Communication campaigns have become a central component of family planning programs designed to shape social norms and individual behavior related to fertility. Communication at multiple levels (individual, family, community and mass media) has been used to heighten awareness of family planning, change attitudes toward contraceptive use, and shape norms surrounding family planning. Communication campaigns play a key role in providing people with access to accurate information in order to promote informed choice and to dispel rumors and myths about family planning. They also help improve service quality by enhancing the interpersonal skills of providers (Robey et al. 1994).
Campaigns have an important, complementary function that supports service delivery efforts, the policy environment, and community-based programs. Because population campaigns create demand for services, they are typically coordinated with improvements in service delivery infrastructure, service provider skill, and contraceptive supplies to meet the expectations generated through the campaign. Communication campaigns, in concert with other family planning program components, have promoted informed choice, improved the quality of services, assisted couples to achieve their ideal family size, saved the lives of women and children, and curbed population growth.
Evolution of Population Campaigns
Once characterized as relying on clinic-based, passive approaches, campaigns today are increasingly complex, using multiple channels and participatory techniques. Early programs, starting with the “clinic era,” relied on a medical model in which communication efforts were limited and family planning clients were expected seek services simply because they were available – reflecting a “build it and they will come” philosophy (Rogers 1973; Piotrow et al. 1997). Once at the clinic, clients primarily listened as providers communicated family planning messages. While this model worked for highly motivated clients, it did not address the needs of those who did not feel comfortable discussing such private issues in public clinics.
The late 1960s marked the beginning of the “field era,” when the largely passive, one-way communication model was replaced by active dialogue. At the same time, while clinics continued to be an important component of family planning programs, their activities were complemented by outreach efforts undertaken by family planning field workers. Field workers, armed with posters, leaflets, radio broadcasts, and more, attracted new clients to clinics and also provided information and limited family planning services (Rogers 1973; Piotrow et al. 1997).
Over the past 20 years, population campaigns have grown in sophistication and reach. Today population campaigns are strategic, following a systematic approach with a focus on key behavior change objectives. In this “strategic era,” campaigns are results-oriented and designed, implemented, and evaluated on the basis of the latest behavioral science models and with the active participation of stakeholders and beneficiaries (Piotrow et al. 1997). Communication has moved beyond dialogue to convergence; an iterative process in which participants create and share information in order to achieve mutual understanding (Kincaid 1979; Rogers & Kincaid 1981). No longer focused on distributing a high volume of materials, campaigns now rely on multiple, mutually reinforcing channels that may include a mix of mass media, community mobilization, client-centered counseling, social network interventions, social marketing, TV or radio spots, dramas and music, public policy advocacy, and more. Entertainment education, an approach that capitalizes on the persuasive power of promoting educational messages through entertainment formats such as songs, dramas, and soap operas, has transformed communication and expanded the reach of family planning messages. Today’s campaigns also make use of positioning to determine how to best motivate audiences to adopt a specific behavior, and they benefit from more sophisticated audience segmentation, which differentiates audiences according to their family planning attitudes, needs, or concerns rather than just on basic demographic characteristics such as age, marital status, and socio-economic status (Piotrow et al. 1997).
Context Surrounding Population Campaigns
The environment in which population campaigns operate has been shaped by international population conferences held every 10 years. At the 1974 World Population Conference at Bucharest, participants addressed population in relation to development. While more developed countries were in favor of controlling population growth with the idea that reduced population leads to improved development, a sub-group of attendees resisted the idea of demographic targets and argued that investments in development would promote fertility decline. Despite this disagreement, attendees created the World Population Plan of Action, a document on population policy and programs that was the first of its kind (Ashford 1995). The next population conference, convened in Mexico in 1984, is best known for the United States’ declaration that it would withdraw funds from programs that promoted or provided abortion. Though this so-called Mexico City Policy was rescinded in 1993, it was reinstated in 2001 and continues to shape family planning efforts worldwide, forcing some organizations to shift operations in the face of losing funds.
One positive outcome from this conference was the call to make family planning services universally available (Ashford 1995). The 1994 conference in Cairo marked a major paradigm shift for international family planning programs. The landmark conference shifted the focus of family planning programs away from demographic objectives to an emphasis on the rights and needs of women and encouragement of a more comprehensive reproductive health approach. The Program of Action called for expanded family planning programs that promoted informed choice, increased access to contraception, and included programs aimed at men and young people.
One common thread of each of the conferences is that each country has the sovereign right to develop its own population policy in ways that are consistent with national laws, development priorities, and cultural values. Consequently, while the latest program of action, adopted at the 1994 Cairo Conference, advocated a couple’s right to choose from a variety of contraceptive methods in order to achieve their fertility desires, some national population policies and related campaigns, undermine a couple’s human right to choose the number and timing of their children, rather than promoting voluntary use of contraception. China’s “One Child Policy,” which restricts couples living in urban areas to one child, is an often-cited example of a national policy that goes against the spirit of the program of action adopted in Cairo in 1994.
Theory and Practice
Fertility decline was once primarily explained by the demographic transition theory, a model attributing fertility decline to decreased mortality and to socio-economic factors such as urbanization and industrialization, which resulted in the rising cost and declining economic value of children (Notestein 1953). However, as more evidence has become available, scholars have come to acknowledge the critical and complementary role of the diffusion of new attitudes, behaviors, and technology through social interaction. This “ideational model” attributes fertility decline to the spread of ideas and innovation through mass media, social networks, and interpersonal communication. As these new ideas take root, social norms change, making contraceptive use and the small family norm more acceptable, eventually resulting in fertility decline (Cleland & Wilson 1987).
In practice, population campaigns are guided by behavior change communication theories, particularly stage or step theories that describe the process that individuals undergo to change their behavior. The specific objectives of population campaigns are often related to the maturity of organized family planning programs. Less mature programs with relatively low modern contraceptive prevalence rates (CPR) may focus on developing a supportive environment by increasing public awareness of the benefits of family planning, whereas a more mature program with relatively high CPR may direct its efforts to improving provider interpersonal communication skills to insure informed choice and contraceptive continuity. Campaigns often operate at one or more levels including the social and political environment, the service delivery system, the community, the family, the couple, and the individual. Elements of mass media, primarily used to create awareness and influence attitudes and beliefs about family planning, are often complemented with interventions aimed at improving interpersonal communication between providers and clients, husbands and wives, and family and community members, which help to motivate behavior change.
Challenges and Opportunities
Proving that changes in social norms and contraceptive behavior can be attributed to population campaigns has been a challenge, particularly since it is nearly impossible to use the “gold standard” (an experimental design using pre- and post-tests, a control group, and randomized participants) to measure the impact of programs with a mass media component (Figueroa et al. 2002). The very nature of mass media interventions using radio or television precludes this, since it is almost impossible to create a control group with no exposure to campaign messages. Consequently, evaluators have been challenged to develop better methods to demonstrate that change can be attributed to population campaigns.
The Program of Action developed at the 1994 conference in Cairo provided an opportunity for communication campaigns to reach new audiences segments by specifically calling for the expansion of family planning programs to provide information, counseling, and services for young people and men. Young people often have an unmet need for family planning. While young people are sexually active and young women do not want to become pregnant, many do not know about or have access to contraceptives. However, creating communication campaigns that satisfy young people’s need for information and help them make healthy decisions, while at the same time making them acceptable to adults and sensitive to cultural norms, is a challenge. Men have also been increasingly recognized as having an important role in improving family planning and reproductive health following the 1994 conference. Men who have been exposed to information about family planning are more likely to support their partner’s family planning decisions, and communication campaigns aimed at men can improve spousal communication about family planning, which is positively associated with contraceptive use.
Expanded access and new channels of communication also present opportunities and challenges for family planning campaigns. Today, people worldwide not only enjoy greater access to television and radio, but also have the opportunity to use new communication technologies. For example, the Internet has expanded access to health information and facilitated information sharing in a way once inconceivable. Throughout the world, health professionals and consumers can retrieve the latest health information at the touch of a button. Internet technologies provide access to health-related databases and documents and can facilitate information sharing through listservs, discussion forums, chat-rooms, and the like. While the Internet provides new opportunities for reaching audiences with family planning messages, it also has its drawbacks. As more and more channels of communication become available, population communication programs will have to work harder and be more creative in attracting audience attention. Furthermore, traditionally underserved populations will have unequal access to technology such as the Internet. Consequently, health communicators will need to address barriers that create a “digital divide” occurring at country, community, and individual levels (Maxfield 2004).
- Ashford, L. S. (1995). New perspectives on population: Lessons from Cairo. Population Bulletin, 50(1), 1–44.
- Cleland, J., & Wilson, C. (1987). Demand theories of the fertility transition: An iconoclastic view. Population Studies, 41, 5–30.
- Figueroa, M. E., Bertrand, J. T., & Kincaid, D. L. (2002). Evaluating the impact of communication programs: Summary of an expert meeting. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs.
- Kincaid, D. L. (1979). The convergence model of communication: Paper 18. Honolulu: East West Communication Institute, East West Center.
- Maxfield, A. (2004). Information and communication technologies for the developing world: Health communication insights. Baltimore, MD: Health Communication Partnership based at Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs.
- National Research Council (2001). Diffusion processes and fertility transition: Selected perspectives (ed. J. B. Casterline). Washington, DC: National Academy Press.
- Notestein, F. (1953). Economic problems of population change. Proceedings of the Eighth International Conference of Agricultural Economist, 13–31.
- Piotrow, P. T., Kincaid, D. L., Rimon, J. G., & Rinehart, W. (1997). Health communication: Lessons from family planning and reproductive health. Westport, CT: Praeger.
- Robey, B., Piotrow, P. T., & Salter, C. (1994). Family planning lessons and challenges: Making programs work. Baltimore. MD: Johns Hopkins School of Public Health, Population Information Program.
- Rogers, E. M. (1973). Communication strategies for family planning. New York: Free Press.
- Rogers, E. M., & Kincaid, D. L. (1981). Communication networks: Toward a new paradigm for research. New York: Free Press.
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