Learn how we use evidence-based behaviour change campaigns to improve and save lives in low-income countries.
Learn about how DMI brings together two different worlds: demonstrable scientific practice and creative storytelling.
Location Family planning
With our first randomised controlled trial, we showed that mass media can successfully persuade parents to seek treatment for children with life-threatening diseases. But can mass media change the more personal, complex behaviours associated with family planning? Our second RCT set out to test whether it could increase the uptake of modern contraception.
Family planning – increasing modern contraceptive uptake
88 x 30- or 60-second radio spots and 168 longer drama segments used as part of interactive radio shows, all in six languages.
Our radio campaign ran from June 2016 to December 2018 on eight radio stations across Burkina Faso, with eight radio stations as controls.
We identified 16 areas in Burkina Faso, each with their own radio station, and randomly assigned them into control and intervention groups. Innovations for Poverty Action (IPA), one of two evaluation partners for this study, surveyed 7,500 women of reproductive age in 252 villages before and after the campaign. They collected information about their age, education, wealth, radio listening habits, access to health centres and use of modern contraceptives. We also conducted focus group discussions with thousands of participants in rural Burkinabe communities to understand barriers and enablers to the uptake of modern contraceptives and family planning.
We discovered that lack of information about modern contraception and fear of possible side effects such as infertility were common barriers to behaviour change. Deep-seated attitudes towards family size and lack of decision-making power for women also became apparent. We used these insights to develop key messages which our scriptwriters in Ouagadougou used to create:
For 30 months we broadcast 30- and 60-second spots 10 times per day, every day, on eight radio stations, in six languages.
In addition, we worked with the eight community radio stations to produce 2-hour live interactive phone-in shows, 3 nights per week, 52 weeks a year on each station. Audiences phoned in to discuss their fears, beliefs, and uncertainties with peers, and to receive accurate information and reassurance from health experts.
Watch the video
We worked with the Jamal Abdul Lateef Poverty Action Lab (J-PAL) to measure the impact of our 2.5-year radio campaign on mCPR, analysing routine health centre data from 461 clinics as well as the survey data collected by IPA. The results were remarkable. Our campaign led to a 20% increase in mCPR in intervention areas compared to controls. It doubled the rate of increase of modern contraceptive uptake. And modelling suggests a national Saturation+ radio campaign would lead to an additional 225,000 women using modern contraceptives in Burkina Faso – at a cost of $7.70 USD per woman.
The campaign also shifted knowledge and attitudes about family planning. Women in intervention areas were 35% less likely to believe that modern contraceptives cause side effects such as illness or infertility compared to control areas. They were also 14% more likely to say that “women should control the number of children they have during their lifetime”.
The primary outcome measure for this trial was mCPR (% of women aged 15-49 using, or whose partner is using, a modern contraceptive at the time of survey). Our 2.5-year campaign led to a 5.9 percentage point (pp) increase in mCPR in intervention zones compared to control zones, corresponding to a 20% relative increase (p=0.046).
If we assume a constant trend, it would take 2.5 years for the control group to catch up with the intervention group’s mCPR at endline. Our 2.5-year intervention therefore approximately doubled the rate at which mCPR increased.
We compared the rate of increase in modern contraceptive use from out RCT intervention areas to the average national increases in Kenya, Uganda, DR Congo, Ethiopia, Cote d’Ivoire, Ghana, Nigeria and Niger. The average national increase per year is 1.2 percentage points in these countries, ranging from -1.2pp to 2.8pp. By comparison, the average increase was much greater in our intervention zones, at 4.1 percentage points per year. For more information on how the increase in modern contraceptive use brought about by our radio campaign compares to other countries, click here.
It is important to clarify, when making cost-effectiveness comparisons, that DMI’s demand-side campaigns would have zero impact without supplies of contraceptives being available. It can only be meaningfully evaluated as an add-on to supply-side investments. The Guttmacher Institute estimates that over the 2.5-year period of our campaign, all other national family planning investments came to a cumulative cost of approximately $45 million. Our intervention cost $3.4 million, indicating that it is a highly cost-effective add-on: doubling the increase in mCPR for a tiny fraction of the supply-side cost.
Read our published papers and more in-depth project information here.
We are grateful to J-PAL and IPA for evaluating the intervention, and to the Global Innovation Fund (GIF), Development Innovation Ventures (DIV), and a private philanthropist for funding it.
We have taken our family planning campaigns to national scale in Burkina Faso, formed part of the SWEDD initiative, working with governments and UNFPA to run family planning campaigns in Burkina Faso, Niger, Chad, Mali and Mauritania, and are now delivering family planning multimedia campaigns in seven countries in East and Southern Africa through the WISH2ACTION project. Next, we want to scale up our family planning campaigns in Niger, Benin and Guinea, where we believe a media campaign would have a significant impact.