Despite improvements in family planning (FP) knowledge and services in West Africa, unmet need for FP continues to grow. Many programs apply a demographically and biologically driven definition of unmet need, overlooking the complex social environment in which fertility and FP decisions are made. This longitudinal, qualitative cohort study captures the changing nature of FP need, attitudes and behaviors, taking into account life context to inform understanding of the complex behavior change process. Purposively sampled, 25 women and 25 men participated in three rounds of in‐depth interviews over 18 months. Analyses used a social network influence lens. Findings suggest alignment of six foundational building blocks operating at individual, couple, services, and social levels is essential to meet FP need. If one block is weak, a person may not achieve met need. Women and men commonly follow five pathways as they seek to fulfill their FP need. Some pathways achieve met need (determined users, quick converters), some do not (side effect avoiders), and some do not lead to consistent FP outcomes (male‐priority decision makers, gender–egalitarian decision makers). Findings clarify the role of social determinants of FP and offer insight into program approaches informed by user typologies and return on program investments.

中文翻译：

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现代计划生育之路：贝宁男女社会影响的纵向研究

尽管西非的计划生育 (FP) 知识和服务有所改善，但未满足的计划生育需求仍在继续增长。许多项目采用人口统计学和生物学驱动的未满足需求定义，忽略了生育和生育决定的复杂社会环境。这项纵向、定性的队列研究捕捉了 FP 需求、态度和行为的不断变化的性质，同时考虑到生活背景，以了解复杂的行为变化过程。有目的地抽样，25 名女性和 25 名男性参加了 18 个月的三轮深度访谈。分析使用了社交网络影响镜头。调查结果表明，在个人、夫妻、服务和社会层面运作的六个基本构建块的一致性对于满足 FP 需求至关重要。如果一个街区很弱，一个人可能无法满足需求。女性和男性在寻求满足他们的 FP 需求时通常遵循五种途径。有些途径可以满足需求（确定的用户、快速转换者），有些不能（避免副作用），有些不会导致一致的 FP 结果（男性优先决策者、性别平等决策者）。调查结果阐明了 FP 的社会决定因素的作用，并提供了对由用户类型和项目投资回报提供的项目方法的洞察。