Elements of Family Planning Success

“Successful family planning programs need to offer more than just clinical services and contraceptive choices for their clients. You just can't assume that people will seek contraceptives—you have to market your services and your products. Businesses don't just put products on the shelves and expect people to buy them. They show people the benefits of using their specific products."
-- Ruwaida Salem, the INFO Project, coauthor, "Communication for Better Health" [Listen to the interview]
 
Coupled with strong and readily available services, communication can raise awareness about family planning, motivate individuals to seek services, and help them to successfully use their method of choice.  
 
Q. Why should family planning programs invest in communication strategies?
A. Behavior change communication (BCC) strategies can help family planning programs reduce unmet need for contraception and help couples choose and use suitable methods. For example, communication can:  
• Help people appreciate the benefits of practicing family planning
• Influence individuals’ and communities’ attitudes toward family planning and family planning methods
• Show people that they have the ability to use a contraceptive method effectively and with satisfaction
• Inform people’s reproductive health decisions, including choice and use of a contraceptive method.
 
Q. Who should be involved in developing a communication strategy and campaign?
A. Any group with an interest in a family planning program should be involved. Most importantly, a family planning program should involve the intended audience. For a radio campaign addressing youth, for example, young people can help design and test communication materials and messages.
 Other stakeholder groups may include nongovernmental organizations, schools, faith-based organizations, and the media. Who to involve depends on program goals and cultural context. These stakeholders should be included in developing the communication campaign from the beginning, so that their contributions truly help shape the entire process and outcome.
 
Q. Which communication channels should programs use?
A. For greatest impact, successful programs use a mix of the three major communication channels:
 
1. Mass media—for example, radio serial dramas, TV spots, and “agony aunt” newspaper columns answering readers’ questions.
2. Community channels—for example, public meetings and street theatre.
3. Interpersonal communication—for example, counseling and telephone hotlines.
Each type of channel has its own strengths. To help determine the best mix of channels, programs will need to consider factors such as which channels will reach the intended audience, which channels are appropriate for conveying the complexity of information in the program’s message, and what the program can afford.
 
Q. Aren’t mass media campaigns expensive?
A. The mass media can get messages to thousands or even millions of people. Because of their reach, mass media campaigns can be very cost-effective, even if production costs are high.
A successful TV drama may cost US$3 or less per person influenced to adopt a healthy behavior. Entertainment-Education (E-E) programming is the use of drama, music, or other mass communication formats that engage emotions to inform audiences and change attitudes, behavior, and social norms. E-E can address controversial issues and be particularly engaging and highly persuasive—and thus particularly cost-effective.
 
Q. What is social marketing, and what is the role of communication in social marketing programs?
A. Social marketing combines education to motivate healthy behavior with the sale of health products and services. Effective communication is a key ingredient of social marketing. With effective communication, social marketing often can make branded health products, including contraceptives, more desirable—and thus more widely used—than generic products that may be available free.
 
Q. Why should program managers use theory to develop a communication campaign?
A. Behavioral theories help programs to understand why people behave the way they do. With this understanding, programs develop effective strategies to encourage healthy behavior or change unhealthy behavior.
 
 "Programmers don't have to reinvent the wheel. They can use theories to provide a framework to help them work more efficiently and effectively, to reach their target audience."
-- Ruwaida Salem [Listen to the interview]
 
Case Study
 In Ghana Life Choices Program Increases Use of Modern Contraceptives
 
Program Goals
 
The Life Choices program sought to re-energize the national family planning program and to reposition the concept of family planning as relevant and beneficial to couples in
Ghana. It sought to dispel myths and build social support for family planning. 
• In 1998, 45 percent of married women had a stated desire to delay the birth of their next child or stop childbearing altogether.
• Only half of these women were using some form of family planning.
• Nearly 40 percent of family planning involved less effective traditional methods such as periodic abstinence and withdrawal.
• This suggested the actual unmet need for effective family planning may be closer to 70 percent.
• Analysis found that women with an unmet need for family planning feared possible side effects associated with contraceptive use and felt they lacked social support, especially from their spouse or partner.
 
Communicating With All Channels
 
Responding to these concerns, Life Choices used mass media and community activities to emphasize the wide range of contraceptive options available, as well as social support for family planning use. Messages addressed the roles of family planning at various stages in life—for example, spacing children in the early years of marriage and limiting family size.
 
Life Choices activities included: 
• 560 educational sessions in clinics, reaching 32,000 women,
• Community-level rallies,
• "Vox Pop," a reality-based TV show documenting the lives of satisfied contraceptive users across Ghana,
• Music video titled "It's Your Life, It's Your Choice," and
• Products made (800,000 leaflets, 40,000 posters, and 30,000 stickers) to promote the Life Choices brand. These provided a visible link between the national mass media activities and the local community and clinic-level activities.
 
Getting Results
 
"It's your life, it's your choice" was a slogan that 50 percent of those surveyed could recite without prompting.  
• Use of modern contraceptive methods increased among both men and women.
• Among men, current use of modern contraception increased from 21 percent in 2001, prior to the campaign's launch, to 45 percent in 2003.
• Among women, current use of modern contraception increased from 18 percent in 2001 to 30 percent in 2003.
• Use of modern contraceptive methods was higher among men and women with greater exposure to the Life Choices campaign.
• Men were more likely to report discussing contraceptive use with their spouse or sexual partner in 2003 than in 2001.
• 59 percent of men and 50 percent of women in 2003 believed a friend would approve of the use of modern contraceptives compared with 52 percent and 36 percent, respectively, in 2001.
• The program also reduced concerns about side effects.
 
Partners for Success
 
Life Choices was designed and implemented by a public/private partnership consisting of the Ministry of Health/Ghana Health Service (MOH/GHS), National Population Council (NPC), and other stakeholders, with technical assistance from the Population Communication Services project and later the Health Communication Partnership (HCP), both funded by USAID and based at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs.
 

*Read detailed information on how to establish a behavior communication change program:
Key Steps to Establishing Behavior Communication Change Programs
 

Each of the 10 elements was chosen based on online survey results and was discussed in an online forum hosted by the Implementing Best Practices (IBP) Knowledge Gateway. Read more about the survey, forum and results in the Forum Synopsis. Learn more about IBP Knowledge Gateway, and join their Initiative here.
 
 

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