Moving Family Planning Programs Forward: Learning from Success in Zambia, Malawi, and Ghana

This 26-page evaluation report from the ACQUIRE Project shares information from three case studies undertaken in countries that were identified as having been successful in increasing contraceptive use and lowering fertility - Ghana, Malawi, and Zambia. The case studies were part of the Repositioning Family Planning programme, a project undertaken and funded by the United States Agency for International Development (USAID), and were intended to identify lessons learned to guide strategy development and identify key investments. The research found that family planning programmes in these three countries were successful not just through supply side interventions, but also through effective and innovative efforts on the demand side, including both working with the communities and bringing services closer to rural populations. Key messages were developed in consultation with the community to ensure that they were appropriate and meaningful.

According to the report, in the Zambian case, in addition to improving the supply side of services, there was also a strong emphasis on demand creation through a wide range of communication activities, such as creation of a family planning logo and radio and television programmes. The number of women who had heard a radio message about family planning or had viewed a message on television increased, and this exposure was associated with increased contraceptive use. For example, 24.4% of listeners of any radio programme were currently using family planning compared with only 11.9% of non-listeners.

The report also states that family planning has been remarkably successful in Malawi, particularly considering the constraints faced in the country. Malawi's contraceptive prevalence rate (CPR) increased from 7% to 26% between 1992 and 2000, despite high rates of economic poverty, low rates of literacy, a predominantly rural population (86%), and a 14% prevalence of HIV/AIDS in the adult population. The report suggests that it is particularly impressive that gains in CPR cut across the economic spectrum. On the demand side, multiple channels of communication in multiple languages were used, including radio jingles, posters, dramas, health talks, and community-based distribution activities, so that Malawi was "flooded with information, education, and communication (IEC) messages." The research found that one reason for the effectiveness of these messages was that they were developed through consultation with communities - "asking them to analyse the situation. They talked about all these problems they had because of too many children", problems that included land disputes and disputes between husbands and wives.

Under the Ghana Family Planning and Health Program (1991-1996), IEC activities addressed constraints including widespread myths, rumours, and health fears. The Health Education Unit of the Ministry of Health coordinated a campaign that involved both the private and public sectors. However, a lack of funding limited regional efforts by the public sector, and some of the advertising materials created controversy, leading to the television ads being cancelled and then only allowed to be broadcast after 10:00 pm. In 2001, the Ghana Health Service and private-sector partners launched the Life Choices behaviour change campaign, to reposition family planning in people's mind and to dispel rumours about methods. The campaign gave people the knowledge and tools to see that family planning was directly related to their lives and their personal aspirations for a better future. Vans that brought information, materials, and songs moved throughout the country. Nearly 7 out of 10 men and half of the women interviewed in 2003 reported that they had heard the key slogan of the campaign - "Life choices: It's your life, it's your choice."

The evaluation found that experiences from Ghana, Malawi, and Zambia all point to the importance of addressing the demand side through effective IEC. Myths, rumours, and misperceptions about family planning were common in all three countries, and these continue to varying degrees. Communication activities helped to bring about a shift from seeing family planning as not only a way to limit the number of children (which often led people to associate family planning with not having any children at all) to seeing it as a way to space births and improve the health of women and children. The high levels of knowledge of family planning in all three countries demonstrate that IEC can be effective even in settings with low literacy. Exposure to IEC messages was associated not only with increases in knowledge but also with changes in behaviour, such as increased use of modern contraception. The report concludes that to develop appropriate messages, it is essential to consult with the community.