Evaluation of a Mass Media Family Planning Campaign on the Uptake of Modern Contraceptive Methods in Burkina Faso

The intervention we evaluate is a mass media campaign through local radio stations in Burkina Faso.
The media campaign design and production will be implemented by Development Media International (DMI) in an attempt to change contraception-related behavior and improve health outcomes in Burkina Faso. The campaign will be broadcasted in different languages corresponding to the local languages of the targeted clusters.
Based on formative qualitative research in the field, messages are formulated to overcome the cognitive barriers and social norms that prevent the uptake of modern contraceptives. The media campaign, which will last 3 years, will include short (60-seconds) radio spots, phone-in programs, and interviews with stakeholders and key figures.

The main themes include:
-Delaying the age at first pregnancy
-Increasing the time interval between pregnancies
-Reducing the number of total children per woman
-Benefits of family planning in enhancing financial conditions, health, and opportunities for the family
-Information on safe modern contraceptive methods including types, sources, advantages, and disadvantages of different contraceptive methods

2016-06-01

2019-06-01

Primary outcomes: Total contraceptive prevalence rate (including modern methods and effective traditional methods such as withdrawal. To understand mechanisms we will also analyze impact separately by modern and effective traditional methods)

Secondary outcomes include:
A. attitudes towards contraception
1. Percentage of women intending to use contraception in the future
2. Percentage of women sexually active but who do not want to become pregnant
3. Percentage of women seeking family planning advice
4. Percentage of women discussing family planning with their partners
5. Index of attitudes towards contraception, appropriate age of marriage, and age of first birth
6. Index of partners perceptions of family planning (as described by women)

B. Impact of use of contraception (these are important impact questions but we will have limited power to test for them so do not expect to find significant impacts).
7. Average time lapse between pregnancies
8. Number of unwanted pregnancies
9. (if accurate population level data on total births in communities become available) number of births per 1,000 women of reproductive age

C. Knowledge about modern contraception
10. Percentage of women who know the price, source, advantages, and disadvantages of different contraceptive methods

D. Potential knock on effects (third level of priority)
10. Attitudes and perceptions related to gender norms
12. Women's subjective health and well being (potential negative effects, as women might have to lie to their husbands when using contraception, which generates a sense of mistrust and tension)
13. Domestic violence and sexual harassment (potential negative effects, as violence might increase in the cases where women choose to use contraception when the husband doesn't approve it)

-Measure of attitudes and perceptions related to family planning: a construct of different variables, including whether women think it is acceptable to talk about family planning in public (radio, TV, schools..); women's opinion on the ideal age of marriage, ideal gap between pregnancies, and ideal number of children to have.

-Measure of attitudes and perceptions related to contraception: Whether women think it's embarrassing to buy or to get a contraceptive; whether women think it's embarrassing to buy or to get a contraceptive in front of other women from the village; whether women believe that some modern contraceptive methods could cause infertility or sickness; and whether it is justified for a woman to use contraceptive methods without her husband's knowledge.

-Measure of attitudes and perceptions related to gender norms: how much women agree with certain statements regarding superiority of men, education for boys vs. girls, access to resources for men vs. women.

The intervention will take place in 16 local radios available for the study, 8 of which will be randomly assigned to treatment. This number is limited by the number of radio stations that can be sampled without overlap in the broadcasting reach to allow for separation of treatment and control groups. These radio stations will also broadcast messages in local languages corresponding to the rural zones targeted. The possibility of leakages between treatment and control groups is therefore unlikely, as people living in rural areas speak different languages.


Although the messages diffused will address both men and women to influence cognitive barriers to usage of contraception among couples, our study will only survey women at the age of reproduction (15-49 years old). We will survey an average of 20 villages per radio station cluster, and 25 women per village.

-We will conduct a baseline survey to capture baseline levels of mCPR and other population characteristics. We will use these to stratify our sample prior to randomization.
-We will be monitoring supply of contraceptive methods throughout the intervention in an attempt to disentangle demand and supply factors in changing the level of contraceptive uptake.

In office by a computer following random assignment after stratification.

We will be stratifying our samples on the region, village, and individual levels to guarantee a balance between treatment and control groups along certain key characteristics (baseline level of mCPR, education, number of children, age, distance to clinics, marital status, religion...)

Treatment will be administered through radio stations, and therefore on clusters formed by the regions of coverage of these radio stations.

Yes

The number of radio station clusters is limited to 16 to make sure that the broadcast regions do not overlap.

We will survey 20 villages per cluster, and 25 women per village. Out total sample size is approximately 8000 women.

Among the 16 regions, 8 will be assigned to treatment and the remaining 8 to control

Based on DHS data in the rural areas where our study takes place: (1) Baseline level of mCPR: 12%. (2) ICC at the radio station level clusters: 0.013/ (3) ICC at the villages level: 0.06. (4) Detectable treatment effect corresponding to 80% power: 6 percentage points increase in mCPR. Using simulations on Stata, we test the robustness of power to different levels of baseline mCPR, since this level is reported differently by different sources. We also test the robustness of power to different levels of ICC. As expected, power is most sensitive to the radio station level ICC, since it's the highest level of randomization, and the level on which treatment is assigned and administered. Empirical data suggests however that this ICC level is very low in our sample. Actual power will be higher than in this exercise because (1) we will stratify, (2) we will have a panel structure and (3) will control for the baseline level of mCPR and other explanatory variables. The ICC level should be lower after controlling for explanatory variables as some of the differences between regions is due to differences in observables such as education). There is uncertainty over ICC and the baseline level of mCPR and there is a risk that power is lower than we think it is based on these data and simulations. If that is the case we will only be able to pick up a larger MDE.