Skip to main content Accessibility help

Family networks and healthy behaviour: evidence from Nepal

  • Jolene Skordis (a1), Noemi Pace (a2), Marcos Vera-Hernandez (a3), Imran Rasul (a3), Emla Fitzsimons (a4), David Osrin (a5), Dharma Manandhar (a6) and Anthony Costello (a7)...


Models of household decision-making commonly focus on nuclear family members as primary decision-makers. If extended families shape the objectives and constraints of households, then neglecting the role of this network may lead to an incomplete understanding of health-seeking behaviour. Understanding the decision-making processes behind care-seeking may improve behaviour change interventions, better intervention targeting and support health-related development goals. This paper uses data from a cluster randomised trial of a participatory learning and action cycle (PLA) through women’s groups, to assess the role of extended family networks as a determinant of gains in health knowledge and health practice. We estimate three models along a continuum of health-seeking behaviour: one that explores access to PLA groups as a conduit of knowledge, another measuring whether women’s health knowledge improves after exposure to the PLA groups and a third exploring the determinants of their ability to act on knowledge gained. We find that, in this context, a larger network of family is not associated with women’s likelihood of attending groups or acquiring new knowledge, but a larger network of husband’s family is negatively associated with the ability to act on that knowledge during pregnancy and the postpartum period.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Family networks and healthy behaviour: evidence from Nepal
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Family networks and healthy behaviour: evidence from Nepal
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Family networks and healthy behaviour: evidence from Nepal
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Correspondence to: Jolene Skordis-Worrall, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. Email:


Hide All
Acharya, L. and Cleland, J. (2000), ‘Maternal and child health services in rural Nepal: does access or quality matter more?’, Health Policy and Planning, 15: 223229.
Adongo, P., Phillips, J., Kajihara, B., Fayorsey, C., Debpuur, C. and Binka, F. (1997), ‘Cultural factors constraining the introduction of family planning among the Kassena-Nankana of Northen Ghana’, Social Sciences and Medicine, 45: 17891804.
Alkire, S. and Foster, J. (2011), ‘Counting and multidimensional poverty measurement’, Journal of Public Economics, 95(7): 476487.
Alkire, S. and Santos, M. E. (2011), ‘Acute Multidimensional Poverty: A New Index for Developing Countries’, Proceedings of the German Development Economics Conference, Berlin.
Aubel, J., Toure, I. and Diagne, M. (2004), ‘Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change’, Social Science and Medicine, 59: 945959.
Barr, A. and Oduro, A. (2002), ‘Ethnic fractionalization in an African labor market’, Journal of Development Economics, 68: 355379.
Becker, G. (1973), ‘A theory of marriage: part 1’, Journal of Political Economy, 81: 813846.
Becker, G. (1974), ‘A theory of marriage: part 2’, Journal of Political Economy, 82: s11s26.
Besley, T., Coate, S. and Loury, G. (1993), ‘The economics of rotating savings and credit associations’, American Economic Review, 83: 792810.
Bista, D. B. (1996), People of Nepal, Kathmandu: Ratna Pustak Bhandar.
Bolin, K., Jacobson, L. and Lindgren, B. (2001), ‘The family as the health producer – when spouses are Nash-bargainers’, Journal of Health Economics, 20: 349362.
Bolin, K., Jacobson, L. and Lindgren, B. (2002), ‘The family as the health producer – when spouses act strategically’, Journal of Health Economics, 21: 475495.
Borghi, J., Ensor, T., Neupane, B. and Tiwari, S. (2006), ‘Financial implications of skilled attendance at delivery in Nepal’, Tropical Medicine and International Health, 2: 228237.
Bourguignon, F. and Chakravarty, S. R. (2003), ‘The measurement of multidimensional poverty’, The Journal of Economic Inequality, 11: 2549.
Cameron, A. C., Gelbach, J. B. and Miller, D. L. (2008), ‘Bootstrap-based improvements for inference with clustered errors’, The Review of Economics and Statistics, 90(3): 414427.
Cochrane, J. (1991), ‘A simple test of consumption insurance’, Journal of Political Economy, 99: 957976.
Cox, D. and Fafchamps, M. (2008), ‘Ch. 58: Extended Family and Kinship Network: Economic Insight and Evolutionary Direction’, in T. P. Schultz and J. A. Strauss (eds), Handbook of Development Economics 1st edn, Volume 4, New York: Elsevier, 37113784.
Fafchamps, M. and Lund, S. (2003), ‘Risk sharing networks in rural Philippines’, Journal of Development Economics, 71: 261287.
Fafchamps, M. and Gubert, F. (2007), ‘The formation of risk sharing networks’, Journal of Development Economics, 83: 326350.
Gram, L., J. Skordis, D. Manandhar, D. Strachan, J. Morrison, N. Saville, D. Osrin, K.M. Tumbahangphe, A. Costello and M. Heys (2018). ‘The long-term impact of community mobilisation through participatory women’s groups on women’s agency in the household: A follow-up study to the Makwanpur trial’. Mimeo . Under second review in Plos One.
Granovetter, M. (1995), Getting a Job: A Study of Contacts and Careers, 2nd edn, Chicago, IL: University of Chicago Press.
Gray, J. (2008), The Householders: Purity, Power and Dominance in a Nepal Village, Delhi: Oxford India Paperbacks.
Grossman, M. (1972), ‘On the concept of health capital and the demand for health’, Journal of Political Economy, 80: 223255.
Grossman, M. (2000), ‘The Human Capital Model of the Demand for Health’, in A. J. Culyer and J. P. Newhouse (eds), Handbook of Health Economics, Elsevier: Amsterdam, 347408.
Hotchkiss, D. (2001), ‘Expansion of rural health care and the use of maternal services in Nepal’, Health and Place, 7: 3945.
Jacobson, L. (2000), ‘The family as producer of health – an extension of the Grossman model’, Journal of Health Economics, 19: 611637.
Karmacharya, C., Cunningham, K., Choufani, J. and Kadiyala, S. (2017), ‘Grandmothers’ knowledge positively influences maternal knowledge and infant and young child feeding practices’, Public Health Nutrition, 20: 21142123.
Kondos, V. (2004), On the Ethos of Hindu Women: Issues, Taboos and Forms of Expression, Kathmandu: Mandala Book Point.
LaFerrara, E. (2003), ‘Kin groups and reciprocity: a model of credit transactions in Ghana’, American Economic Review, 93: 17301751.
Lucas, R. and Stark, O. (1985), ‘Motivations to remit: evidence from Botswana’, Journal of Political Economy, 93: 901918.
Maasoumi, E. (1986), ‘The measurement and decomposition of multi-dimensional inequality’, Econometrica: Journal of the Econometric Society, 54: 991997.
Manandhar, D. S., Osrin, D., Prasad Shrestha, B., Mesko, N., J. Morrison, K. M. Tumbahangphe, S. Tamang, S. Thapa, D. Shrestha, B. Thapa, J. R. Shrestha, A. Wade, J. Borghi, H. Standing, M. Manandhar, A. M. Costello and Members of the MIRA Makwanpur trial team (2004), ‘Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial’, The Lancet, 364: 970979.
Manser, M. and Brown, M. (1980), ‘Marriage and household decision theory – a bargaining analysis’, International Economic Review, 21: 2134.
Mesko, N., Osrin, D., Tamang, S., Shrestha, B., Manandhar, D., Manandhar, M., Standing, H. and Costello, A. (2003), ‘Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components’, BMC International Health and Human Rights, 3: 3.
Montgomery, J. (1991), ‘Social networks and labor-market outcomes: toward an economic analysis’, American Economic Review, 81: 14081418.
Morrison, J., Tamang, S., Mesko, N., Osrin, D., Shrestha, B., Manandhar, M., Manandhar, D., Standing, H. and Costello, A. (2005), ‘Women’s health groups to improve perinatal care in rural Nepal’, BMC Pregnancy Childbirth, 5: 6.
Morrison, J., Tumbahangphe, K. M., Budhathoki, B., Neupane, R., Sen, A., Dahal, K., Thapa, R., Manandhar, R., Manandhar, D., Costello, A. and Osrin, D. (2011), ‘Community mobilisation and health management committee strengthening to increase birth attendance by trained health workers in rural Makwanpur, Nepal: study protocol for a cluster randomised controlled trial’, Trials, 12: 128.
Munshi, K. (2003), ‘Networks in the modern economy: Mexican migrants in the U.S. labor market’, Quarterly Journal of Economics, 118: 549597.
Niraula, B. B. (1994), ‘Use of health services in Hill villages in Central Nepal’, Health Transition Review, 4: 151166.
Prost, A., T. Colbourn, N. Seward, K. Azad, A. Coomarasamy, A. Copas, T. A. Houweling, E. Fottrell, A. Kuddus, S. Lewycka, C. MacArthur, D. Manandhar, J. Morrison, C. Mwansambo, N. Nair, B. Nambiar, D. Osrin, C. Pagel, T. Phiri, A. M. Pulkki-Brännström, M. Rosato, J. Skordis-Worrall, N. Saville, N. Shah More, B. Shrestha, P. Tripathy, A. Wilson and A. Costello (2013), ‘Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis’, The Lancet, 381: 17361746.
Rosenzweig, M. (1988), ‘Risk, implicit contracts and the family in rural areas of low-income countries’, Economic Journal, 98: 11481170.
Rosenzweig, M. and Stark, O. (1989), ‘Consumption smoothing, migration, and marriage: evidence from rural India’, Journal of Political Economy, 97: 905926.
Sear, R., Mace, R. and McGregor, I. (2003), ‘The effects of kin on female fertility in rural Gambia’, Evolution and Human Behavior, 24: 2542.
Sear, R. and Mace, R. (2008), ‘Who keeps children alive? A review of the effects of kin on child survival’, Evolution and Human Behavior, 29: 118.
Townsend, R. (1994), ‘Risk and insurance in village India’, Econometrica, 62: 539591.
van den Brink, R. and Chavas, J. P. (1997), ‘The microeconomics of an indigenous African institution: the rotating savings and credit association’, Economic Development and Cultural Change, 45: 745772.
Wade, A., Osrin, D., Shrestha, B., Sen, A., Morrison, J., Tumbahangphe, K., Manandhar, D. and Costello, A. (2006), ‘Behaviour change in perinatal care practices among rural women exposed to a women’s group intervention in Nepal’, BMC Pregnancy Childbirth, 6: 620.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed