Lowering barriers to contraception use through mass media

Twenty-five percent of women of reproductive age¹ in sub-Saharan Africa want to stop or delay childbearing but do not use contraception, even where it is available and affordable. Cultural and behavioral norms, combined with misinformation, contribute to this gap between demand and use. Researchers conducted a randomized evaluation to determine the impact of a family planning campaign delivered via radio in Burkina Faso. The campaign reduced misperceptions about contraception, increased contraception use, lowered births, and increased women’s reported welfare. Based on these results, Development Media International scaled up the highly cost-effective campaign to 39 radio stations across Burkina Faso, reaching 16.3 million people and leading to 225,000 additional women using modern contraception. Lessons from the evaluation informed the adaptation and scaling of mass media campaigns to support family planning in seven countries across southern and eastern Africa.

The Problem

In 2016, nearly a quarter of women in Burkina Faso wanted to stop or delay childbearing, but did not use modern contraception methods. 

At the time of the study, West Africa had among the highest fertility rates in the world. High fertility rates and short periods of time between births are associated with poor health outcomes for women. Many women across sub-Saharan Africa want to stop or delay childbearing but do not use contraception. In Burkina Faso, the percentage of women of reproductive age who are using a modern contraception method—like female or male condoms, implants, injectables, or pills—was just over 21 percent in 2016.² That same year, modern contraception helped avert an estimated 380,000 unwanted pregnancies and 920 maternal deaths.³ Still, there is a gap between demand and use: 24.1 percent of sexually active women did not want to get pregnant but were not using contraception.⁴

Women commonly cite concerns about contraception’s side effects and negative health impacts like infertility. Further, social norms can favor large families and limit the decision-making power of women, who often want fewer children.

In Burkina Faso, community radio serves as a major source of information, including about contraception. However, most media coverage of contraception focuses primarily on when and where it can be obtained with less emphasis on the different methods available and their benefits and side effects.

The Research

A mass media family planning campaign challenged misconceptions about contraception and increased modern contraception use in Burkina Faso.

Development Media International (DMI), a nongovernmental international organization that develops evidence-based behavior change campaigns to improve health across sub-Saharan Africa, and Innovations for Poverty Action partnered with J-PAL affiliate Rachel Glennerster (University of Chicago) and invited researcher Victor Pouliquen (University of Essex), together with Joanna Murray (DMI), to conduct a randomized evaluation of a radio campaign. The campaign aimed to promote modern contraception in Burkina Faso, with the goal of scaling it across the country if successful. This campaign aligned with the policy priorities of the Government of Burkina Faso, which is a strong proponent of family planning access.⁵

To develop the radio campaign, DMI conducted formative research through focus groups and key informant interviews, which identified barriers and enablers to contraceptive use among rural Burkinabe communities. Insights from the formative research informed radio messages on time between births, myths about contraception’s side effects, and how different methods work.

The radio campaign ran from June 2016 to December 2018, and used a high level of broadcast intensity consisting of 1) one-minute and 30-second radio spots broadcast ten times a day every day and 2) three one-hour interactive phone-in radio shows every week in six local languages. Sixteen community radio stations—reaching over 5 million people—were randomly selected to participate in the media campaign (8 radio stations) or not (8 radio stations). Additionally, radios were randomly distributed to 1,557 women who did not already have one to measure the impact of exposure to mass media with or without the campaign.

In areas without the radio campaign, receipt of a radio resulted in a decrease in modern contraception use relative to women who did not receive a radio, suggesting that typical radio programming in Burkina Faso may perpetuate conservative gender attitudes. However, the family planning campaign offset the negative impact of radio access, leading to an increase in the percent of women using a modern contraception method in those areas relative to non-campaign areas. This impact appeared to be driven by an increase in contraception knowledge and more positive attitudes toward family planning: women exposed to the campaign were less likely to think modern contraception could make a woman sterile and also less likely to believe contraceptives cause sickness. Clinics in areas exposed to the campaign held more family planning consultations and distributed more contraceptives.

For more information, please see the evaluation summary.

From Research to Action

Based on initial findings, DMI scaled up its programming in Burkina Faso, expanding access to more women, and then adapted the campaign to other countries in southern and eastern Africa.

Findings from the evaluation informed DMI’s decision to scale up the mass media campaign nationally in January 2019 and enabled DMI to secure funding. Researchers presented results from the study to La Direction de la Santé de la Famille (the Family Health Department), the Cabinet Ministerial of the Government of Burkina Faso, and family planning partners and NGOs in Burkina Faso and beyond.

Initial scale-up started with new stations just broadcasting spots, as DMI worked to train presenters and radio station staff to broadcast the interactive shows. Over the subsequent months, the interactive shows were rolled out to a total of 17 stations that had sufficient capacity to deliver the regular evening programs. As of April 2021, the campaign was broadcast on 39 radio stations, in ten local languages, reaching 80 percent of the population of Burkina Faso.

The researchers estimate that national-level implementation equates to about 225,000 additional women using modern contraception at a cost of $7.70 (FCFA 4,250) to the government per additional woman annually—or $11.20 (FCFA 6,180) when including the cost of contraception—and 10,000 fewer births a year. During the period of the campaign, the Government of Burkina Faso spent an average of $14.22 on family planning per woman using modern contraception. The cost of the campaign to increase contraception use was thus 21 percent lower than the average cost of $14.22, suggesting that mass media is a cost-effective add-on to existing family planning infrastructure.

The evaluation has also informed broader regional scale-up. DMI joined a consortium to lead campaigns based on the same model in seven countries in southern and eastern Africa (Ethiopia, Madagascar, Malawi, Mozambique, Tanzania, Uganda, and Zambia) as part of WISH2ACTION. In these countries, the consortium invested in developing partnerships with Ministries of Health to identify the governments’ family planning objectives, conduct research to identify barriers to meeting those objectives, and design messages to tackle those barriers. DMI replicated the key elements of its model—intensive broadcasting to ensure frequent exposure to messaging and use of dramatic storytelling via radios—and added short films and social media.

Findings from the evaluation suggested that the campaign was most effective for women who were already using contraception but perhaps inconsistently. In light of this finding, DMI introduced additional activities in WISH2ACTION to reach new users and worked in tandem with service providers to ensure the campaign was more closely integrated with other ongoing community-based activities to decrease barriers to contraception use. 

At its peak, WISH2ACTION broadcast on 136 radio stations and 16 TV stations across seven southern and eastern African countries in 29 languages. Radio programming reached approximately 76 million people, with the combined campaign on radio, TV, and social media reaching 121 million. If the intervention had a similar impact to the one measured in Burkina Faso, the radio programs would have led to about one million additional users of modern contraception across these seven countries.⁶ DMI also provided additional technical support to the International Planned Parenthood Federation (IPPF) member associations in Sudan and South Sudan.

In some of these countries, methods from the campaign have been adopted as part of standard government protocol. For example, the Government of Uganda has increased its budget for social and behavior change (SBC) programs at a district level by 30 percent and now requires program implementers to conduct formative research and pre-testing to inform campaign content.

Other NGOs have also adopted DMI’s approach and are conducting radio campaigns in other contexts. For example, in 2021 Family Empowerment Media launched a radio campaign based on DMI’s approach in Nigeria.