Unintended Pregnancy Prevention
Conditions
Keywords
Contraceptive Use, Family Planning, Child Spacing, Multimedia Evaluation, Social and Behavior Change
Brief summary
The Center on Gender Equity and Health is evaluating a multimedia social and behavior change (SBC) intervention in Kano and Kaduna states in Nigeria to assess its impact, cost-efficiency and how it works. The intervention, led by BBC Media Action, uses radio, TV, other media, community outreach and SBC approaches to increase women's and couples' ability to make and act on reproductive and family planning decisions. Over a three-year period (2025- 2028), we will use a mixed-methods prospective longitudinal cohort study design to meet the research objectives. This includes estimating the impact of the intervention on use and intent to use modern contraception (alone, when combined with other family planning programs, and among non-users), exploring the pathways through which the intervention increases contraceptive use, estimating the cost-efficiency of the intervention and, evaluating the sustainability of the intervention. Data will be collected from three states - Kano and Kaduna (intervention states) and Nasarawa (comparison state). Through this evaluation, we aim to contribute to the family planning and mass media SBC fields by strengthening the evidence on the impact of a multimedia SBC intervention as well as the additional impact of combining the intervention with family planning service delivery interventions.
Detailed description
Background: Modern contraception use to space or limit births is an important aspect of reproductive health because it has the potential to improve maternal health and child outcomes, reduce poverty, and promote gender equality. Despite their benefits, modern contraceptive use remains low in many developing countries, including Nigeria. Nigeria has the largest population and one of the lowest modern contraceptive use rates in sub-Saharan Africa. The 2023-2024 Nigerian Demographic and Health Survey (NDHS) found that the prevalence of modern contraceptives among married women was 15.3%, a 3-percentage point increase from the 2018 NDHS. Rates in Kano and Kaduna continue to remain lower than the national average. In Kano, about 10.6% of married women were using a modern method, roughly double the level recorded in the 2018 NDHS, while in Kaduna, a slight decrease was observed (0.6%) over the years and by 2023-2024 survey about 13.1% were using a modern contraceptive method. Mass media interventions have been used over the years to address low family planning uptake because they can simultaneously influence individuals, families, peer networks and communities. Evidence across these different ecological levels have found that mass media approaches can influence family planning behaviors, knowledge, perceptions, attitudes and expectations . However, despite the large body of evidence documenting the impact of mass media, there's a need for rigorous evaluations that measure multiple outcomes along the behavioral pathway as well as assessments that capture the cost implications. Objective: The objective of this study is to evaluate a multimedia intervention to be implemented by BBC Media Action in Kano and Kaduna. This evaluation will estimate the intervention's impact on family planning/child spacing method use, examine behavioral mechanisms of change, estimate cost-efficiency, and generate insights into its sustainability. Methodology: Using a quasi-experimental design, the evaluation will be conducted in Kano, Kaduna, and Nasarawa (comparison) States. It is a three-year (2026 - 2028), mixed-methods, longitudinal evaluation of the BBC Media Action multimedia SBC intervention. Data collected will include a longitudinal cohort survey with women of reproductive age who meet our inclusion criteria at baseline. The baseline survey will be collected before the intervention begins and a follow-up survey will be conducted two years after the start of intervention implementation. In addition, in-depth interviews will be conducted with a subset of the cohort women and their partners, and program monitoring interviews with intervention women, intervention men, and program implementers. Key informant interviews and an online survey will be conducted with key implementing partners to gather insights into sustainability. To inform the cost efficiency analysis, costs associated with implementation will be collected from the financial management systems of partners along with semi-structured interviews with partners.
Interventions
BEHAVIORALMultimedia (BBC MA) intervention: Changing the Script in Nigeria
Led BBC Media Action (BBC MA) and implemented in collaboration with multiple partners, the intervention will create an integrated "story world" designed to shift knowledge, attitudes, and beliefs, spark conversations, and reshape social norms around family planning or child spacing. The aim is to empower women and couples to make and act on informed family planning/child spacing decisions, ultimately increasing uptake and continuation of contraception. This will be achieved through a range of multimedia channels and formats, including TV drama, radio drama, radio discussion and call-in shows, public service announcements, social media, mobile IVR drama, and community engagement.
OTHERSupply-side interventions (MSI)
Family planning services in the public sector in Nigeria supported by supply-side interventions implemented by Marie Stopes International (MSI) Nigeria. Supply-side interventions include health provider training on family planning service provision, supporting family planning commodity supply, and monitoring family planning service quality.
Sponsors
University of California, San Diego
Oxford Policy Management
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Quasi-experimental design with three study arms (two intervention arms and one comparison arm)
Eligibility
Sex/Gender
FEMALE
Age
15 Years to 44 Years
Healthy volunteers
No
Inclusion criteria
All eligibility criteria based on self-report: * Aged 15-44 years old at baseline * Female * Sexually active (based on self-report; i.e., in union) * Able to provide informed consent * Current residence in the selected intervention or comparison area
Exclusion criteria
* Are not considered sexually active (i.e. not in union) * Are unable to provide consent * Are younger than 15 years and older than 44 years at baseline
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Current family planning use | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women's self-reported FP use (1) any FP method; 2) modern FP method) between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences) |
| Intent to use a family planning method | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women's self-reported intent to use an FP method between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences). This will be a categorical variable measured among all participants, defined as 0=No intent, 1=Intent, 2=FP User. Intent to use FP will be assessed in the following scenarios: 1. At any time in the future 2. In the next 12 months/within 12 months of giving birth (for pregnant women) 3. After the birth of the next child to delay a subsequent pregnancy 4. After the birth of the next child to allow for rest before another pregnancy 5. Once ideal family size is reached 6. If she needs to avoid or delay a pregnancy for health reasons |
| Favorable attitude towards family planning | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women reporting that they are in favor of the use of family planning/child spacing methods between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Confidence in ability to use family planning | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women reporting that they feel confident they could use FP if they wanted to between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences) |
| Self-efficacy to discuss family planning/child spacing with partner/husband | Baseline and follow-up (2 years after implementation start) | Change in women's mean self-efficacy score (CSESSA Nigeria husband/partner communication sub-scale) between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in differences). Range: 0-40 with higher values indicating higher levels of self-efficacy. |
| Frequency of communication about family planning/child spacing with husband/partner | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women reporting that they communicate about family planning/child spacing methods with their husband/partner "often" or "sometimes" between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences) |
| Perceived prevalence of family planning use | Baseline and follow-up (2 years after implementation start) | Change in mean number of married women in the community (out of 10) that participants think use family planning/child spacing methods between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences). Range: 0-10 with higher values indicating a higher perceived prevalence of FP use among married women in their community. |
| Concrete plan to use family planning | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women reporting that they have a concrete plan to start using an FP method (including having identified a place to access the FP method) between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences) |
| Preference-aligned fertility management (PFM) | Baseline and follow-up (2 years after implementation start) | Change in prevalence of women whose fertility preferences align with their contraceptive behavior between baseline and 2-year follow-up in each intervention group compared to the comparison group (difference-in-differences). PFM is defined as: 1. Currently using an FP method (always or sometimes) + Desiring to use that FP method OR 2. Currently not using an FP method + Do not desire to use an FP method |
| Family planning intent actualized | Follow-up (2 years after implementation start) | Change in prevalence of women reporting FP use (1) any FP method or 2) modern FP method) any time within the 2-year follow-up period among those who reported intending to use an FP method at baseline between each intervention group compared to the comparison group at the 2-year follow-up (single time point) |
Countries
Nigeria
Contacts
CONTACTFrancine E Wood, PhD, MPH
CONTACTErin Pearson, PhD, MPH
PRINCIPAL_INVESTIGATORErin Pearson, PhD, MPH
University of California, San Diego
Outcome results
None listed