Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria

Background Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)–a long-acting, highly effective contraceptive with important non-contraceptive attributes–the method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method. Methods We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria. We analyzed survey data descriptively by method and assessed factors associated with hormonal IUD use through multivariate logistic regression models. Follow-up in-depth interviews conducted with 32 women were analyzed thematically. Results There were few differences by method used in the socio-demographic profiles and contraceptive history of participants. Among users choosing a long-acting, reversible method, the top reasons for method choice included perceptions that the method was “right for my body,” long duration, recommended by provider, recommended by friends/family, few or manageable side effects, and high effectiveness. Among hormonal IUD users, 17% mentioned reduced bleeding (inclusive of lighter, shorter, or no period), and 16% mentioned treatment of heavy or painful periods. Qualitative data supported these findings. Among survey respondents, between 25% and 33% said they would have chosen no method if the method they received had not been available. Both quantitative and qualitative data indicated that partner support can affect contraceptive use, with in-depth interviews revealing that women typically needed partner permission to use contraception, but men were less influential in method choice. Conclusions Expanding access to the hormonal IUD as part of a full method mix provides an opportunity to expand contraceptive choice for women in Nigeria. Findings are timely as the government is poised to introduce the method on a wider scale.

Know Your Counterparts: The Importance of Wording for Stakeholder Communication in Social Franchise Enterprises

Social enterprises pursue a dual mission: on the one hand, they strive for social purpose, while on the other, they try to achieve economic stability despite scarce resources. To achieve the dual mission, social enterprises avail themselves of both for-profit and non-profit institutional logics. Due to this combination of multiple institutional logics, such enterprises can be classified as hybrid organizations. This study focuses on these organizations and investigates tensions between social enterprises and various stakeholder groups caused by the use of commercial logics within the social sector. In particular, we examine the perception of commercial versus social welfare logics by various stakeholder groups, and investigate the effects on organizational communication. Our study is centered on social franchise enterprises. We use an exploratory qualitative research approach based on semi-structured interviews with 21 social franchisors and social franchisees of seven social franchise enterprises. Our main results suggest that the use of commercial logics in the social sector tends to decrease the legitimacy of social franchise enterprises in the eyes of internal stakeholders, the general public, and various (but not all) external stakeholder groups. Many stakeholders of social franchise enterprises show a strong aversion to commercial logics, and particularly to commercial terminology. Overall, we conclude that social franchise enterprises very consciously apply commercial and social welfare logics and use alternative terminology where necessary to retain legitimacy and prevent tensions.

Social Franchising Model as a Scaling Strategy for ICT Reuse: A Case Study of an International Franchise

Reuse is a type of concept meant to solve environmental problems and can be implemented in different models. This study explores the social franchising model in the area of ICT reuse, relying on a case study of international social franchise and a comparative analysis of its three franchisees. The concept of the proposed social franchising model is based on a theoretical framework and a case study organization analysis, and has four developmental phases with nine identified key factors, which are essential to creating the necessary systematic approach for a successful outcome by creating both economic and social impact on a scale. This article contributes to the social entrepreneurship literature by analyzing success factors that have allowed our case study to operate as a highly successful franchise. The empirical part of the paper employs a case study of the organization to provide evidence of the existing model for social franchising in the reuse of ICT in Ireland, the U.S. and Slovenia. The paper concludes by revealing the social franchising model framework in the reuse of ICT.