Delivering impactful, cost-effective family planning messaging at scale: the results of the first cluster randomised controlled trial to put a family planning radio campaign to the test.
Summary:
Mass media reaches a large share of the population in low-income countries, but can it be used to tackle poverty and change behaviours, such as the adoption of modern contraception? Given the low marginal costs of mass media campaigns, even small effects could be highly cost-effective. To answer this question, in collaboration with academic researchers and Innovations for Poverty Action (IPA), Development Media International (DMI) conducted a cluster randomised controlled trial (RCT) to evaluate the impact and cost-effectiveness of an intensive, 2.5-year radio campaign in Burkina Faso that promoted family planning and in particular, uptake of modern contraception. Radio spots and phone-in shows were designed to address, in an entertaining way, the key barriers to adoption of contraception. The campaign provided information about the modern methods of contraception that are available in Burkina Faso (implants, injectables, condoms and pills) and the health and economic benefits of birth spacing. It also addressed concerns about side effects, misconceptions about infertility risks, gender norms and the responsibilities of men. The campaign led to a 5.3 percentage point (pp) increase in the modern contraceptive prevalence rate (mCPR): at follow up, 30.4 percent of the control group were using modern contraception compared to 35.7 percent in the group exposed to the campaign. These results demonstrate that high-intensity mass media campaigns can have a significant positive impact on uptake of modern contraception and are likely to be highly cost-effective in countries like Burkina Faso.
Background/Objectives:
According to the World Health Organization, the main barriers to modern contraceptive uptake in Sub-Saharan Africa are a lack of information and awareness and fear about contraceptives, rather than access to contraception. Mass media campaigns have the potential to provide useful information on family planning and to influence social norms around such contentious topics, at low cost. The objective of this trial was to test, with a cluster RCT, whether mass media campaigns can impact modern contraceptive uptake, and whether they can do so in a cost-effective manner.
Description of Intervention and/or Methods/Design:
The radio campaign was developed and implemented by DMI and consisted of 1-minute and 30-second radio spots broadcast 10 times a day every day, and three two-hour interactive phone-in radio shows every week, in six local languages. The campaign lasted 2.5 years, from June 2016 to December 2018. Researchers selected sixteen community radio stations collectively reaching over 5 million people that had minimal overlap in coverage area and broadcast in different languages. Of these sixteen radio stations, half were randomly selected to receive the media campaign. The other half served as a comparison group and did not receive the campaign during the study period. The research team used panel survey data from 7,500 women (aged 15-49 years), combined with survey and administrative data from 838 clinics across the trial clusters, to measure contraception disbursement and use.
Results/Lessons Learned:
The campaign led to a 5.3pp increase (a 17.4% relative increase) in modern contraceptive prevalence rate (mCPR) in the intervention zones compared to controls. A key mechanism for the increase in mCPR uptake appears to be improved understanding of modern contraception; the campaign led to a large reduction in women who think that modern contraception can make a woman sterile (9pp reduction) or cause sickness (8.4 pp reduction). Survey results were supported by administrative clinic data which showed a positive impact on the number of family planning consultations and contraceptives distributed in treatment areas. There is evidence that the impact on contraception translated into a reduction in fertility and an increase in women's self-assessed health and well-being. The campaign's impact was also greater amongst women who had previously used contraception, who reported using it more consistently. Norms about fertility and birth spacing among women were not significantly affected.
Discussion/Implications for the Field:
Overall, these results demonstrate that high-intensity mass media campaigns can significantly improve uptake of modern contraception, particularly among women who have previously used it inconsistently. However, changing fertility norms and reaching segments of the population with negative attitudes toward modern contraception is challenging. Intensive media campaigns such as these are likely to be highly cost-effective in many other countries when delivered at scale. We estimate that a nationwide media campaign could lead to 240,000 additional women using modern annually at a cost of $13 USD per additional woman.
Abstract submitted by:
Joanna Murray - Development Media International (DMI)
Aida Alonzo - Development Media International (DMI)
Mass media reaches a large share of the population in low-income countries, but can it be used to tackle poverty and change behaviours, such as the adoption of modern contraception? Given the low marginal costs of mass media campaigns, even small effects could be highly cost-effective. To answer this question, in collaboration with academic researchers and Innovations for Poverty Action (IPA), Development Media International (DMI) conducted a cluster randomised controlled trial (RCT) to evaluate the impact and cost-effectiveness of an intensive, 2.5-year radio campaign in Burkina Faso that promoted family planning and in particular, uptake of modern contraception. Radio spots and phone-in shows were designed to address, in an entertaining way, the key barriers to adoption of contraception. The campaign provided information about the modern methods of contraception that are available in Burkina Faso (implants, injectables, condoms and pills) and the health and economic benefits of birth spacing. It also addressed concerns about side effects, misconceptions about infertility risks, gender norms and the responsibilities of men. The campaign led to a 5.3 percentage point (pp) increase in the modern contraceptive prevalence rate (mCPR): at follow up, 30.4 percent of the control group were using modern contraception compared to 35.7 percent in the group exposed to the campaign. These results demonstrate that high-intensity mass media campaigns can have a significant positive impact on uptake of modern contraception and are likely to be highly cost-effective in countries like Burkina Faso.
Background/Objectives:
According to the World Health Organization, the main barriers to modern contraceptive uptake in Sub-Saharan Africa are a lack of information and awareness and fear about contraceptives, rather than access to contraception. Mass media campaigns have the potential to provide useful information on family planning and to influence social norms around such contentious topics, at low cost. The objective of this trial was to test, with a cluster RCT, whether mass media campaigns can impact modern contraceptive uptake, and whether they can do so in a cost-effective manner.
Description of Intervention and/or Methods/Design:
The radio campaign was developed and implemented by DMI and consisted of 1-minute and 30-second radio spots broadcast 10 times a day every day, and three two-hour interactive phone-in radio shows every week, in six local languages. The campaign lasted 2.5 years, from June 2016 to December 2018. Researchers selected sixteen community radio stations collectively reaching over 5 million people that had minimal overlap in coverage area and broadcast in different languages. Of these sixteen radio stations, half were randomly selected to receive the media campaign. The other half served as a comparison group and did not receive the campaign during the study period. The research team used panel survey data from 7,500 women (aged 15-49 years), combined with survey and administrative data from 838 clinics across the trial clusters, to measure contraception disbursement and use.
Results/Lessons Learned:
The campaign led to a 5.3pp increase (a 17.4% relative increase) in modern contraceptive prevalence rate (mCPR) in the intervention zones compared to controls. A key mechanism for the increase in mCPR uptake appears to be improved understanding of modern contraception; the campaign led to a large reduction in women who think that modern contraception can make a woman sterile (9pp reduction) or cause sickness (8.4 pp reduction). Survey results were supported by administrative clinic data which showed a positive impact on the number of family planning consultations and contraceptives distributed in treatment areas. There is evidence that the impact on contraception translated into a reduction in fertility and an increase in women's self-assessed health and well-being. The campaign's impact was also greater amongst women who had previously used contraception, who reported using it more consistently. Norms about fertility and birth spacing among women were not significantly affected.
Discussion/Implications for the Field:
Overall, these results demonstrate that high-intensity mass media campaigns can significantly improve uptake of modern contraception, particularly among women who have previously used it inconsistently. However, changing fertility norms and reaching segments of the population with negative attitudes toward modern contraception is challenging. Intensive media campaigns such as these are likely to be highly cost-effective in many other countries when delivered at scale. We estimate that a nationwide media campaign could lead to 240,000 additional women using modern annually at a cost of $13 USD per additional woman.
Abstract submitted by:
Joanna Murray - Development Media International (DMI)
Aida Alonzo - Development Media International (DMI)
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Development Media International (DMI)