Planned social network change and modern contraceptive use in a rural Ethiopian community

# Background Over the last decade, Ethiopia has substantially increased uptake of modern contraception and experienced a decline in total fertility, coinciding with implementation of the national Health Extension Programme (HEP), involving an extensive deployment of health extension workers (HEWs), and a health development army (HDA) of volunteer families. The dynamics of such change are important. This multi-method qualitative study was conducted in a rural community in Oromia, Ethiopia, as part of a larger effort to understand the influence of social networks on modern contraceptive use. # Methods Data were collected in five focus groups and twelve individual interviews (n = 59) with men, women, adolescents and key informants in a rural area in Oromia, Ethiopia, together with participant observation. Analysis was conducted using NVivo qualitative research software. # Results We found two types of decision-making social networks for family planning: (i) one pertaining to basic decisions about having children *per se*, which remains the prerogative of traditional, patriarchal social structures; and (ii) a second network, which included HEWs, that applies after initial childbirth, concerning family size and spacing decisions for additional children. # Conclusions While this study supports other research on the effectiveness of the HEP, the study also identified limitations, and raised questions about the replicability of the Ethiopian model for reducing fertility. The level of government commitment and resources required for the HEP are linked to Ethiopia's key position among recipients of development assistance, likely connected to its history and geopolitical role. These circumstances may not be widely applicable.