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ORIGINAL ARTICLE

Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation

Ilene S Speizer, Meghan Corroon, Lisa Calhoun, Peter Lance, Livia Montana, Priya Nanda and David Guilkey
Global Health: Science and Practice December 2014, 2(4):410-426; https://doi.org/10.9745/GHSP-D-14-00109
Ilene S Speizer
aThe University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA
bThe University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
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  • For correspondence: ilene_speizer@unc.edu
Meghan Corroon
bThe University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
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Lisa Calhoun
bThe University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
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Peter Lance
bThe University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
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Livia Montana
cHarvard University Center for Population and Development Studies, Cambridge, MA, USA
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Priya Nanda
dInternational Center for Research on Women, Asia Regional Office, Delhi, India
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David Guilkey
bThe University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
eThe University of North Carolina at Chapel Hill, Department of Economics, Chapel Hill, NC, USA
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Figures

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  • Figure 1.
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    Figure 1.

    Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Union and Not Sterilized at Baseline in India

    Abbreviation: UHI, Urban Health Initiative.

    Model controls for age group, education, wealth, religion, city of residence, and other country-specific variables.

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    Figure 2.

    Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Kenya

    Abbreviation: FP, family planning.

    Model controls for age group, education, wealth, religion, city of residence, marital status, and other country-specific variables.

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    Figure 3.

    Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Union in Senegal

    Abbreviations: FP, family planning; ISSU, l'Initiative Sénégalaise de Santé Urbaine.

    Model controls for age group, education, wealth, religion, city of residence, and other country-specific variables.

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    Figure 4.

    Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Nigeria

    Abbreviations: FP, family planning; NURHI, Nigerian Urban Reproductive Health Initiative.

    Model controls for age group, education, wealth, religion, city of residence, marital status, and other country-specific variables.

  • Figure5
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    A roadside market umbrella in Mapo district in Ibadan, Nigeria, branded with the “Get it Together” NURHI puzzle logo, encourages people to “know” about family planning, “talk” with their partner about it, and “go” for family planning services.

Tables

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    Table 1. Summary of Urban Reproductive Health Initiative Country Programs
    CountryProject Name, Lead, and WebsiteInitial Intervention CitiesDelayed Intervention CitiesKey Programmatic Strategies at Launch
    India (Uttar Pradesh)Urban Health Initiative (UHI), FHI 360, http://uhi-india.org/
    • Agra

    • Aligarh

    • Allahabad

    • Gorakhpur

    • Moradabad

    • Varanasi

    Demand Generation
    • Interpersonal communication: home visits by peer educators to provide women and men information, counseling, and referral; focus on LAPMs for pregnant women

    • Mid-media: street plays, road shows, magic shows (low exposure)

    • Mass media: radio and television with targeted messages

    Supply Side Activities
    • Postpartum service integration: targeted FP information, counseling, and promotion during pregnancy and postpartum; ensure supplies and provider competencies to offer LAPMs

    • Postabortion service integration: provide FP counseling and services during postabortion care

    • Expand service delivery and quality

      • Expand method choice

      • Improve technical and client-provider interaction skills of providers

    • Public-private partnerships

      • Partnerships with Janani and other high-volume private facilities

      • Strengthen routine and fixed day services for poor from slum communities

    • Social marketing of condoms and pills

    Advocacy
    • Focus on policy, advocacy, scale

    KenyaTupange (“Let's Plan”), Jhpiego, www.tupange.or.ke/
    • Nairobi

    • Kisumu

    • Mombasa

    • Kakamega

    • Machakos

    Demand Generation
    • Generate demand by addressing social norms and barriers that inhibit FP use

      • Community mobilization

      • Wide distribution of print project materials

    • Local and mass media, including radio and television shows targeted to urban poor and young audiences

    Supply Side Activities
    • Improve quality and accessibility of FP services through integration of services. Focus on facilities: close to slum/informal settlements; with high-volume attendance; and with high usage from slum/informal settlements

    • Ensure contraceptive security throughout the life of the project and beyond by addressing poor forecasting and developing electronic stock-out reporting system

    • Engage formal and informal private sector: work with selected private nurses and clinical officers to offer high-quality and low-cost comprehensive FP services

    Advocacy
    • Advocacy for improved policy environment

    • Capacity building and sustainability: build capacity of local implementing partners, policy makers, private and public-sector providers to respond to FP/RH goals and needs

    SenegalL'Initiative Sénégalaise de Santé Urbaine (ISSU) (“Senegal Urban Reproductive Health Initiative”), IntraHealth International, www.facebook.com/sante.urbaine
    • Dakar

    • Guédiawaye

    • Pikine

    • Mbao

    • Mbour

    • Kaolack (outside the region of Dakar)

    Demand Generation
    • Outreach workers identifying FP needs

    • Theater to promote discussion on a topic

    • Small group discussions led by midwives with users to discuss FP-related topics

    • Engagement of religious and community leaders to participate in and lead FP discussions

    • Radio and television using public, private, and community-level stations

    Supply Side Activities
    • Integration of FP into MCH services including postpartum and postabortion care

      • Train providers to use cost-effective and evidence-based service delivery systematic screening tool to identify unmet FP needs

    • Expand availability and quality of long-acting FP services in health facilities

      • Train providers; ensure stock reliably available

      • Integrate trained midwives into facilities to increase access to and availability of FP on a regular basis

      • Outreach through mobile clinics targeting poor areas

    • Social franchise strategies to increase access through the private sector

      • Use Blue Star to increase access to FP in existing private-sector services

    Advocacy
    • Advocacy to create a favorable policy environment

    NigeriaNigerian Urban Reproductive Health Initiative (NURHI), Johns Hopkins Center for Communication Programs, www.nurhi.org/
    • Abuja

    • Ibadan

    • Ilorin

    • Kaduna

    • Benin City

    • Zaria

    Demand Generation
    • Social mobilization: interpersonal communication activities to encourage discussion and reduce barriers of miscommunication and social stigma to normalize FP, undertaken in various settings including markets, special events; spread of branded items in numerous community settings

    • Media: radio and television at the state and local levels; use local-language slogans for specific city radio programs; radio magazine entertainment-education program

    Supply Side Activities
    • Improve quality and integrate high-volume facilities: train providers, ensure stock, improve facility environment including quality standards

    • Test novel public-private partnerships: Family Planning Providers Network trains, markets, and supplies providers with what they need to provide appropriate FP services and networks the providers together

      • Clinical services: performance improvement to ensure that clinical providers offer full menu of methods with quality counseling and integrated services

      • Patent Medicine Store/pharmacist: provide information, basic counseling, and non-clinical FP methods as first-line providers

    Advocacy
    • Advocacy to promote FP discussions in public forum and to encourage acceptance at all levels

    • Abbreviations: FP, family planning; LAPMs, long-acting and permanent methods; MCH, maternal and child health.

    • View popup
    Table 2. Number of Women Interviewed in Baseline and Midterm Surveys, by Country
    CountryBaseline, No.Midterm, No. (% of Eligible Subsample Interviewed)Samples for Longitudinal Analysis
    India (Uttar Pradesh)17,6435,790 (85.8%)4,029 women interviewed at both baseline and midterm and who, at baseline, were in union, had not been sterilized, and had not had a hysterectomy
    Kenya8,9323,207 (56.1%)3,205 women interviewed at both baseline and midterm, regardless of their marital status at either time period, with non-missing data
    Nigeria16,1444,331 (64.6%)4,303 women interviewed at both baseline and midterm, regardless of their marital status at either time period, with non-missing data
    Senegal9,6142,744 (80.7%)1,538 women interviewed at both baseline and midterm and who were in union at baseline
    • Source: Measurement, Learning & Evaluation project baseline18–21 and midterm22–25 surveys of the Urban RH Initiative country programs.

    • View popup
    Table 3. Baseline Demographic Characteristics of the Matched Baseline–Midterm Analysis Samples,a by Country (%)
    CharacteristicIndia (UP) (N = 4,029)Kenya (N = 3,205)Nigeria (N = 4,303)Senegal (N = 1,538)
    Age group
     15–193.489.4216.173.99
     20–2418.7525.1515.2114.42
     25–2924.2823.6418.6518.49
     30–3421.8415.9716.5219.92
     35–3915.7312.3314.3918.38
     40+15.9313.5119.0624.80
    Education
     None/Quaranic26.957.1310.1342.93
     Primary8.7036.7313.7839.64
     Secondary36.9939.8048.4915.67
     Higher27.3516.3426.701.77
     Missing0.000.000.890.00
    Wealth group
     Poorest22.5016.7614.4915.49
     Poor21.4419.6617.9222.53
     Middle18.9021.2619.9526.43
     Rich19.1121.6722.4119.28
     Richest18.0520.6425.2216.27
    Religion
     Hindi80.98
     Catholic21.965.05
     Protestant63.8642.01
     Muslim19.01b12.0452.2394.11
     Otherc5.89
     No religion2.080.05
     Missing0.060.66
    Marital status
     Never marriedNA25.7130.11NA
     In unionNA63.3765.83NA
     Separated/divorced/widowedNA10.914.07NA
    • Abbreviation: NA, not applicable (sample includes only women in union); UP, Uttar Pradesh.

    • ↵a The matched analysis sample comprised, in India, women in union and not sterilized at baseline; in Kenya and Nigeria, all women; and in Senegal, women in union at baseline.

    • ↵b Includes “other” category.

    • ↵c Includes Christian and “other” categories.

    • View popup
    Table 4. Percentage of Womena Recalling Exposure to Specific Program Activities at Midterm, by Country
    Program ActivityIndia (UP)KenyaNigeriaSenegal
    Exposure to CHW in the last 3 months22.52
    Ever saw any UHI TV programb41.52
    Ever heard any UHI radio programb5.32
    Attended FP/Tupange meeting in the last year11.49
    Saw Tupange leaflet in the last year32.58
    Saw Tupange poster in the last year43.16
    Saw Shujazz comic book in the last year16.94
    Heard Jongo Love radio program in the last year16.29
    Saw episode of Matatu TV program in the last year22.33
    Heard or seen “NURHI” in the last year23.01
    Ever heard of language-specific NURHI radio programs28.96
    Heard NURHI phrases/slogansc in the last year30.91
    Ever listened to language-specific NURHI radio programs56.55
    Seen NURHI puzzle logo in the last year26.81
    Received info on FP/birth spacing at a community eventd in the last year20.85
    Heard general FP messages on the radio in last 3 months63.38
    Saw FP on TV in last 3 months (NURHI was only group with TV advertisements during project period)59.29
    Heard at least 1 ISSU radio program in the last year40.57
    Saw at least 1 ISSU TV program in the last year66.43
    Participated in at least 1 ISSU community activity in the last year22.31
    Heard an FP radio advertisement in the last year47.59
    Heard religious leader speak favorably about FP in the last year27.18
    • Abbreviations: CHW, community health worker; FP, family planning; ISSU, l'Initiative Sénégalaise de Santé Urbaine; NURHI, Nigerian Urban Reproductive Health Initiative; UHI, Urban Health Initiative; UP, Uttar Pradesh.

    • ↵a The matched analysis sample comprised, in India, women in union and not sterilized at baseline; in Kenya and Nigeria, all women; and in Senegal, women in union at baseline.

    • ↵b The midterm questionnaire for India asked specifically about 3 UHI spots: (1) Sambhal lunga, about a wife taking control and going to see a doctor and to use a contraceptive method; (2) Munna, in which a husband adopts male sterilization after talking to a doctor and has a happy married life afterwards; and (3) Kishton Mein, a story about a couple who adopts female sterilization at the time of delivery because they don't want any more children. Each was asked related to TV and radio exposure separately.

    • ↵c Includes “Get it Together”; “Know, Talk, Go”; “No Dulling”; and attending a family planning meeting led by someone wearing a program t-shirt.

    • ↵d Includes association meetings, naming and freedom ceremonies, graduation events, Christmas/Eid celebrations, and weddings.

    • View popup
    Table 5. Contraceptive Method Use Among Surveyed Womena at Baseline and Midterm, by Country
    Type of MethodIndiaKenyaNigeriaSenegal
    BaselinebMidtermBaselineMidtermBaselineMidtermBaselineMidterm
    No method39.1037.1250.9946.4668.8961.2971.0466.12
    Traditional method24.2425.324.237.817.838.922.942.36
    Modern method36.6637.5644.7845.7323.2829.7926.0231.52
    • ↵a The matched analysis sample comprised, in India, women in union and not sterilized at baseline; in Kenya and Nigeria, all women; and in Senegal, women in union at baseline.

    • ↵b In India, when considering all women in union (including those were who were sterilized at baseline) who were surveyed at midterm (N = 5,790), at baseline, 48.91% were using a modern method, 17.19% were using a traditional method, and 33.89% were not using a method.

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Global Health: Science and Practice: 2 (4)
Global Health: Science and Practice
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December 01, 2014
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Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation
Ilene S Speizer, Meghan Corroon, Lisa Calhoun, Peter Lance, Livia Montana, Priya Nanda, David Guilkey
Global Health: Science and Practice Dec 2014, 2 (4) 410-426; DOI: 10.9745/GHSP-D-14-00109

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Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation
Ilene S Speizer, Meghan Corroon, Lisa Calhoun, Peter Lance, Livia Montana, Priya Nanda, David Guilkey
Global Health: Science and Practice Dec 2014, 2 (4) 410-426; DOI: 10.9745/GHSP-D-14-00109
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  • Article
    • ABSTRACT
    • INTRODUCTION
    • URBAN RH INITIATIVE INTERVENTIONS
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