Use of modern contraceptives remains low in much of Sub-Saharan Africa. Researchers evaluated the impact of a two-and-a-half-year mass media radio campaign that promoted modern contraception use in Burkina Faso. The campaign increased contraception use, largely by reducing misconceptions about potential side effects of modern contraception methods. The campaign also convinced women who were already in favor of modern contraception to use it more consistently. 

Policy Issue 

High fertility rates and short spacing between births are both associated with poor health outcomes for women. While many women report that they would like to have greater control over the number and timing of births, they are not using contraception.  According to the World Health Organization, the main barriers to contraceptive uptake in Sub-Saharan Africa are a lack of information and awareness, and fear about contraceptives, rather than access to contraception.

Mass media campaigns have the potential to provide useful information on the benefits and logistics of family planning and influence social norms around such contentious topics at low cost. However, mass media campaigns are also hard to evaluate given the difficulty in finding good comparison groups when national media is typically the most powerful channel. As a result, limited evidence exists on their effectiveness in changing attitudes and behavior.

Context of the Evaluation 

In 2014, only 16 percent of women of childbearing age in Burkina Faso used modern methods of contraception, and the average woman gave birth to six children over her lifetime. Surveys suggest that women lack information about the health benefits of controlling fertility and massively overestimate the health risks of contraception. Gender attitudes and intra-household bargaining issues are likely a barrier to contraception use: most rural women report never having discussed contraception with their husbands and at the same time many report it is appropriate for a woman to hide contraception use from her husband.

Local radio stations broadcasting in local languages dominate Burkina Faso’s media environment, making radio one of the best ways to reach large numbers of women. In this study, researchers have partnered with Development Media International (DMI), an organization that runs radio, television, and mobile campaigns to change knowledge and behaviors around reproductive, maternal and child health.

Details of the Intervention 

Researchers partnered with Development Media International to evaluate the impact and cost-effectiveness of a two-and-a-half-year mass media campaign focused on family planning in Burkina Faso. The campaign included 90-second radio spots, which were broadcast 10 times per day, and three regular two-hour interactive phone-in programs per week, in six local languages. The campaign aimed to increase contraception use by addressing, in an entertaining way, the key barriers to adopting contraception. The campaign focused on providing information on different types of safe modern contraceptive methods available in this context (implants, injectables, condoms, and pills).It also addressed concerns about side effects, misconceptions about infertility caused by modern contraceptives, information on the health and economic benefits of birth spacing, gender norms, and the responsibilities of men.

Researchers selected sixteen community radio stations—collectively reaching over 5 million people—that had minimal overlap in coverage area and broadcast in different languages. Of these sixteen radio stations, half were randomly selected to receive the media campaign. The other half served as a comparison group and did not receive the campaign during the study period. 

In addition, researchers identified 3,138 women living in both the treatment and comparison group areas who had no radio in their household and randomlyselected half of them to receive a radio. This additional intervention allowed researchers to measure the impact of receiving a radio in areas where the mass media campaign was implemented and to compare it with the impact of receiving a radio in control areas not targeted by the media campaign.

Following the campaign, researchers collected data from 7,500 women of reproductive age (15-49 years old) in 252 villages to evaluate the campaign’s impact on contraception use, perceptions of family planning, and general gender norms. They also used administrative and survey data from 838 health clinics to measure the impact of the campaign on family planning consultations and disbursement of contraceptives.

Results and Policy Lessons 

The campaign increased contraception use, largely by reducing misconceptions about potential side effects of modern contraception methods and improving attitudes toward family planning. The campaign also convinced women who were already in favor of modern contraception to use it more consistently. 

Contraceptive Use and Attitudes: The campaign led to a 5.3 percentage point increase in modern contraceptive prevalence rate (mCPR), a 17.5 percent increase from an uptake rate of 30.4 percent in the comparison group. This impact was larger for women who had access to a radio when the program started or who were given a radio. Health clinics in areas that received the campaign had a higher number of family planning consultations and distributed more contraceptives. Researchers did not detect any impacts on fertility preferences, attitudes toward birth spacing, or husband preferences (reported by women). 

The media campaign was also more effective for women who were already using contraception before the campaign (but who may not have been using it consistently) and who started with more information on contraception and more positive attitudes toward family planning and birth spacing. This suggests that media campaigns can be an important tool for women who are not strongly opposed to modern contraception rather than by changing fertility preferences.

In areas that received the campaign, women who received a radio were more likely to use a modern contraceptive method than similar women who did not. However, distributing radios in comparison group areas that did not receive the campaign had a negative impact on modern contraception uptake. This finding suggests that in this context, local radio stations do not promote progressive values on gender and modern contraception. In areas receiving the campaign, the positive impacts of the campaign more than offset this negative impact of radio access.

There is evidence that the impact on contraception translated into other important outcome for women: women in areas targeted by the campaign had lower fertility and higher levels of self-assessed health and well-being. 

Cost-effectiveness: The results demonstrate that an intensive mass media campaign can substantially increase the uptake of modern contraception. This impact is likely to be highly cost-effective in countries like Burkina Faso, where an estimated 33,000 additional women are using modern contraception as a result of the campaign, at an annual cost of US$49 per additional woman using modern contraception.