Beyond the mother-child dyad: Is co-residence with a grandmother associated with adolescent girls’ family planning knowledge?

Background: In South Asian countries, adolescent girls are generally embedded in multigenerational households. Nevertheless, public health research continues to focus on the nuclear family and overlook the role of grandmothers in adolescent socialization and the transfer of health information. This study compares family planning knowledge of adolescent girls in households with and without a resident grandmother. Two main types of family planning knowledge were assessed: (1) modern contraceptive knowledge and (2) healthy timing and spacing of pregnancy knowledge. Methods: This study is a secondary data analysis of the 2017 Suaahara II cross-sectional survey in 16 of Nepal’s 77 districts. Family planning knowledge among 769 adolescent girls was assessed and compared between those living with a grandmother (n = 330) and those not living with a grandmother (n = 439). An analysis of the relationship between co-residence and family planning knowledge was carried out using multivariate logistic regression, adjusting for potential confounders and clustering. Additionally, we used the same method to analyze the association between grandmothers’ family planning knowledge and that of co-resident adolescents. Results: The odds of correct adolescent modern family planning knowledge were 1.81 (95% CI = 1.27,2.58) times higher in households with a grandmother. The study also identified higher odds of adolescent knowledge of modern contraceptives in households where grandmothers also had correct knowledge (OR 2.00, 95%, CI = 0.97,4.11), although this association was not statistically significant at the 0.05 alpha level. There was insufficient evidence to support the association between grandmother’s co-residency and correct adolescent knowledge of the healthy timing and spacing of pregnancy. Conclusion: This study provides support for expanding adolescent reproductive health to include the role of senior women in promoting and transmitting health care knowledge to younger women in the household.