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:
1. 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. Usage of contraception and family planning
2. Percentage of women intending to use contraception in the future
3. Percentage of women seeking family planning advice
4. Percentage of women discussing family planning with their partners and others
5. Percentage of women who are fecund and sexually active who do not want to become pregnant but are not currently using contraception

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).
6. Average time lapse between pregnancies
7. Number of unwanted pregnancies
8. Number of births per 1,000 women of reproductive age (if accurate population level data on total births in communities become available)
9. Number of family planning products delivered throughout the study period (from administrative data, if available)

C. Knowledge, attitudes, and perception of about contraception and family planning
10. Mean effects on survey questions relating to knowledge of contraceptive methods
11. Mean effects on survey questions relating to attitudes towards contraception
12. Mean effects on survey questions relating to knowledge of family planning
13. Mean effects on survey questions relating to attitudes towards family planning
14. Mean effects on survey questions relating to women’s perceptions of fertility and birth spacing
15. Mean effects on survey questions relating to partners’ perceptions of fertility and birth spacing (as reported by women)

D. Potential knock on effects (third level of priority)
16. Mean effects on survey questions relating to perceptions on gender norms
17. Mean effects on survey questions relating to behavior reflecting women empowerment
18. Mean effects on survey questions relating to women's subjective health and well-being
19. Mean effects on survey questions relating to domestic violence and sexual harassment

10. Mean effects on survey questions relating to knowledge of contraceptive methods
• Variables include: knowledge of the existence, price, source, advantages, and disadvantages of different methods, including rejection of misconceptions such as contraception causing sterility or sickness

11. Mean effects on survey questions relating to attitudes towards contraception
• Percentage of women who think that it is embarrassing to buy a contraceptive method
• Percentage of women who think that using contraceptive methods is a sign of not trusting their partner

12. Mean effects on survey questions relating to knowledge of family planning
• Percentage of women who know benefits of spacing births
• Percentage of women who know benefits of delaying the age of marriage for young girls

13. Mean effects on survey questions relating to attitudes towards family planning
• Percentage of women who think it is acceptable to talk about family planning in public (radio, schools, posters, etc.)
• Percentage of women who think that a woman should be able to control the number of children she has during her lifetime

14. Mean effects on survey questions relating to women’s perceptions of fertility and birth spacing
• Women’s perception on the ideal age at first birth (in standard deviation units from the control group)
• Women’s perception on the ideal time lapse between first and second birth (in standard deviation units from the control group)
• Women’s perception on the ideal number of children in total (in standard deviation units from the control group)

15. Mean effects on survey questions relating to partners’ perceptions of fertility and birth spacing (as reported by women)
• Partners’ perception on the ideal time lapse between first and second birth (in standard deviation units from the control group)
• Partners’ perception on the ideal number of children in total (in standard deviation units from the control group)

16. Mean effects on survey questions relating to perceptions on gender norms
• Percentage of women who think that it is better to be a man than a woman
• Percentage of women who think that boys should have better access to resources in education
• Percentage of women who think that men must be more educated than their wives
• Percentage of women who think that men should have better access to consumption of meat and imported products

17. Mean effects on survey questions relating to behavior reflecting women empowerment
• Percentage of women working or participating in a productive activity
• Percentage of women participating in decision-making when it comes to different household expenditures

18. Mean effects on survey questions relating to women's subjective health and well-being
• Percentage of women satisfied with their lives
• Percentage of women considering themselves healthy compared to other women in the village
• Percentage of women considering themselves happy compared to other women in the village

19. Mean effects on survey questions relating to domestic violence and sexual harassment
• Percentage of women whose husbands / husbands’ families get jealous when they walk to other men
• Percentage of women whose husbands / husbands’ families don’t allow them to see their female friends
• Percentage of women whose husbands / husbands’ families insist on knowing where they are in the village at any time of the day
• Percentage of women whose husbands / husbands’ families ever threatened to harm them or their families
• Percentage of women whose husbands / husbands’ families ever destroyed their personal objects
• Percentage of women whose husbands / husbands’ families ever physically hurt them

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).
Our total sample size will be around 8000 across more than 250 villages across in 16 radio station clusters. Women selection will be stratified on education and access to radio, while village selection will be stratified by average distance to a clinic.

-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.

Stratified randomization of villages and women selection is done in office by a computer.

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 252 villages across the 16 clusters. 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.