Anukriti from The World Bank and Mahesh Karra from Columbia University, along with Herrera-Almanza, argue that peer support works not merely by providing information, but by expanding women’s social networks in environments where such spaces are limited. By embedding choice within companionship, the intervention helped women navigate restrictive norms without direct confrontation.
The findings carry broader policy implications. “Household decision-making in such contexts involves more than just husbands and wives,” Herrera-Almanza noted. “Mothers-in-law often wield significant influence, especially when husbands migrate for work. Any reproductive health policy must account for these realities.”
The study is published in the Journal of Development Economics and underscores a critical insight: improving women’s reproductive agency may not always require sweeping reforms. Sometimes, meaningful change begins when choice is allowed to travel with a friend.
