Evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI) Program

“Gaps remain in understanding whether family planning (FP) programs can change urban women's FP behaviors. Even less is known about what works among poor urban women.”

This article, published online in the Studies in Family Planning journal, presents results of the impact evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI) programme, which was led by the Johns Hopkins Center for Communication Programs and implemented in collaboration with partners including the Association for Reproductive and Family Health and the Center for Communication Programs Nigeria. NURHI, implemented between 2010 and 2014 in six cities in Nigeria, was designed to be an integrated demand- and supply-side programme to meet the family planning needs of urban women, particularly poor urban women.

As explained in the article, “The multi-component programme was designed on the assumption that creating demand for FP will drive the supply of services. Demand generation for women and men focused on de-medicalizing and demystifying family planning use, increasing understanding of and appreciation for planning one's family, supporting a person's contraceptive use, and improving knowledge and perceptions of methods in the urban contexts where the program operated. This effort was undertaken through interpersonal communication in the home, on the street, at work, in clinics, and in locations where women or men congregate. It was also done using radio and television". On the supply side, the programme included the improvement of health services through clinic renovations, resolving supply chain challenges, training of providers, and supplying health care providers with badges that read “Ask me about FP”.

The article describes the study methodology in detail which, in brief, involved the collection of longitudinal data from women and health facilities at the start and finish of the programme. It surveyed more than 16,000 women at baseline and more than 10,000 of the same women in 2014 and compares and analyses the results. The two key dependent variables for this study are the use of modern contraception and desire for no more children. The key independent variables pertain to the NURHI demand- and supply-side activities such as the mass media and interpersonal communication activities described above. Women were asked about exposure to NURHI mass media messages on the radio and to outreach events where NURHI discussed family planning.

The findings showed the NURHI "led to significant increases in modern contraceptive method use and declines in the desire for more children in a short period of time. Overall, we observed an increase in modern method use between baseline and endline of about 10 percentage points and increases in the desire for no more children by a similar amount.… In particular, we find that among all women, exposure to the various demand-creation activities - television, radio, community outreach at key events, and the provider badge - was associated with increases in modern method use.” The research therefore confirms that an integrated family planning programme focusing on both supply and demand is effective.

In conclusion, the article reports that the “evidence from this impact evaluation is being used by the NURHI team to inform scale-up and expansion of programs into other urban areas and into rural areas. The findings from this study should also be used to inform future evidence-based family planning programs in urban and rural Nigeria and elsewhere in sub-Saharan Africa, especially those targeting the poor.”