Radio and Community Outreach to Promote Gender Equity and Family Planning in Tanzania: Results of a Field Test

This 33-page report shares findings of a study to investigate the potential of radio messages with gender-transformative content to increase the sales of contraceptives from community-based distributors in two peri-urban areas of Tanzania. The project, run by C-Change, also provided special training on gender to community-based distributors as part of the operations research study. According to the report, radio promotion, which has been demonstrated to influence family planning use, may be an effective and cost-effective way to influence gender norms.

Radio spots were broadcast in areas where T-MARC, a Tanzanian social marketing company, was implementing a Community-Based Distribution (CBD) programme in partnership with PRINMAT, a local NGO that provides low cost reproductive health services through a network of clinics. The pilot project tested the effectiveness of a community-based distribution (CBD) model in which community-based distributors — known as washauri — provided health education messages on family planning and other topics and sold socially marketed health products, including contraceptives. The campaign was designed so that the radio spots were aired in each site over two 16-week periods, separated by a period of four weeks; however, due to programmatic delays, the breaks between the periods were extended in each site. The content of gender-themed messages focused on eliciting husbands' support for wives’ family planning decision-making and on reducing the belief, among both men and women, that only men make decisions about contraceptive use.

Some of the results of the study, as outlined in the report, were as follows:

• In the site without gender interventions, there was a significant drop in both women's and men's Gender Equitable Men (GEM) scores. In Dodoma, the site with gender interventions, both women's and men's GEM scores show a substantial and significant increase between baseline and midline, and a decrease at endline, suggesting that the effects of the interventions on attitudes may have diminished over time. However, the improvement between baseline and endline scores is still significant for women. The increase was found for both genders at midline and only for women at endline, when it nearly doubled. Men's knowledge dropped precipitously at endline to below pre-intervention levels. It is important to note that, in general, knowledge is high, at least in being able to recognise the names of contraceptive methods.
• There was not a significant difference in the sales patterns between the intervention and non-intervention sites, but the data gap precludes conclusive statements on that point. This ratio prevents variation in the number of contacts made from influencing the overall sales numbers and provides a better proxy for demonstrated enthusiasm for the products. According to the available data, it appears the radio messages had a negligible long-term effect. While there were strong rising sales initially in both Sengerema and Dodoma, the sales-per-contact graphs are not as strongly positive in the initial months, and overall the trend lines for the sales-per-contact data are all approximately flat.
• In the first round of focus group discussions (FGDs), which were conducted in both Dodoma (the gender site) and Sengerema (the non-gendered site), women who had experienced negative effects from family planning supported advertisements depicting characters who discarded contraceptive use. These participants also showed support for traditional family planning methods. Respondents in all groups also indicated that the approval of family planning methods by a government entity (such as the Ministry of Health) makes more people believe that family planning methods are effective. Women and men generally said women were the ones to initiate conversations about family planning, but both men and women believed that the husband’s decision was more important because the husband is the traditional decision-maker and breadwinner. Both men and women stated that it was better for spouses to discuss family planning together and come to an agreement, but if a husband does not agree to use family planning methods, wives may use methods in secret.
• Washauri in Dodoma reported that the gender training equipped them with knowledge on gender issues that allowed them to raise awareness of family planning at the community level by encouraging people to avoid practices that promote gender discrimination, and instead promote gender equity. Participants also perceived that the training equipped them with strategies and skills to challenge harmful gender norms. Washauri reported many challenges to their work, including inadequate training and knowledge to educate their customers and the general community, and reported that the length of the gender training they received was inadequate to cover the entire agenda.

The report concludes that it is as-yet-unknown as to whether the incorporation of gender themes in radio spots promoting family planning, and the provision of gender training for community-based contraceptive and health product distributors, results in greater increases in family planning knowledge and use and gender equitable attitudes than the same interventions without gender themes. Among the survey findings, those on women's gender attitudes were probably the most compelling, with relatively strong evidence that women's attitudes became more equitable as a result of the gender and family planning interventions. If men's gender attitudes became more equitable, as the midline survey results suggest, this effect did not last long. However, despite the weaknesses in implementation of the interventions tested in this study, the report states that the results do provide modest support for the hypothesis that media programming addressing the inequitable gender norms that inhibit the practice of family planning can have a positive impact on gender attitudes and contraceptive knowledge. Ultimately, media programming that focuses on the gender norms that serve as barriers to family planning may influence gender attitudes (making them more equitable) and contraceptive knowledge, but whether this can influence modern contraceptive use requires further testing.