Publications

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Communication Impact! 9

THE CARE FOR HEALTH CAMPAIGN: Making Family Planning a Household Norm in Russia (April 2000)

The first national family planning promotion in Russia, the Care for Health Campaign, helped increase use of modern contraceptives by 12 percentage points in the targeted oblast (region) of Ekaterinburg (Figure 1). The campaign was one element of the larger Women’s Reproductive Health Program (WRHP) that also included training for health care providers and pharmacists, advocacy and research. Together these activities also resulted in increased family planning counseling for women in the postpartum and postabortion period (Figure 2), longer contraceptive continuation rates (Table 1), and a 10-50% increase in family planning clinic attendance in the three oblasts where data were collected.

The WRHP was initiated in 1994 by the US Agency for International Development/Moscow. It was designed to improve the health of women and children by promoting change in the current family planning communication and service delivery systems, leading to a greater use of modern contraceptive methods. Modern methods then available in Russia were condoms, injectables, intrauterine devices and pills. The Johns Hopkins University Center for Communication Programs (JHU/CCP) provided technical assistance to the WRHP’s behavior change communication component, including the Care for Health Campaign. JHU/CCP collaborated closely with a consortium of public and private Russian organizations including the Ministry of Health (MOH), the Russian Family Planning Association (RFPA), the University of Moscow, a commercial public relations firm and film production company, as well as with several US cooperating agencies.

The Care for Health communication campaign used a strategic approach to increase demand for family planning as a desirable, healthy alternative to abortion. The campaign was designed to bring family planning into the public arena and to highlight its importance to women and families. The campaign’s specific objectives were to increase: knowledge and positive attitudes toward modern contraceptives, attendance at clinics, contraceptive use by 3%, and to improve the capacity of local non-governmental organizations (NGOs) and government organizations to design and implement health communication programs and enhance family planning counseling techniques. The multimedia campaign, which ran from February to July 1998, focused mainly on women ages 18 to 30.

Campaign Activities

Originally designed to reach only six oblasts, the Care for Health Campaign became a national project with direct involvement and ongoing support from the MOH. The program was adopted as a deliverable under the Gore-Chernomyrdin Commission, leading to discussions about family planning at the highest policy levels. Then Prime Minister Viktor Chernomyrdin wrote a directive to national television stations resulting in approximately $200,000 worth of donated airtime for the campaign. The family planning message ultimately reached women in the program oblasts, throughout Russia, and in neighboring countries of the former Soviet Union.

The Pygmalion Film Company, a Russian commercial firm, worked with JHU/CCP to develop television and radio spots, a family planning logo and slogan (front page inset) and campaign posters and souvenirs. Assisted by JHU/CCP, the RFPA printed over one million client brochures on contraceptive methods. The Russian public relations firm, Alter Ego, hosted press conferences and conducted numerous advocacy activities such as convening a committee of prominent national figures, including Mikhail Gorbachev, to sign a declaration of support for family planning. Local partners in the oblasts carried out a variety of promotional activities ranging from a traveling lecture series, a hotline, clinic open houses and disco events. Russia’s first major independent press syndicate, Globe, published over 120 articles on women’s health and family planning and a weekly newspaper advice column "Ask Dr. Olga."

For doctors and nurses, materials on modern contraceptive technology including laminated job aids describing contraceptive methods, Russian translations of Population Reports and a video on counseling techniques were developed and used in training activities for the WRHP. JHU/CCP responded to Russian doctors’ requests for help in educating women and promoting modern contraceptives by conducting seminars on health communication theory and practice for local specialists. These included: a 1-week materials design seminar, a 3-day session on pretesting and a 2-week international course Advances in Family Health Communication.

Impact

The VCIOM Research Company in Moscow, in collaboration with the US Centers for Disease Control and Prevention, evaluated the impact of the Care for Health Campaign by comparing a 1996 baseline survey with a 1998 follow-up survey among women in Perm (a comparison site) and women in Ekaterinburg (an intervention site). In Ekaterinburg local media, community activities and print materials accompanied national television and radio ads as well as other WRHP activities. Clinic attendance at several sites was monitored as well.

Results showed a dramatic jump in modern contraceptive use from 46% to 58% in Ekaterinburg compared to Perm where use increased from 43% to 48% (Figure 1). Respondents in Ekaterinburg were also significantly more likely than those in Perm to report that they had talked to a doctor or nurse about family planning after their most recent birth or abortion and more likely to have left the maternity or abortion clinic with either a family planning method or a prescription for one (Figure 2).

Likewise, there has been a positive impact regarding contraceptive attitudes and practices from 1996 to 1998. A total of 626 women were interviewed in both the 1996 and 1998 surveys. Of these women, who formed a panel, almost half of the non-users in Ekaterinburg compared to one-third of the non-users in Perm adopted a modern contraceptive method. Almost 80% of modern contraceptive method users in Ekaterinburg compared to 68% in Perm continued using a modern method over the two-year period (Table 1). In addition to these survey results, statistics collected from other oblasts show dramatic increases in clinic attendance: 10% in Tver oblast family planning clinics, 12% in Ivanovo and 50% in Ekaterinburg.

A consortium of agencies formed during the campaign gave women throughout Russia the opportunity to see and hear the campaign’s message: "Family Planning: Care for Health." Using the powerful medium of television, such widespread delivery of the message has helped the MOH recognize the need to work closely with the media and collaborating agencies. The MOH has since included public health communication as a line item in its annual budget, and the RFPA has institutionalized pretesting of communication outputs.

The Care for Health Campaign demonstrates that a well developed and managed health communication program can be very effective in changing personal behavior. Russian women are willing to accept alternatives to abortion as long as contraceptive methods and services are made available by trained providers along with strong family planning promotion.

To learn more about the Care for Health Campaign, contact:

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