New Ideas and Fertility Limitation: The Role of Mass Media Author(s): Jennifer S. Barber and William G.

Axinn Reviewed work(s): Source: Journal of Marriage and Family, Vol. 66, No. 5, Special Issue: International Perspectives on Families and Social Change (Dec., 2004), pp. 1180-1200 Published by: National Council on Family Relations Stable URL: http://www.jstor.org/stable/3600333 . Accessed: 20/03/2012 18:31
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JENNIFER S. BARBER AND WILLIAM G. AXINN

University of Michigan

New Ideas and FertilityLimitation: The Role of Mass Media

This article investigates the mass media as a social change that shapes individualbehavior primarily via ideational mechanisms. We construct a theoretical framework drawing on social demography and social psychology to explain how mass media may affect behavior via attitudinal change. Empirical analyses of 1,091 couples in the Chitwan Valley Family Study,using detailed measuresof social change from rural Nepal, show that exposure to the mass media is related to childbearingbehavior, and to preferencesfor smallerfamilies, weaker son preferences,and tolerance of contraceptive use. This result should motivate greater research attention to the influenceof changing ideas on behavioralchanges,particularlyin the studyoffamilies. A controversybetween structural ideational and of behaviorcharacterizes much of explanations social science research, including numerous studies of families and social change. Although there are strong theoreticalreasons for expecting both structural and ideational forces to shape behavior (Alexander, 1988; Coleman, 1990; Giddens, 1984), clear empiricalevidence of these simultaneous effects is rare because social scientists often have no direct measurement of ideational mechanisms of social change. They may demonstrate evidence for
Institutefor Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248 (jebarber@ umich.edu).
Key Words: attitudes, childbearing, media, Nepal, social change. contraception, mass

ideational mechanisms by documentinga lack of evidence for structural influenceson behavior or by using models of spatial diffusion, but neither approach provides direct evidence of specific ideational mechanisms. In addition, because many specific social changes have both structuraland ideational consequences, social scientists rarely have the opportunityto document a purely ideationalmechanism.For example, although mass education is explicitly designed to propagatenew ideas and information, education also restructuresthe costs and benefits of specific behaviors(Axinn & Barber, 2001). Depending on the setting, other mechanisms of social change are also likely to share both structural and ideational consequences. This generallack of measurement distinguish to between ideational and structuralmechanisms of social change prevents clear documentation of the simultaneousinfluenceof both forces. This articlepresentsan empiricalanalysis of mass media as a mainly ideational mechanism of social change. We focus on exposureto mass media in a setting without previous exposure. The main risk in this approachis thatthe spread of mass media will be closely tied to other social changes that dramaticallyrestructure the costs and benefits of behavior.Therefore,measurement of all concurrent social changes is needed to demonstratethe independent influence of the introduction mass media. of RuralNepal provides an ideal setting for our study because the recency of dramatic social change there affords the rare opportunity to document the beginning of the spread of mass media. Our measures document individuals' first contact with various forms of media, as

1180

Journalof Marriageand Family 66 (December2004): 1180-1200

Mass Media and FertilityLimitation well as both the exposure to and experience of many other important mechanisms of social change. The recency of these social changes also makes it possible to measurethe concomitant variation in ideas as these changes are occurring.We use this comprehensivemeasurement of social change and ideational variation to demonstrate that mass media influence behavior independentof numerousother mechanisms of change, and that they are associated with ideas that were extraordinarily in this rare 50 years earlier. setting The behavioraltransitionwe examine in rural Nepal is the shift from families with many children and no use of birth control to families with few children and the widespread use of birth control. This change in fertility behavior provides a fruitful subject for our research because theory from multipleperspectivesidentifies potentiallyimportant ideationalinfluences on fertility decisions. As we discuss below, there are compelling theoretical reasons to expect ideationalmechanismsto play a part in in numerousfamily changes, particularly fertility transition.Our analyses provide compelling empirical support for these theoretical arguments.
THEORETICAL FRAMEWORK

1181 WhyDo CouplesAdopta Permanent Method? Contraceptive Specifically, our framework draws from the fertility supply-demandframework(Bulatao & Lee, 1983; Easterlin& Crimmins,1985), which posits that a couple's supply of and demandfor children jointly determine their motivation to regulate-or limit-their fertility. In other words, the number of children a couple wants given the number they have determines their motivation to stop childbearing.This motivation to regulate fertility, combined with the potentialcosts of regulatingfertility-including monetarycosts (e.g., the price of a contraceptive method), opportunitycosts (e.g., missed work during recovery from a sterilizationoperation), and psychological costs (e.g., stress associated with violating personalor societal proscriptions against contraceptiveuse)-determines contraceptive use behavior (Hermalin, 1983). Thus, couples who have at least the number of childrenthey want will tend to use a contraceptive method to terminate future childbearing (permanentcontraception)if its costs do not outweigh theirmotivation. This frameworkis similar to social psychobehavior. logical frameworksfor understanding For example, the theory of planned behavior (Ajzen, 1988; Fishbein & Ajzen, 1975) asserts that attitudes (in this case, attitudes toward additional childbearing) lead to behavioral intentions (intentions about whether to have additional children), but are mediated by perceived social norms (e.g., disapprovalof having or not having more children) and structural barriers(access to or costs of alternativesto having more children). An extension of the theorypredictsthat attitudestowardalternatives to large families, such as attitudestoward contraceptiveuse or sterilization,are likely to influence fertility decisions as well (Barber,2001). For example, this extension predicts that positive attitudestowardcontraceptive are likely use to reduce positive attitudes toward additional childbearing,to reduce the perceived costs of use, and to increasethe likelihood contraceptive of adoptinga permanentcontraceptivemethod. In the fertility supply-demandframework,negative attitudes toward contraceptive use-for instance, the belief that contraceptive use is importantpsyimmoral-represent particularly chological costs to adopting a contraceptive method.

Theories of fertility transitionhave focused on a rangeof factorslikely to affect couples' childbearing behavior. Although microeconomic mechanisms affecting the costs and benefits of childbearing and childrearinghave dominated the researchliterature (e.g., Becker, 1960, 1991; Willis, 1973), additionalperspectiveshave also been suggested. Some of these focus on changes in institutional contexts (McNicoll, 1980; Smith, 1989); othersfocus on variationin women's relationships to their husbands and in-laws (Dyson & Moore, 1983; Mason, 1987), changes in the social organizationof families (Axinn, 1992a; Axinn & Yabiku, 2001; Thomton & Lin, 1994), or on diffusion of new technology or new ideas (Anderson, 1986; Cleland & Wilson, 1987; Knodel & van de Walle, 1986; Montgomery& Casterline,1993). Our overall hypothesis aboutmedia exposure draws from these perspectives.We hypothesize that media exposure affects behavior mainly relatedto fertility because of changes in attitudes behavior.We explain this hypothesis in greater detail below.

1182 Of course, even individualswho prefersmall families and who feel positively towardcontraceptive use do not always adopt a permanent contraceptivemethod. Both the plannedbehavior theory and fertility supply-demand framework elucidate the importance of barriersto implementingchildbearingpreferencesvia contraceptiveuse. Other perspectives also emphasize the difficultyin translating preferencesinto rational behavior. One perspective describes humans as boundedly rational (e.g., Carley, 2001; Carley& Newell, 1994; Carley& Prietula, 1994). Another describes the extent to which humans systematically deviate from expected utility theory (e.g., Kahneman, Slovic, & Tversky, 1982; Ross, Greene, & House, 1977; Tversky & Kahneman, 1974). For example, decisions may be made based on whether individualsthink thatthey could possibly regret the decision, rather than on the decision's expected benefit (Bell, 1982; Loomes & Sugden, 1982). Here, we take the view that the influence of attitudes and preferences on behavior is temperedby costs and knowledge aboutoptions. How Are AttitudesTowardChildbearing and ContraceptiveUse Formed? Sociology, psychology, cognitive science, and communicationtheories posit multiple mechanisms of attitudeformation,including socialization, social learning, social comparison, social information processing, and social influence. Most of these theoriesemphasizehow individuals acquire and use new information within networks. These theories emphasize both a structuralcomponent (e.g., an individual's location within a specific network)and an ideational component (e.g., the ideas and attitudes of other network members). Similarly, Mead arguesthat individualsdevelop a self, including attitudes,throughthe process of role taking, or interactingwith and takingon the roles of other networkmembers(Mead, 1967). Carley (2001) emphasized that networks are composed of multiple types of nodes (e.g., schools and sources of mass media), in additionto people (e.g., neighbors, friends, and relatives). (Also see Mead, 1967, p. 154, footnote7, for a description of the possibility of nonhuman interactions influencingattitudes.) Multiple theories address the mechanisms likely to produceattitudechange. Cognitive sci-

Journal of Marriageand Family ence theories, for example, posit that whether a specific message affects behavioris a function of the extent of the receiver's contact with the message via other nodes in the network, the degree of social influence that the nodes have on the receiver, and the extent to which the message supportsthe receiver's existing beliefs (Carley, 2001). Similarly, social psychological theories predict that attitude change is most likely when the source of new informationis considered both expert and trustworthyby the receiver (Perloff, 1993). Theories of social influence find that behavioral change is also more likely when individualsascribe trustworthiness and expertise to the source of influence (e.g., Milgram,1974). WhatRole Does the Mass Media Play in TheseProcesses? For decades, social scientists have been interested in the media's influenceon how individuals construct their behavior and self-identity (e.g., Bennett, 1975; Gamson,Croteau,Hoynes, & Sasson, 1992; Gamson & Modigliani, 1989). Research provides evidence of an important, relationcontroversial,and not well-understood ship between mass media and fertilitybehavior. Many studies have suggested that television, radio, and newspaper campaigns increase knowledge and communication about family planningand contraceptiveuse, increasesterilization behavior, and reduce family size preferences. Strong associations have been found in settings as diverse as Brazil, Guatemala, Nigeria, Gambia,Zambia, Colombia, and Iran. For a critical review of many of the studies of mass media and fertilitychange, see Homik and McAnany(2001). In poor countries, mass media offerings are typically producedin urbanareas,such as capital cities, or are importedfrom other countries. The United States,WesternEuropeancountries, and some Asian countriesexport a wide range of televised situation comedies, dramas, soap operas, and music videos to countries that do not produce much of their own television. In Nepal, for example, most televised programs are importedfrom the United States, India, and other foreign countries, with a few Nepalese options. Feature-lengthmovies are even more likely to originateoutsidepoor countries. We argue that the mass media alterbehavior both by providing new informationor options

Mass Media and FertilityLimitation (a type of structural change) and by shapingthe self-identity of consumers (a type of ideational change). In terms of new information, mass media may provide some health and family However, mass media are planninginformation. even more likely to influencewho an individual wants to be-for example, a rich person who the uses contraception, fatherof two children,or someone who is equally happy with daughters as sons. This is because mass media are likely node in individuals'network to be an important of possible informationsources. Whethermessages provided by this node actually change attitudesis a function of whetherthe individual of receives the message, characteristics the node whether the node is perceived as expert (e.g., and trustworthy),and the individual's existing beliefs. If the message successfully alters an individual's attitudes, we posit that these new attitudeswill guide behavioras predictedby the fertility supply-demand framework and the theory of plannedbehavior,and as temperedby theories such as boundedrationalityand deviations fromexpectedutility. Thus, mass media may affect consumers' behaviorrather directlyby increasingknowledge or correcting misinformation; for example, a radio story may provide new informationon the health benefits and risks of medical contraceptive methods. Mass media may also affect attitudesvia consumers' identificationwith, for example, radio or television personalities. In addition, because mere exposure may produce positive attitudes toward a stimulus object (Zajonc, 1968), mass media may influence attitudes and behaviorsimply throughcontact.For example, consumersexposed to television programs that portray contraceptive methods or small nuclear families-whether the programs in are educational,promotional,or entertaining become positively disposedtoward nature-may these issues. Finally,mediaimagesandmessages thatshowcaseaffluencemay also influencefertilwhich ity by increasingconsumptionaspirations, may in turn decrease preferences for a large family (Faria& Potter, 1999; Freedman,1979; Homik & McAnany, 2001). Evidence of this phenomenon has been observed in the United have found that indiStates, where researchers viduals with high consumptionaspirations delay marriageand childbearingwhile accumulating consumergoods (Barber, 2001; Easterlin,1980). Throughmass media and othernodes in their network, individuals are exposed to multiple

1183 ideas, many of which conflict with one another and with the individual's own ideas and attitudes. We argue that individuals limit their information intake by watching, reading, or listening to only a selection of these sources, and by filtering the messages they incorporate from the selected sources. The theories on attitude development and change described above provide some insight into which mass media messages individuals are likely to adopt and into incorporate theiridentities. Balance theory suggests that individualswill attempt to reduce discord between their own attitudesand salient media messages that conflict with them. Television and movie actorsand the characters they portraytend to be richerthan media consumers, especially in poor countries and ruralsettings. In part because of this, consumersmay also perceive them to be bettereducated, more glamorous, and generally more successful, which may make them objects of admiration or even role models (Thornton, 2001). Admiration or respect for actors (and their characters)may cause consumers to consider them expert or trustworthy.Because balance theory and other cognitive dissonance theories predict that attitude change is most likely when the source of new informationis or consideredexpert or trustworthy, is admired, or liked (Heider, 1958; Perloff, respected, 1993), mass media personalitiesmay have profound effects on consumers. In particular,if consumers find their own attitudes conflicting with the attitudesor behaviors they ascribe to admiredactors or their characters,or with the lifestyle messages promulgatedthrough adverthey may programming, tising or entertainment alter their own attitudesto betteralign with the attitudesand behaviorsthey encounterin media sources. Specifically, we argue that mass media is likely to influence family formation behavior because it shapes two specific aspects of selfidentity:(a) attitudesand preferencesregarding family size, and (b) decisions regarding the of implementation those preferences. SETTING Mass Media in Nepal We examine the relationship between media exposure and fertility behavior in a district of south central Nepal, Chitwan. The population

1184 of Chitwan Valley had no access to television, radio, or movies until the early 1970s. In addition, Chitwanremainedrelatively isolated from other parts of Nepal until the late 1970s, when major roads linking Narayanghat (Chitwan's largest town) to the eastern, northern, and western portions of the country were built. As a result of the new roadways, by 1983, Narayanghat became a transportation hub within the country,and a varietyof government offices, businesses, and employmentopportunities developed in Narayanghat and spread throughout Chitwan. Over the next several decades, Chitwan changed greatly, from relative isolation to a busy hub with a vast array of new institutions,services, and opportunities (Axinn & Yabiku, 2001). One result of this change was a dramaticproliferationof access to mass media in the late 1970s, and continuing through the 1980s and 1990s. For example, in 1944, virtually no Chitwan residents had listened to the radio, seen a movie, or watched television. By 1996, 85% had seen a movie at a movie theater, nearly 90% had watched television, and virtually everyone had listened to the radio. Television.Television programming Chitwan in is of two types: (a) free programming,which includes two stations: the national channel (Nepal Television) and Indian Television (Dor Darsan),and (b) cable/satellitetelevision, which is providedby StarTelevision and costs approximately $3.50 per month. This is quite expensive for a typical family in Nepal, where the per capita Gross Domestic Product(GDP) in 1992 was US$144 (relativeto $23,332 in the United States;UnitedNations, 1995). Nepal Television was startedin 1985 as a project under the Sixth Development Plan, as a way to "enhancethe country'ssocioeconomic development" (Nepal Television web site, http://explorenepal.com/ntv/).It is currently availableto approximately 42% of the country's populationand 32% of the land area. The programming is supervised and approved by a boardof directors,which is appointedby the The stagoverment's Ministryof Information. tion transmits61 hours per week (includingthe daily news in both English and Nepali), other currentaffairsprograms,and news magazines. Nepal receives the same channels from Star Television India (via cable and satellite) as India does. Star Television is the largest pro-

Journal of Marriageand Family vider of cable and satellite television in India, dominatingwith 40 of the top 50 shows every week. It is owned by the News Corporation, which also owns approximately85% of Fox and it provides multiple chanEntertainment, nels. Star Movies broadcastsmainly American movies, both new and old. For example, the for programming July 15, 2002 includedAmerican Beauty, Anna Karenina, Orient Express, Exposure, Jerry Maguire, and others. Star World broadcasts mainly American sitcoms, game shows, soap operas, and talk shows. On July 15, 2002, the offerings included The X-Files, Caroline in the City, Hollywood Squares,Family Ties, OprahWinfrey,The Bold and the Beautiful, Baywatch, The Simpsons, Friends, and EverybodyLoves Raymond. Star Plus is the Hindi entertainment channel, offering primarily30-minuteprogramsin Hindi. Star Gold broadcastsHindi movies from the 1940s throughthe 1980s. StarNews is an Asian news channel. Star Sports broadcasts Indian and regional sporting events. Channel V is Indian music television, which shows mainly Hindi music videos, and also some American and European music videos. Star Television also includes a National Geographic documentary channel;AdventureOne, an adventurechannel; ESPN, a regional and international sportschannel; and Radio City, an Indianmusic channel. Radio. Similar to television, radio stations in Nepal are both publicly and privately owned. The public nationalradiostationis Radio Nepal. Establishedon April 1, 1951, Radio Nepal is broadcastfor 15 hours per day on both short andmediumwave, andreacheslistenersthroughout Nepal (http://www.radio-nepal.com/). In Chitwan, several additional FM stations are available, including Synergy FM 91.6, Manakamana Hetauda,and Annupura FM FM Pokhara. These stations broadcast approximately 80% music programs and 20% other types of programs, such as talk shows, telephone call-in shows, and news. The music broadcast is mainly Nepali and Hindi, with a small amountof popularmusic in English. Movies. Movie theaters in Chitwan generally show both Nepali and Hindi films. The Hindi film industry,centeredin Bombay (Mumbai),is the largestfilm industryin the world. It is commonly called "Bollywood," a combination of

Mass Media and FertilityLimitation Bombay and Hollywood. Hindi movies tend to contain multiple common elements, including love, fantasy, violence, and intergenerational independence, combined with a great deal of singing and dancing. These films often depict rich families with high standardsof living, and explore conflict between historically held Hindu behavioral standards and standards in Western Europe and North America. For example, a common theme is the conflict between parentalcontrol of the marriageprocess and the direct participation young peoof ple in courtshipand love. Nepali films, though usually made with a smaller budget, often examine similarthemes. Newsprint. A wide variety of magazines and newspapers are available in Chitwan, particuthe larly in Narayanghat, largest city in the district. The Gorkhapatrais the official daily newspaper in Nepal, owned and published by the national government.According to a local newsstandowner, the most populardaily newspapers in Chitwan are the Chitwan Post (Nepali), the Kantipur Dainiki (Nepali), the KathmanduPost (English), Rajdhani (Nepali), Gorkhapatra (Nepali), the Rising Nepali (English), Space Time (Nepali), the Space Time Today (English),Himalaya Times (Nepali), and the Himalayan(English).Except for Gorkhapatra, all are privately published. Most are relatively inexpensive, especially compared with other forms of mass media. For example, the ChitwanPost costs 3 rupees, or approximately $.05. HYPOTHESES Our theoreticalframeworkpredictsthat, in this setting, exposure to mass media will be associatedwith smallerfamily size preferences, greater methods,and higher acceptanceof contraceptive rates to limit family size. In addicontraception tion, we anticipatethat exposureto mass media will also be associatedwith weaker son preferences, which will affect contraceptiveuse to limit family size. Demographers hypothesize that one reason people in some poor countries have large families is that they desire at least one son, and they may continue childbearing past their ideal family size until they have one (Niraula & Morgan, 1995). Because in Nepal, many families prefer two sons (Niraula & Morgan;Stash, 1996a, 1996b),we expect thatan

1185 associationbetween media exposure and weaker son preferencewill lead to smallerfamilies. METHOD Data In 1996, the ChitwanValley Family Study collected informationon all residentsfrom a representative sample of 171 neighborhoods in western Chitwan Valley. Neighborhoods were defined as clusters of approximately5 to 15 households. In this rural setting, these clusters define groups of people who have daily face-toface contact. Information about changes in schooling opportunities, the availability of health services, improvementsin transportation infrastructure, and other important social changes occurringin those neighborhoodswas collected using the NeighborhoodHistory Calendar technique (Axinn, Barber, & Ghimire, 1997). This technique uses a combination of and structured interview archival,ethnographic, methodsto arriveat detailedmeasuresof neighborhoodchange over time. The ChitwanValley Family Study then interviewed all residents (and their spouses) between the ages of 15 and 59 in the 171 neighborhoods.The study had an overall response rate of 97%, or 5,271 completed interviews. All interviews were conductedin Nepalese, the most common language in Nepal. (The English questions presented below are translations.) Life history calendars,which were administered using a semistructuredinterview technique, assessed respondents'contraceptiveuse, migration, marriage, childbearing, education, and work behaviors(Axinn, Pearce,& Ghimire, Thorton, Cambum,Alwin, & 1999; Freedman, Young-DeMarco, 1988). Structured survey questions assessed respondents'exposure to the mass media. In the analysis of permanentcontraceptiveuse describedbelow, we use information from the 1,091 married couples with at least one child and in which the wife is 25-54 years old at the time of interview. We do not or use dataon very young, never-married, childless women because they are very unlikely to have used a permanent contraceptivemethod in the Nepalese context (Acharya & Bennett, 1981; Axinn, 1992a; Bennett, 1983; Tuladhar, 1989). For our analyses of attitudes toward childbearingand contraceptiveuse, we restrict our sampleonly by age (ages 25-54).

1186 Measures Permanentcontraceptiveuse. A variety of contraceptivemethods has been available in Nepal for the past 20 years, including sterilizationand other birth control methods such as Norplant (an implanted 5-year time-release contraceptive), Depo-Provera(an injected 3-month contraceptive), and the intrauterinedevice (IUD). The residents of Nepal, as other South Asian populations, however, have demonstrated a strong preference for using contraceptive methods to stop all future childbearing, as opposed to merely delaying it. Sterilizations accountfor the vast majorityof birthsavertedin Nepal (Nepal 1996: Results from the Family Health Survey, 1998; Tuladhar,1989). Further, even methods that could be used merely to delay childbearingare generally used with the intent to stop childbearing (Axinn, 1992a). Among marriedwomen in the Chitwan Valley Family Study ages 25-54 with at least one child, 99% who had ever used Norplant, Depo-Provera,or the IUD said thatthey wanted no more children.In the 3 years after the interview, of the women who wanted no more children,only 3% actuallyhad anotherchild. Given these data from the Chitwan Valley Family Study and the ethnographicevidence indicatingthat these contraceptivemethods are generally used to stop future childbearing (Axinn, 1992b), we consider Norplant, DepoProvera, and the IUD, as well as sterilization and spouse sterilization,to be permanentcontraceptivemethods in this context. To estimate our hazard models, we code a time-varying dichotomousvariable 1 the first time a respondent uses any of these methods. Table 1 shows the means, standarddeviations,minimums,and maximumsfor each variableused in the analyses. As indicated in Table 1, 63% of all the couples had used a permanent contraceptive method by the end of our observationperiod. Of those couples who used permanentcontraception, the vast majority used sterilization (18% female sterilization,59% male sterilization). The remaining23% used Depo-Provera, an IUD, or Norplant. Attitudes.Oursurveydesign team includedboth U.S. and Nepali researchers. used a lengthy We process to develop measuresof attitudestoward childbearing,son preference,and contraception. We began with ethnographicwork to discover

Journal of Marriageand Family the language used by local people to talk about these issues, and also to uncover the tensions inherentin the issues. For example, we learned that many Nepali people perceived a tension between having a large family and being rich, both of which are desirable. And Hindu religious customs require children, particularly sons, to performrituals at the time of death in orderto enter "heaven."We discovereda common Nepali phrase: "Yota aka, ke aka? Yota chora, ke chora?" or "One eye, what eye? One son, what son?" The phrase refers to the need for two sons in case something happens to the first son, similar to the need for two eyes. We also learned that although many Nepali men would like to use contraception,they perceive religiousproscriptions againstits use. Next, we examined existing large-scale surveys to see whetherthey included measuresof attitudes toward childbearing, son preference, and contraceptive that would be appropriate use in the Nepali context. Using our ethnographic informationand the questions borrowed from othersurveys,we developed a lengthy questionnaire. Our experienced Nepali staff, including faculty from the local university,translatedthe questions into Nepali. They were then backtranslatedinto English to check their meaning. After another iterationof the translation/backtranslation process was completed, we conducted a pretest.Based on information from the interviewersabout which concepts were difficult for respondents,as well as response distributions, we chose items for inclusion in the final questionnaire. Some of the items were altered and pretested again to increase the amountof variancethat we could expect in the final survey. We attemptedto include multiple measuresof each substantivedomain. Family size preferenceswere measuredwith the Coombs scale (Coombs, 1974, 1979). This is important because the vast majority of respondentsin Nepal stateda preferencefor two children.The Coombs scale allows us to differentiate between those respondents who want two children at maximum and those who want two childrenat minimum.Respondentsare first asked how many children they would like to have. (Respondentswho alreadyhave children are asked how many childrenthey would like to have if they could startlife over.) Next, they are asked how many children they would like to have if they could not have their first choice. Finally, they are asked how many childrenthey

Mass Media and FertilityLimitation would have if they could have neither of their first two choices. The scale based on these responses is depictedin Figure 1. The remainder the attitudes measured of are by Likert-scale responsesto a series of statements. Attitudestowardlarge families are measuredby responsesto the statements"Havingmany childrenis betterthanbeing rich" and "A man with no children cannot go to heaven." Attitudes towardson preference measured responses are by to "Yotaaka, ke aka? Yotachora, ke chora?"or "One eye, what eye? One son, what son?" Finally, attitudestoward contraceptiveuse are measured by responses to the statements "A vasectomizedman cannot be blessed by God," and "Everyoneshoulduse family planning(conused the Becauseso few respondents traception)." categoriesstronglyagree and stronglydisagree, we recodedresponsesinto two categories: agree stronglyagree andagree) anddisagree (including (including strongly disagree and disagree). moreposResponsesarecoded so that1 indicates itive attitudes towardlarge families, strongerson of and preference, tolerance contraception. Note that these measures of attitudestoward childbearing and contraceptive use are not indicators of one or more underlying factors. Althoughthe correlationsare statisticallysignificant in all cases, Cronbach'salpha for a scale combining the three measures of attitudes toward family size was only .14, and factor analysis revealed that all items contribute equally (poorly)to the scale. Media exposure. Exposure to mass media is measured by survey questions about whether the respondenthad ever (a) watched television, (b) listened to the radio, (c) watched a movie at a theater,or (d) read a newspaper.For the first three sources of mass media, respondentswere also asked their age when first exposed; a dichotomousmeasure indicates whethertheir exposure to each source was before or after marriage. We construct the measures in this way to control for the possibility that individuals who used contraceptionto achieve smaller families were subsequently more likely to be exposed to the mass media. Limiting media exposure to before marriageprovides very conbetweenmedia servativetests of the relationship and permanent contraceptive use, exposure however. Thus, we also estimate the relationship between ever being exposed to each type of use. mass media and permanent contraceptive

1187 Finally, we constructan index combiningthe dichotomous indicators of each type of media (except newspapers),indicating the number of media types to which the individual was exposed before marriage,and an index (excluding radio) indicating the number of types exposed to duringthe individual'slifetime. We exclude radio from the latter index because nearly everyone in the sample had listened to a radio during their lifetime, which provided very little variance in this measure (see Table 1), and we exclude newspapersfrom the former index because respondents were not asked aboutage of firstexposureto newspapers. Couple-level and individual-levelcontrols. We also statisticallycontrolfor multiple individuallevel and couple-level characteristicsthat may jointly influence whether women or their husbands are exposed to the mass media, and whether they use a permanent contraceptive method. Because the propensityto use contraception, the availability of contraception, and mass media exposure have all changed dramatically in Nepal over the past several decades, we control for the wives' birth cohort. Women born between 1952 and 1961 (ages 35-44 at the time of the survey) and those bor between 1942 and 1951 (ages 45-54) are comparedwith the youngest respondents,those born between 1962 and 1971 (ages 25-34). Because the propensityto use contraception and exposure to the mass media vary dramatically among different religious/ethnoracial groups, we include a series of five dichotomous variables: Upper Caste Hindu, Lower Caste Hindu, Newar, Hill Tibeto-Burmese,and Terai Tibeto-Burmese. (For a rich descriptionof these groups, see Acharya& Bennett, 1981; Bennett, 1983; Fricke, 1986; Gellner & Quigley, 1995; Guneratne, 1994; Gurung, 1980; Macfarlane, 1976.) We also controlfor multiplemarriagecharacteristics in our models of contraceptive use. First, because women living apart from their husbandsare unlikely to use a permanentcontraceptivemethod given their low risk of pregnancy, we use a time-varying dichotomous measureof whetherthe couple coresided in the previous year. Second, because women with longer first-birthintervals may be particularly unlikely to use permanentcontraceptivemethods, especially if the long interval was due to

1188

Journal of Marriageand Family

TABLE 1. MEANS AND STANDARD DEVIATIONS MEASURESUSED IN ANALYSES (N = 1,091 COUPLES) OF

M Dependentvariables use of Permanent contraceptive (proportion by couples who used permanent contraception end of observationperiod) Attitudes Family size preference(Coombsscale) Havingmanychildrenis betterthanbeing rich Man with no childrencannotgo to heaven One son, what son? One eye, whateye? A vasectomizedman cannotbe blessed Everyoneshoulduse family planning Mediaexposure Listenedto a radio Before marriage Lifetime Saw a movie in a theater Before marriage Lifetime Watchedtelevision Before marriage Lifetime Read a newspaper Lifetime Sum of types of mediaexposure Before marriage (radio,movie, television) Lifetime(newspaper,movie, television) Individual-and couple-levelcontrols Cohort(wife) Born 1962-1971 (age 25-34) Bor 1952-1961 (age 35-44) Born 1942-1951 (age 45-54) Religious/ethnicgroup UpperCaste Hindu(reference) LowerCaste Hindu Newar Hill Tibeto-Burmese TeraiTibeto-Burmese Couple coresided(previousyear) Yearsbetweenmarriage firstbirth and Years since firstbirtha Total numberof childrena Total numberof boys Education Wife attendedschool (beforemarriage) Husbandattendedschool (beforemarriage) Eitherof wife's parentsever attendedschool Eitherof husband'sparentsever attendedschool Nonfamilywork Wife workedoutsidethe home (beforemarriage) Husbandworkedoutside the home (beforemarriage)

SD

Minimum

Maximum

.63

6.94 .30 .24 .49 .68 .82 Wife Husband .65 .96 .43 .81 .14 .81 .20 1.22 1.82 .80 .98 .72 .88 .22 .90 .62 1.64 2.39

2.69

1
0 0 O 0 0 0

25 1 1 1 1 1

0 0 0 0 0 0 0 .99 .84 0 0

I
I

1
1

1
1

3 3

.45 .37 .19 .46 .10 .07 .17 .19 .86 3.29 11.58 4.23 1.64 .34 .69 .23 .14 .18 .45

0
0 0 0 0 0

1 1
1 1 1 1
1

2.72 7.46 2.91 1.17

0 0 0 1 0 0
0 0 0 0 0 0

18 37 13 7
1 1 1 I

1 1

Mass Media and FertilityLimitation

TABLE 1. CONTINUED M Eitherof wife's parentsworkedoutsidethe home (beforewife's age 12) Eitherof husband'sparentsworkedoutside the home (beforehusband'sage 12) Nonfamilyliving Wife lived away fromfamily (beforemarriage) Husbandlived away from family (beforemarriage) controls Neighborhood-level has electricity Neighborhood Hoursto nearestmovie theater Miles to nearesttown Numberof services within 5-minutewalka Numberof services within 1-hourwalk duringchildhood .42 .45 SD Minimum 0 0

1189

Maximum 1 1

.01 .28 .27 1.69 8.49 1.54 Wife Husband 2.76 2.94

0 0 0 1.18 4.00 1.46 1.69 .03 .02 0 0

1 1 1 6.00 17.70 5 5

Note: Statistics for control variablespertainto the couple-level file (1,091 couples, used in hazardmodels of permanent use). Means for the individual-levelfile (used in analysesof attitudes)are very similar. contraceptive Means for time-varyingmeasurespertainto the final period of observation(year of first permanentcontraceptiveuse for those who ever used a permanent method,or year or interviewfor those who did not). contraceptive

difficulty conceiving, we use a measure of the number of years between marriage and first birth,coded in years. Third,we also control for time-varyingyears since the firstbirth.Because we start the period of risk at the time of first conbirth, this is essentially a countervariable trolling for the baseline hazard of permanent contraceptiveuse. Finally, in our hazardmodels, we also include time-varyingmeasures of the couple's childbearing behavior: the total number of children ever bor, and the total number of boys ever bor. We include these measures to compare the contraceptiveuse of couples in similarchildbearingsituations. In all of our models, we include multiple measuresof the couple's and theirparents'edu-

cation, occupation,and nonfamilyliving experiences before marriage.These factors are likely to increase exposure to mass media, and are known to increasepermanentcontraceptiveuse (Axinn, 1992a; Axinn & Yabiku, 2001). Measures of whether the wife, the husband, the wife's parents, and the husband's parentsever attendedschool or workedoutside the home are coded dichotomously. Because these experiences are even less common in the parentalgeneration, we use an indicatorof whethereither of the wife's parents or either of the husband's parentsever had these experiences.In addition, althoughwe do not have measuresof nonfamily living among the parental generation, we include dichotomous measures of whether the

PREFERENCES SIZE 1. SCALE FAMILY OF FIGURE COOMBS

1 0 2 2 3 3 4 4 3 5 4 5 6 5 6 7 6 5 7 8 8 6 9 9+ 9

First choice Second choice Third choice

A
0

A
0

1 3

A
1

3 4

A A A A A A A A
2 1 4 2 5 2 5 3 6 3 6 4 7 4 7 5 8 7 7 8 9 10

A
8

A
7 6 9

Code

10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25

Note: Respondentsare first asked how many childrenthey would like to have. (Respondentswho alreadyhave childrenare asked how many childrenthey would like to have if they could startlife over.) Next, they are asked how many childrenthey would like to have, if they could not have theirfirstchoice. Finally,they are asked how many childrenthey would have if they could have neitherof their first two choices. For example, a respondentwhose first choice is two children,second choice is threechildren,and thirdchoice is one child would score 6 on the scale.

1190 husbandor wife ever lived away from theirfamilies before marriage. To foreshadow our results, however, the relationships between media exposureand the multipledependentvariables we use are very similarin models where these measuresareexcluded. Neighborhood-levelcontrols. We include three separatemeasuresof neighborhoodcharacteristics thatare theoreticallymost directlyrelatedto media exposure:whetherthe neighborhoodhas electricity,the distance (in hours) to the nearest movie theater,and the distance(in miles) to the nearesttown. Researchhas shown thatthe presence of nonfamily institutionssuch as schools and employersis strongly associatedwith early terminationof childbearingvia permanentcontraceptiveuse (Axinn & Barber,2001; Axinn & Yabiku, 2001), and may be related to mass media exposure as well. Thus, we also include an index of the number of nonfamily institutions-schools, health centers, bus routes, employers, and markets-within a 5-minute walk of the couple's current neighborhood. They are time varying in our hazardmodels of permanent contraceptiveuse, and correspondto the year in which attitudeswere measuredfor our models of attitudes.Third, we include an index of the numberof those same services that were located within a 1-hour walk of the respondent's neighborhood during childhood. This index is created from informationin the individual survey interview. Because husbands and wives typically grow up in differentneighborhoodsin this setting,the index is constructed separatelyfor husbandsand wives. AnalyticStrategy Permanentcontraceptiveuse. We use event historymethodsto model the risk of adoptinga permanentcontraceptivemethod. Because the data are precise to the year, we use discrete-time methods to estimate these models, and personyears of exposure are the unit of analysis. We consider women to be at risk of adoptinga permanent contraceptive method after they are marriedand have at least one child. We use logistic regressionto estimatethe discrete-time hazard models. Our time-varying measures of characteristicsof the respondents and their communitiesare measuredin the year prior to the currentyear of permanentcontraceptive use (i.e., lagged by one year). Because

Journal of Marriageand Family the probabilityof adoptinga permanentcontraceptive methodis so small within each year, the hazard of permanentcontraceptiveadoption is very similarto the rate of permanent contraceptive adoption.Thus, for ease in description,we will sometimesreferto the effects of the covariates on the rate of permanent contraceptive adoption.We used multilevel discrete-timesurvival analysisto estimateour models because of the correlated error structure among couples within the same neighborhoods(Barber,Murphy, Axinn, & Maples, 2000). Attitudes.We use logistic regression to model the correlationbetween the independentvariables and attitudestowardchildbearingand contraceptive use, and ordinary least squares regressionto model the correlationbetween the independent variables and the Coombs scale measure of family size preference. We estimated our models of attitudesusing multilevel analysis to adjustfor the correlatederrorstructure among individuals within neighborhoods. Because the correlation between individuals within the same householdis quite small, we do not estimate three-level models to correct for this correlation. InferentialDesign our analysisis based on a nonrandomAlthough ized observational design, we take numerous analytic precautionsto assure that the associations we observe are not the spuriousby-product of an important unobservedfactor.First, we statisticallycontrol for a rich set of individual and neighborhood characteristicsavailable in our data. Existing researchhas not incorporated such a rich set of neighborhood-levelcharacteristics in models of the influence of media exposure on contraceptive use. Second, we investigate multiple media types-radio, movies, television, and newspapers-each with its own criteria for access and self-selection. On one hand, although movie theaters tend to be placed in specific neighborhoods by outside groups, radios, television, and newspapers are more widely availableand more broadlyaccessible in geographic terms. On the other hand, movies are relatively inexpensive (e.g., 5 rupees,or about8.33 cents), whereastelevisions are expensive, and radios are somewhere in between. Newspapersappealmainly to the literate population,whereas radios, televisions, and

Mass Media and FertilityLimitation movies can be absorbedby the illiterateas well. By examining exposure to a variety of types of media with different access and self-selection criteria,we can make a strongercase for causal ratherthan selection effects of media exposure. RESULTS Media Exposureand ContraceptiveUse Table 2 shows the overall relationshipbetween wives' exposure to mass media and couples' hazard of adopting a permanentcontraceptive method. Models 1 through 5 include measures of wives' media exposure before marriage,and models 6 through 10 include measures of wives' lifetime media exposure. Models 1 and 2 show that a wife's premarital exposure to radios and movies is significantly associated with higher rates of limiting family size via adopting a permanent contraceptive method. Model 4 illustratesa large cumulative relationshipbetween multiple types of premarital media exposure and adopting a permanent contraceptivemethod. For example, individuals exposed to three sourceshave .38 higher (.19 X con2 = .38) log-odds of adoptinga permanent method than individuals exposed to traceptive one source.Finally, Model 5 shows thatthe correlationsbetween adoptinga permanentcontraceptive method and exposure to radios and movies are independent-that is, exposure to radios is associated with higher rates of adopting a permanentcontraceptivemethod regardless of exposureto movies, and vice versa. By constrainingmedia exposureto the period before marriagein Models 1 through5, we capture only a portion of an individual's lifetime media exposure. Models 6 through 10, which focus on lifetime media exposure, also show strong positive correlationsbetween exposure Because and adoptingpermanent contraception. a portion of lifetime media exposure may have occurred after couples adopted a permanent contraceptive method, these coefficients may representan overestimateof the true relationship. The coefficients in Models 6 through 10 are substantiallylarger than the coefficients in Models 1 through5, however, which may indicate that limiting media exposure to the period before marriageleads to conservativeestimates of the magnitude of that relationship.In addition, interactionmodels show that the association between media exposure and permanent

1191 contraceptiveuse is strongest among those in the oldest cohort. This makes sense because exposure was much rarerin the lives of those older women. The patternof statisticalsignificance and the magnitudefor even the youngest cohort is similar to what we present in the tables, however. The coefficientsfor media exposurepresented in Table 2 are not only statisticallysignificant but they are also indicativeof a substantiverelationship between media exposure and permanent contraceptive use. In fact, the media exposure coefficients are as large as many of the othercoefficientsfor controlvariablesin the models, including those for husband's educahusband's tion, wife's labor force participation, labor force participation,and current parents' characteristics. and childhoodneighborhood Models of the relationship between husbands' media exposure (not shown in tables) and adopting permanentcontraceptionsuggest thatwives' exposureto mass media, both before marriageand over the lifetime, has a stronger correlation.Six of the eight coefficientsin Table 2 (for wives) are larger than their counterparts for husbands. In addition, most of the significant coefficients for husbands' media exposure become statisticallyinsignificantwhen included in a model with the equivalent measure of wife's media exposure. For example, including whether the wife saw a movie in a theater (lifetime) in the model, along with whetherthe husbandsaw a movie in a theater,rendersstatistically insignificantthe coefficient for whether the husbandsaw a movie. This is also true for exposure to television and the sum of exposure to media types over a lifetime. Although these results constitutea relatively strong pattern,the gender differentials for specific pairs of coefficients are not large. Furtherresearchwill be required to document whether and why wives' media exposure may be more strongly use. relatedto couples' permanent contraceptive For instance, perhaps media exposure is more strongly related to women's attitudes and behavior, or perhaps women retain different types of informationfrom the mass media than do men. Media Exposureand Attitudes Table 3 shows estimates of the relationship between lifetime exposure to the mass media and current attitudes about family size, son

1192 preference,and contraceptiveuse. Because the dependentvariablesfor all of these models refer to the present ratherthan the past (as in Table 2), we use the measuresof lifetime media exposure (althoughwe also estimatedmodels using measuresof premarital media exposure, as discussed below). Also recall that these are individual-level models rather than couple-level models as presented in Table 2. Thus, we included a measure of respondent gender (female = 1) in each model in Table 3, and we also tested for interactive differences in coefficientsby genderfor each independent variable in the models. In our final models presented in Table 3, we include only those gender interactions that are statisticallysignificant(discussed below). Overall, Table 3 shows strong relationships between lifetime media exposure and attitudes toward childbearing and contraceptive use, measuredin multiple ways. The first two rows of the table display these relationships. Exposure to more types of mass media is associated with lower scores on the Coombs scale (preferrednumber of children), and less agreement with the two statements about the virtue of a large family and the bane of childlessness. Individualswho were exposed to one more source of mass media than their peers score, on average, .38 fewer points on the Coombs scale. In other words, individualswith lifetime exposure to movies, television, and newspapershave a score 1.14 points lower (.38 X 3 = 1.14)-nearly half of a standarddeviation-than individualsexposed to none of these media sources. Similarly, agreement with the statement"Having many childrenis betterthan being rich" is lower among those exposed to mass media, althoughthis is statisticallysignificant only among men. Recall that this is a dichotomous scale of agreement versus disagreement.Thus, men exposed to radio, movies, and TV have 1.44 lower (-.48 X 3 = -1.44) log-odds of agreement than men exposed to none of these sources. More media exposure is also associated with less agreement with the statement "A man with no children cannot go to heaven," but it is also statistically significant only among men. Men exposed to radio, movies, and TV have 1.65 lower (-.55 X 3 = -1.65) log-odds of agreementthan men exposed to none of these sources. (Note thatthe coefficient for "sum of types of media exposure" for women is computed by summing the

Journal of Marriageand Family pooled coefficient [e.g., -.48 for column 2] and the *female coefficient [.38 for column 2]. For both columns 2 and 3, the result is not statistically differentfrom zero.) Media exposureis also associatedwith weaker preferencesfor sons over daughters.Column 4 in Table 3 shows that individualsexposed to radio,movies, and TV have 1.02 lower (-.34 X 3 = -1.02) log-odds than their counterparts of agreeingwith the common Nepali saying, "One son, what son? One eye, whateye?" Finally, exposureto mass media is associated with positive attitudes toward contraception. Recall that the measurein column 5 is reversecoded (because it is phrasednegatively) so that positive coefficients indicate more positive attitudes toward contraceptive use for both measures. Exposure to an additional mass media sourceis associatedwith a .33 increasein the log-odds of disagreeing with the statement "A vasectomized man cannot be blessed by God." Responses to the statement "Everyone should use family planning"also differ according to media exposure. Individualsexposed to movies, television, and newspapers have .93 higherlog-odds (.31 X 3 = .93) of agreeingwith the statement. (Note that this item is phrased positively towardcontraceptiveuse, and thus is not reverse-coded.) Neighborhood characteristics that may be indicatorsof media exposure are also relatedto attitudestowardchildbearingand contraceptive use. Controllingfor whetherthey saw a movie in a theaterbefore they were married,individuals who live far from a movie theater prefer larger families and have stronger son preference, and individuals who live far from the nearest town (where media are most easily accessible) are more likely to agree that having many childrenis betterthanbeing rich. In addition,we estimatedeach of the models in Table 3 with additional controls for total number of children, number of sons, and whetherthe couple had ever used a permanent contraceptivemethod. We included these controls to test whether the attitudesexpressed in the survey are a consequenceof actualbehavior. Indeed, some of those measures are strongly correlatedwith attitudes;individualswith many children report larger family size preferences, and individualswho have used permanentcontraceptionexpress much more tolerantattitudes toward using contraception. Including those variables in our models, however, does not

Mass Media and FertilityLimitation change the estimatedcorrelationbetween media exposure and attitudesreportedin Table 3. This means, for example, thatamong those who have not used a permanent contraceptive method (and among those who have), exposure to the media is associatedwith even more tolerantattitudes toward contraception.Similarly, among those with few children (or many children), exposure to the media is associatedwith preferences for even smallerfamilies. We also reestimatedthe models in Table 3, but including only young couples with fewer than two children. Very few of these couples have used a permanentcontraceptivemethod, and thus it is unlikely that actual contraceptive use is responsible for attitude change in this cohort. We found that the influence of media exposure on attitudeswas actually strongerfor about half of the attitudes among this group. between media expoHowever, the relationship sure and (a) family size preference,(b) agreement that "A man with no childrencannotgo to heaven," and (c) agreement that "Everyone should use family planning" were not statistically significant.In the case of (b), however,this seems to be becausethe coefficientsare not estimated as precisely (i.e., the standarderrorsare larger) and not because the estimated coefficients are smaller.This is not surprising, because the sampleof individualsbetweenage 25 and 34 with no childrenor one child is fewer than200. We also estimatedmodels of the relationship between media exposure before marriage and these attitudes(not shown in tables). Although for all attitudes, the relationship to lifetime media exposure is strongerthan it is to premarital exposure, the coefficients for premarital media exposure effects are statisticallysignificant (p < .05), with the exception of attitude toward contraceptive use (as measured by agreementwith the statement"Everyoneshould use family planning").Because this measureof media exposureis from so early in life (and thus is probablynot a consequenceof fertility-related attitudes), these findings further buttress our argumentthat the relationshipbetween media exposureand attitudesis at least partlycausalthatis, media exposureaffects attitudes. We also estimated the relationshipsbetween specific types of lifetime media exposure and attitudes toward childbearing, son preference, and contraceptive use (not shown in tables). These models show a strong pattern, with all types of media exposure associated with less

1193 positive attitudestowardlarge families, weaker son preference, and more positive attitudes toward contraception.Further,when all three types of media exposureare includedin a single model of each attitude, the vast majority of these coefficients are statistically independent and remain similar in magnitude.For example, having seen a movie is associatedwith attitudes regardless of whether the individual has watchedtelevision or reada newspaper. Finally, we also estimated the relationship between specific types of premaritalexposure and these attitudestowardchildbearing conand traception.Similarto the patternfor the models in Table 3, premarital exposureyielded relationof a smallermagnitudethanlifetime media ships exposure.In all models where the coefficientfor lifetime media exposure is statistically significant, however, the coefficient for premarital media exposure is also statisticallysignificant. buttressesour hypothesisthat Again, this pattern these relationshipsmay representcausal effects of mediaexposureon attitudes. Unfortunately, we cannot directly test the extent to which the relationshipbetween media exposure and attitudesexplains the relationship between media exposure and the rate of adoptmethod.This test contraceptive ing a permanent would requirecontinuous measurementof attitudes towardchildbearingand contraceptive use beginning before attitudes are formed, along with concurrentmeasures of adopting contraceptive methods throughout the life course. However, the relationshipsbetween past media exposure and current attitudes toward childbearing and contraceptiveuse that we describe here supportthe hypothesisthatmedia exposure altersthese attitudes,which in turnare likely to affect contraceptiveuse behavior. Our findings are consistent with the idea that as individuals are exposed to more sources of mass media, they become less positive towardlarge families, feel less like they must have at least one son, and become more accepting of contraceptive use as a way to achieve those desires. Additional researchwill be necessary to directly test the role of attitudechange in transmittingthe influence of media exposure to contraceptive use behavior.
SUMMARYAND CONCLUSIONS

Guided by our theoreticalframework,the evidence presented above is consistent with the

TABLE 2. LOGISTic REGRESSIONESTIMATESOF THE INFLUENCEO~F WIFE'S MEDIA ExpoSURE ON COUPLES' HAZARD OF P

(N =1,091 COUPLES) (STANDARD ERRORS)

Before Marriage 1 Mediaexposure Listenedto a radio Saw a movie in a theater Watchedtelevision Read a newspaper Sum of types of mediaexposure Individual-andcouple-level controls Cohort(wife)C Bum 1952 1961 (age 35-44) Bum 1942 1951 (age 45-54) Religiou,s/ethnoracial groupd Lower CasteHindu Newar Hill Tibeto-Burmese TeraiTibeto-Burmese Couple coreaided(previousyear) Yearsbetweenmarriageand firsthirth Yearssince firsthirth Total numberof children Total numberof boys Education (beforemarriage) Husbandattendedschool (beforemarriage) Eitherof wife's parentsever attendedschool Eitherof husband'sparents ever attendedschool Nonfamilywork Wife workedoutside the home (beforemarriage) Husbandworkedoutsidethe home (beforemarriage) 2 3 4 5 6 7

29*(.10) .31** (.11) .14 (.14) .19*** (.06)

.23* (.1 1) .25* (.11) .05 (.14)

b

.51*** (.13) .35** (.13)

-1.43*** (.17) -1.45*** (.17) -1.48*5**(.17) -1.42*5**(.17) -45** (.16) .07 (.17) -.16 (.13) -1.16*** (.16) .30* (. 13) .03 (.02) -.07*** (.01) .32*** (.04) .44*** (.05)
nA0 (.in1

I1.41***(.17) -43*5 (.16) .07 (.17) -.15 (.13) -1.19*** (.16) .31* (.13) .03* (.02) -.07*** (.01) .32*** (.04) .44*** (.05)
no (.1 n

-148*(.17) -.8*(.16) .08 (.17) -.14 (.13) -l.20*** (.16) .3* (.13) .02 (.02) .07*** (.01) .31*** (.04) .46*** (.05)
in 06 (.0

-1.535*5 (.17

-43 ** (.16) .09 (.17) -.14 (.13) -1.19*** (.16) .31** (.13) .03 (.02) -.07*** (.01) .3 1*** (.04) .45*5* (.05)
n-.0 (. i )

-445* (.16) .12 (.17) -.14 (.13) -1.16*** (.16) .29* (. 13) .02 (.02) -.075** (.01) .31*** (.04) .44*** (.05)
.0nI (. i)

-.425* (.16) .09 (.17) -.15 (.13) -1.19*** (.16) .31* (.13) .03* (.02) -.07*** (.01) .32*** (.04) .44*** (.05)
in no0(II

-39*5 (. 16) .10 (.17) -.14 (.13) -l. 15*** (.1 .30* (. 13) .02 (.02) -.07*** (.01 .31*5* (.04) .45*5* (.05)
un .03 (.0

.39*** (11I) -.01 (.11) -.02 (13)

.39*** (.11) -.01 (.11) .05 (13)

.38*** (.II) .02 (.11) -.03 (13)

.40*** (.11) -.01 (.11) -.05 (13)

*39*** (.II) -.02 (.11) .04 (13)

.37*** (.II) .03 (.11) -.02 (13)

.36*** (.II) .001 (.11) -.01 (.13)

.32** (.12) .02 (11)

.29** (12) .002 (10)

.33** (.12) .02 (11)

.31** (.12) -.01 (.1)

.30** (.12) -.01 (.11)

.33** (.12) .01.(.10)

.34** (12) .02 (10)

TABLE 2. CONTINUED Before Marriage

1 2 3 4 5 6 7

Eitherof wife's parents workedoutside the home (before wife's age 12) Eitherof husband'sparents workedoutside the home (beforehusband'sage 12). Nonfamily living Wife lived away fromfamily (before marriage) Husbandlived away from family (beforemarriage) Neighborhood-levelcontrols Neighborhoodhas electricity Hoursto nearestmovie theater Miles to nearesttown Numberof services within 5-minutewalk Numberof services within 1-hourwalk duringchildhood(wife) Numberof services within 1-hourwalk duringchildhood(husband)

.02 (.09)

-.01 (.09)

-.01 (.09)

.001 (.09)

(09).01002

-.01 .002 (.09

.19* (.09)

.21** (.09)

.19* (.09)

.21** (.09)

.21** (.09)

.19* (.09)

.19* (.09)

.62 (.46) -.08 (.12)

.52 (.46) -.07 (.12)

.57 (.46) -.07 (.12)

.52 (.46) -.08 (.12)

.54 (.46) -.08 (.12)

.64 (.46) -.08 (.12)

.56 (.46)

-.07 (.12)

-.18 (.15) -.02 (.05) -.01 (.02) .05 (.04) .08** (.03)

-.19 (.15) -.02 (.05) -.01 (.02) .05 (.04) .08** (.03)

-.18 (.15) -.02 (.05) -.01 (.02) .05 (.04) .09** (.03)

-.20 (.15) -.02 (.05) -.01 (.02) .05 (.04) .08** (.03)

-.19 (.15) -.02 (.05) -.02 (.02) .05 (.04) .07** (.03)

-.17 (.15) -.02 (.05) -.004 (.02) .06 (.04) .07** (.03)

-.18 (.15) -.02 (.05) -.01 (.02) .06 (.04)

.08** (.03

.01 (.03)

.01 (.03)

.02 (.03)

.01 (.03)

.01 (.03)

.01 (.03)

.01 (.03)

aWe do not estimate a model of the relationship between lifetime radio exposure and permanent contraceptive use because nearly everyon his or her lifetime (see Table 1). The data do not include a measure of when the respondent first read a newspaper, so this measure cann born 1962-1971 (ages 25-34). Reference group is Upper Caste Hindus. *p < .05. **p < .01. ***p < .001 (one-tailed tests).

TABLE 3. OLS AND LOGISTICREGRESSIONESTIMATESOF THE INFLUENCEOF LIFETIMEMEDIA EXPOSURE SCALES ON IN CHILDBEARING AND CONTRACEPTIVE USE (N = 2,525 INDIVIDUALS) (STANDARD ERROR

Positive AttitudesTowardLarge Families

Preferencefor Sons

A Man With No Family Size Having Many Children Is BetterThan Being ChildrenCannotGo to One Son, What Son? Preference Rich Heaven One Eye, What Eye? (Coombs Scale) 1 Sum of types of media exposure -.38*** (.08) Sum of types of media exposure * Female Individual- couple-level controls and Cohort(wife)a Bom 1952-1961 (age 35-44) .65*** (.13) Bom 1942-1951 (age 45-54) .70*** (.17) Religious/ethnoracial group LowerCasteHindu .31 (.19) Newar -.03 (.22) Hill Tibeto-Burmese .06 (.16) TeraiTibeto-Burmese 1.15*** (.16) .03 (.16) Respondentfemale Education Attendedschool (beforemarriage) -.30* (.14) Spouse attendedschool (beforemarriage) -.18 (.12) Eitherparentever attendedschool -.06 (.13) Eitherof spouse's parentsever -.08 (.13) attendedschool Nonfamilywork Workedoutside the home -.09 (.13) (beforemarriage) -.31* (.18) Spouse workedoutside the home (beforemarriage) .59** (.24) Spouse workedoutside the home (beforemarriage)* Female Eitherparentworkedoutside the home .07 (.11) (beforerespondent'sage 12) 2 -.48*** (.09) .38*** (.11) 3 -.55*** (.09) .38*** (.12) 4 -.34*** (.07)

.14 (.12) .23 (.15) .20 (.17) -.27 (.22) .16 (.15) .33 (.14) -.30 (.26) -.44*** (.12) -.14 (.12) -.09 (.13) .04 (.13)

.04 (.13) .29 (.16) .09 (.18) -.50* (.25) -.23 (.16) -.34* (.17) -.18 (.26) -.30* (.13) -.11 (.12) -.20 (.14) .19 (.14)

-.001 (.11) -.01 (.14) .43** (.16) -.11 (.19) .49*** (.13) -.40*** (.14) .07 (.14) .15 (.12) -.01 (.10) -.23* (.11) .04 (.11)

-.15 (.12) .04 (.12)

.12 (.13) -.04 (.13)

-.04 (.11) -.05 (.11)

-.10 (.10)

.09 (.11)

.09 (.09)

3. TABLE CONTINUED Positive AttitudesToward LargeFamilies Preferencefor Sons

A Man With No Family Size Having Many Children Is Better Than Being ChildrenCannotGo to One Son, What Son? Preference Heaven One Eye, What Eye? Rich (Coombs Scale) 1 Eitherof spouse's parentsever workedoutsidethe home (beforerespondent'sage 12) Nonfamilyliving Lived away from family (beforemarriage) Spouse lived away from family (beforemarriage) controls Neighborhood-level Neighborhoodhas electricity Neighborhoodhas electricity * Female Hoursto nearestmovie theater Miles to nearesttown Numberof services within 5-minute walk Numberof services within 1-hour walk duringchildhood -.20* (.11) 2 .18* (.10) 3 .05 (.10) 4 .01 (.09)

.09 (.16) -.30 (.19)

-.01 (.17) -.45** (.16) (.16)

-.01 (.18) .19

-.12 (.14) .03 (.15)

-.16 (.14) .002* (.001) -.04 (.02) -.05 (.03) -.05 (.04)

.23* (.13) .000 (.001) .04* (.02) .04 (.03) .002 (.04)

.19 (.16) -.001 (.001) .05 (.02) -.03 (.04) -.01 (.04)

.07 (.14) .46** (.17) .002* (.001) -.01 (.02) -.01 (.03) -.01 (.03)

Note: Hypotheses predict a negative relationshipbetween media exposure and (a) attitudestoward large families and (b) preferences a positive relationshipbetween media exposure and attitudestoward contraceptiveuse. The measure about vasectomy is phrasednegative tive attitudestowardcontraceptiveuse. aReference groupis cohortbom 1962-1971 (ages 25-34). Reference group is Upper Caste Hindus. *p < .05. **p < .01. ***p < .001 (one-tailedtests).

1198 hypothesis that media exposure affects attitudes about childbearing and contraceptive use, which are likely to shape fertility limitation behavior in this setting. Both premarital and lifetime exposure to mass media are associated with higher rates of permanentcontraceptive use. In addition, individuals exposed to mass media sources prefer smaller families, have weaker preferences for sons, and are more positive toward contraceptiveuse. Lifetime exposure is more strongly related to both attitudes and behavior than premaritalexposure, suggesting that the relationship may be much stronger than the conservative premarital exposure models would suggest. Although we cannot test whether this relationship between media exposure and attitudesis directly responsible for the relationshipbetween media exposure and permanent contraceptive use, we suggest that attitudinalchange is a plausible mechanism based on both our empirical analyses and our theoreticalarguments. In addition, our models control for a broad arrayof factorslikely to influence self-selection into media exposure, including access to electricity, movie theaters,education, and nonfamily work. We interpret the results of these analyses as empiricalevidence thatmedia exposure has an importantinfluence on subsequent fertilitylimitation.Recent theoreticalarguments propose that ideational mechanisms, such as media, may be key in shaping demographic behaviors such as schooling and labor force participationin poor countries such as Nepal (Thorton, 2001). If these argumentsare correct, our models that control for schooling and labor force behaviormay actually overcontrol for individualexperiences(e.g., see Homik & McAnany, 2001). In other analyses not shown here, we find that media exposure effects are even larger when controls for individual experiences are eliminated from the model. The empirical evidence established here should motivate greater attentionto ideational mechanisms of social change, particularlyin family formation behaviors. The microeconomic models of behavior most influential in studies of family formationprocesses are simple, elegant, and powerful. We do not advocate abandoningthem. Those models do not provide a complete explanationof the dramaticbehavioral changes occurringin many poor countries, however. Greaterattentionto the ways in which

Journal of Marriageand Family social changes affect behavior via their influence on attitudes(includingexposure to media, the content of media, and the frequency of media consumption)and to the explicit microeconomic considerationsthat are often inherent in these attitudinal changes is likely to add substantially to our understandingof the forces shaping behavioralchanges in contexts such as ruralNepal. NOTE
This research supported NICHDGrant was HD32912, by of by a P30 Center grantfromNICHDto the University StudiesCenter, by a postdocand Michigan's Population toral fellowshipto the first authorsponsoredby the MellonFoundation. wouldlike to thankN. E. Barr We for helpful comments an earlier on draftof the paper. We wouldalso like to thankthe staff of the Population and Chitwan, Ecology Research Laboratory, Rampur, Nepal for their assistance collectingthe data used in these in Ghimire his excellent for of analyses, Dirgha management this studyin Nepal,JeanneSpicerand Lisa Neidertfor datamanagement and assistance, PaulSchulzforprogramof ming assistance. Any errorsare the responsibility the authors.

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