When Contraception Took on Culture: Lessons from reproductive health conversations with Indian youth
Summary:
The success of Indias family planning program depends on both married and unmarried youth. But a deeply conservative culture discourages open conversations on reproductive health, reinforces harmful gender-norms, and hampers uptake of contraception. In a decade marked by the absence of method-specific campaigns, spousal-support has decreased and myths and misconceptions around contraception have increased affecting contraception uptake among married couples. The lack of formal sex education and open conversations with parents prevents unmarried youth from seeking professional counselling and exposes them to inaccurate and unverified information through peers or the internet. The USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project, led by Abt Associates, addresses underlying barriers to change rooted in culture. Our strategy is anchored in using a surround-sound media effect for changing the culture of conversations around reproductive health. Our mass media campaign is making family planning conversations aspirational among couples and encouraging women to look beyond the culture of misinformation surrounding contraceptive pills. At beauty parlors, workplaces, and weekly markets, engaging interpersonal activities on contraception are becoming conversation-starters among women. Our toll-free, multi-lingual helpline is becoming a trusted information source for reproductive health. We offer safe spaces online for conversations on reproductive health among youth through a unique chat-bot. A radio show and digital platform called MTV Nished is reigniting conversations on previously taboo topics among parents and youngsters. Lessons learned from this research and activities help inform future social and behavior change campaigns.
Background/Objectives:
The projects formative research showed how lack of open conversations was impacting reproductive health outcomes. Women, even those aware of easily accessible methods like oral contraceptives, were hesitant to adopt them due to conversations with their peers that amplified myths and misconceptions. Despite universal awareness, use of oral contraceptive pills remained around 2% in urban India, indicating a clear perception gap. Pre-marital sex remains taboo and unmarried youth hardly ever had conversations on reproductive health with their parents. Pornography, unmonitored websites or experienced friends and relatives controlled their narrative of sex and inaccurate information resulted in unsafe behaviors.
Description of Intervention and/or Methods/Design:
Mass-media campaigns encouraged women to look beyond negative conversations around contraceptive pills and seek the truth about the method themselves by accessing credible advice on our secure, toll-free, multi-lingual helpline. Radio spots made family-planning conversations among couples aspirational. Digital videos busted myths around contraceptive pills. Activities at touchpoints like beauty parlors started conversations among women. We created safe spaces for reproductive health conversations online through a unique chat-bot on Facebook. Partnering with MTV Staying Alive Foundation, we developed Nished, a radio show that stimulates conversations on topics considered taboo: reproductive health, contraception, consent, and agency for youth. On the show, a fictional RJ is making reproductive health conversations mainstream on radio. Hitherto unanswered questions are being asked on nishedlive.com. College campuses, gyms, cinemas, malls and other youth hangouts are being turned into hotspots for reproductive health conversations.
Results/Lessons Learned:
Our oral contraceptive pill (OCP) campaign started conversations among 43 million people and is already contributing positively to family planning outcomes. Our reach and recall survey shows that over 83% of people exposed to our campaign changed their perception of OCPs or intend to find out more about them. A similar proportion believe couples should talk about contraception. Almost two-thirds of respondents, including a quarter of non-users, are likely to start using oral-pills! Our approach builds on past campaigns, the focus of which was largely to address womens doubts around the usage of pills using facts, by addressing root causes of those doubts cultural norms, myths and misconceptions fed by lack of conversations. Reaching 2 million people, our radio show breaks new ground on open conversations. The questions asked by youth on our chat-bot and nishedlive.com showcase the paucity of safe, accurate sources of knowledge today.
Discussion/Implications for the Field:
Ankit Vohra - Abt India
Andy Bhanot - Abt India
Shipra Srihari - Abt Associates
Moni Sagar - USAID
Vijay Paulraj - USAID
The success of Indias family planning program depends on both married and unmarried youth. But a deeply conservative culture discourages open conversations on reproductive health, reinforces harmful gender-norms, and hampers uptake of contraception. In a decade marked by the absence of method-specific campaigns, spousal-support has decreased and myths and misconceptions around contraception have increased affecting contraception uptake among married couples. The lack of formal sex education and open conversations with parents prevents unmarried youth from seeking professional counselling and exposes them to inaccurate and unverified information through peers or the internet. The USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project, led by Abt Associates, addresses underlying barriers to change rooted in culture. Our strategy is anchored in using a surround-sound media effect for changing the culture of conversations around reproductive health. Our mass media campaign is making family planning conversations aspirational among couples and encouraging women to look beyond the culture of misinformation surrounding contraceptive pills. At beauty parlors, workplaces, and weekly markets, engaging interpersonal activities on contraception are becoming conversation-starters among women. Our toll-free, multi-lingual helpline is becoming a trusted information source for reproductive health. We offer safe spaces online for conversations on reproductive health among youth through a unique chat-bot. A radio show and digital platform called MTV Nished is reigniting conversations on previously taboo topics among parents and youngsters. Lessons learned from this research and activities help inform future social and behavior change campaigns.
Background/Objectives:
The projects formative research showed how lack of open conversations was impacting reproductive health outcomes. Women, even those aware of easily accessible methods like oral contraceptives, were hesitant to adopt them due to conversations with their peers that amplified myths and misconceptions. Despite universal awareness, use of oral contraceptive pills remained around 2% in urban India, indicating a clear perception gap. Pre-marital sex remains taboo and unmarried youth hardly ever had conversations on reproductive health with their parents. Pornography, unmonitored websites or experienced friends and relatives controlled their narrative of sex and inaccurate information resulted in unsafe behaviors.
Description of Intervention and/or Methods/Design:
Mass-media campaigns encouraged women to look beyond negative conversations around contraceptive pills and seek the truth about the method themselves by accessing credible advice on our secure, toll-free, multi-lingual helpline. Radio spots made family-planning conversations among couples aspirational. Digital videos busted myths around contraceptive pills. Activities at touchpoints like beauty parlors started conversations among women. We created safe spaces for reproductive health conversations online through a unique chat-bot on Facebook. Partnering with MTV Staying Alive Foundation, we developed Nished, a radio show that stimulates conversations on topics considered taboo: reproductive health, contraception, consent, and agency for youth. On the show, a fictional RJ is making reproductive health conversations mainstream on radio. Hitherto unanswered questions are being asked on nishedlive.com. College campuses, gyms, cinemas, malls and other youth hangouts are being turned into hotspots for reproductive health conversations.
Results/Lessons Learned:
Our oral contraceptive pill (OCP) campaign started conversations among 43 million people and is already contributing positively to family planning outcomes. Our reach and recall survey shows that over 83% of people exposed to our campaign changed their perception of OCPs or intend to find out more about them. A similar proportion believe couples should talk about contraception. Almost two-thirds of respondents, including a quarter of non-users, are likely to start using oral-pills! Our approach builds on past campaigns, the focus of which was largely to address womens doubts around the usage of pills using facts, by addressing root causes of those doubts cultural norms, myths and misconceptions fed by lack of conversations. Reaching 2 million people, our radio show breaks new ground on open conversations. The questions asked by youth on our chat-bot and nishedlive.com showcase the paucity of safe, accurate sources of knowledge today.
Discussion/Implications for the Field:
- Culturally rooted campaigns help address normative barriers to adoption attacking the source credibility of misinformation helped us convince women to take up OCPs.
- Integrated media campaigns provide a multiplier effect and allow for multiple objectives to be achieved - our OCP campaign worked on increasing adoption, gaining spousal support and improving adherence under a larger idea of In the Pill We Trust.
- Content is bigger than advertising entertainment-education approaches like Nished help break new ground in audience engagement that informative messaging alone cannot.
- Use digital for conversion, not just amplification of mass media messages.
Ankit Vohra - Abt India
Andy Bhanot - Abt India
Shipra Srihari - Abt Associates
Moni Sagar - USAID
Vijay Paulraj - USAID
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: SHOPS Plus