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Communication Impact! 3

Philippines Communication Outreach Accelerates Family lanning Use in 1993-1996 (August 1998)

"If you love them, plan for them." This slogan, key to the Philippines' family planning communication outreach programs, honors the Filipino belief in children as central to the family. The slogan and the lively logo (box, left) suggest that the aim of family planning is not so much to avoid having children, as to provide the opportunity to love each child better by planning for each appropriately. Conducted by the Philippines' Department of Health between 1993-1996, these communication programs helped increase modern contraceptive use by five percentage points, from 25% to 30%. (Figure 1). Furthermore, the average rate of increase was only 0.84 percentage points per year between 1968-1993, but during the three-year period that the campaigns were conducted, the average rate of increase doubled to 1.67 percentage points per year.

These results provide clear evidence of the positive influence that communication can have on contraceptive use. A panel survey, re-interviewing the same people over time, demonstrated that exposure to communication outreaches as well as original predispositions led to changes in ideation (conventional ways of thinking and talking) and contraceptive behavior in the audience.

Communication Approach

The two campaigns were undertaken in 1993-1994 and 1995-1996. Prior to the launch service providers were fully trained and logistics systems were in place and operational. Each campaign encouraged couples to visit their family planning provider and select the family planning method of their choice. Campaign spots (on television and radio) presented professional and non-professional community members extolling the virtues of a planned family as a means of having more time to love and enjoy one's children. This careful positioning of the chief message as one of love rather than denial was communicated throughout the outreaches.

Central to the success of the 1993-1994 outreach was the use of a three-phase approach to communication programming. Phase 1 used a series of radio and television spots representing the "voice of the people" on why they support family planning. Phase 2 urged couples to visit trained health providers. Phase 3 used testimonials by actual users of different contraceptive methods. During Phase 1, the then Secretary of Health, Juan Flavier, appeared at the end of each spot inviting couples to visit the Department of Health centers.

The 1995-1996 campaigns rebroadcast most of the 1993-1994 materials plus three new male motivation and spousal communication messages. During both periods, then Assistant Secretary, Carmencita Reodica, who later became Secretary of Health, was in charge of "special concerns" - which included family planning services. The method-specific spots were the first of their kind ever aired on Philippine television.

Communication Theory

Communication - the diffusion and promotion of ideas and new technology - affected the ideational change related to contraceptive use that was encouraged throughout this outreach. To ensure positive ideational change, the messages were based on the Steps to Behavior Change (SBC) model, which was specifically created for the design and evaluation of family planning communication projects. The SBC model posits that behavior change among individuals and groups occurs in five stages: knowledge, approval, intention, practice, and advocacy. The first two stages (knowledge and approval) and the last stage (advocacy) provide six appropriate indicators of ideation (Figure 2, Notes).

Research shows that people usually do not take any action - especially with regard to something new - unless they have sufficient knowledge of it, have a positive attitude towards it, and have talked to others about it. The more of these things they have done, the greater is the likelihood that they will take action. This principle also applies to women who practice family planning. The higher women are on the overall measure of ideation, the greater the percent (probability) that they practice (Figure 2). Among women to whom none of the ideation factors apply, only 10.6% practice family planning. For women to whom five or six ideation factors apply, 71.7% practice family planning. With these principles of ideation in mind, the outreach designers created messages that had a direct positive effect on ideation.

Evaluation and Results

Evaluation of the 1995-1996 communication programs was conducted by means of a national panel survey of 1,563 women ages 15-49 years interviewed in September, 1995, and again in March, 1996. The follow-up survey found that 82.3% recalled at least on of the television method-specific spots. Modern contraceptive use increased 2 percentage points during the 6-month period. Contraceptive prevalence of women who recalled none to two of the television spots was 34%, but increased to 43.2% with recall of 3-6 spots, and then to 52.8% for women who recalled 7-10 spots (Figure 3). A strong relationship was found between level of campaign recall and level of ideation. Only 31% of women with low recall had high levels of ideation, whereas 67% of women with high recall had high levels of ideation.

The longitudinal regression analysis found that women who had high levels of message recall were 1.57 times more likely to have visited a family planning provider, 3.43 times more likely to have high levels of ideation, and 1.65 times more likely to use modern contraceptives than women with low or no recall of the campaign, after controlling for seven socioeconomic variables and prior contraceptive use, ideation, and provider visits.

During the 25-year period before 1993, the total contraceptive prevalence rate in the Philippines increased from 15% to 40%, an average increase of 1.0 percentage points per year (Figure 1). It is significant that from 1993 to 1996 the rate increased from 40% to 48%, an average increase of 2.66 percentage points per year. This represents a dramatic acceleration of contraceptive prevalence - a 166% increase in the rate of change during the two outreaches.

Summary and Conclusion

The significant impact of both Philippine communication programs on ideation and contraceptive use demonstrates clearly that communication can influence contraceptive behavior. The research findings indicate that successful communication interventions design their messages not only to provide a direct call to action (for example, visit a family planning provider) but also to focus on one or more of the key elements of ideation - depending on the position of the intended audience with regard to the SBC model. Appreciation and acceptance of the idea, "If you love them, plan for them", has already led to increased happiness for many families in the Philippines. As ideation increases, so too will family planning and well-planned, well-loved children.

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