By Joanna Murray, Director of Research, Development Media International

An estimated 218 million women across low- and middle-income countries (LMICs) have an unmet need for contraception: that is, they want to avoid a pregnancy but are not using modern contraceptives. Mass media reaches a large share of the population in these countries, but how effective is it in changing behaviors? To answer this question, Development Media International (DMI) conducted a randomized controlled trial to evaluate the impact of an intensive, 30-month radio campaign in Burkina Faso that promoted family planning. The trial was funded by the Global Innovation Fund (GIF), Development Innovation Ventures (DIV) of the United States Agency for International Development (USAID), and an individual philanthropist.

The independent evaluation, led by the Abdul Latif Jameel Poverty Action Lab (J-PAL), and Innovations for Poverty Action (IPA), found that radio is a powerful and cost-effective tool for improving family planning outcomes at a large scale.

Sixteen areas in Burkina Faso, each with its own radio station, were randomly assigned into control and intervention groups. IPA surveyed 7,500 women of reproductive age in 252 villages before and after the campaign, collecting information about their age, education, wealth, radio listening habits, access to health centers, and use of modern contraceptives.

DMI also conducted focus group discussions with hundreds of participants in rural Burkinabe communities to understand barriers and enablers to the use of modern contraceptives and family planning. They discovered that lack of information about modern contraception and fear of possible side effects such as infertility were common barriers to behavior change. Deep-seated attitudes toward family size and lack of decision-making power for women also became apparent. These insights were used to develop key messages from which DMI’s scriptwriters in Ouagadougou created 59 motivational radio spots covering topics such as birth spacing and myths about side effects of contraception, 29 informational radio spots about different modern contraceptive methods and how they work, and 168 drama segments for interactive phone-in shows.

DMI’s approach to social and behavior change using mass media is centered around high-intensity messaging. For 30 months DMI broadcast 30- and 60-second spots 10 times per day, every day, on eight radio stations, in six languages; that’s over 72,000 broadcasts.

DMI worked with the J-PAL team to measure the impact of its radio campaign on the modern contraceptive prevalence rate (mCPR), analyzing routine health center data from 461 clinics as well as the survey data collected by IPA. The results were remarkable. DMI’s campaign led to a 20% increase in mCPR in intervention areas compared with control areas, doubling the rate of increase of modern contraceptive use. Modeling suggested that a national radio campaign would lead to an additional 225,000 women using modern contraceptives in Burkina Faso, at a cost of $7.70 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 than those in control areas. They were also 14% more likely to say that “women should control the number of children they have during their lifetime.” The cost of achieving this rapid increase was equivalent to just 7.5% of the national family planning budget in Burkina Faso. While demand-side campaigns are dependent on supplies being in place, the study shows that mass media is a highly cost-effective impact accelerator.

While the World Health Organization has encouraged information campaigns to address unfavorable attitudes toward family planning and mass media is recognized as a Family Planning High Impact Practice (HIP), until now there has been no rigorous proof that this results in greater use of contraceptives. The results of DMI’s trial contribute to evidence gaps identified in terms of rigorous impact evaluation, as control and intervention zones were used to measure behavior change, and cost-effectiveness was assessed.

DMI has taken its family planning campaigns to national scale in Burkina Faso; formed part of the Sahel Women's Empowerment and Demographic Dividend (SWEDD) initiative, working with governments and the United Nations Population Fund (UNFPA) to run family planning campaigns in Burkina Faso, Chad, Mali, Mauritania, and Niger; and are now delivering family planning multimedia campaigns in seven countries in East and Southern Africa through the WISH2ACTION project, which is funded by the UK’s Foreign, Commonwealth and Development Office. Next, DMI is looking to scale up its family planning campaigns in Benin, Guinea, and Niger, where similar mass media behavior change campaigns could deliver a significant impact.