Evaluation of a Communication Intervention Programme on Birth Spacing in Bihar, India 34th Annual Conference Indian Association for the Study of Population Gokhle Institute of Politics and Economics, Pune December 13-15, 2012 Population Services International India Puspita Datta, Kali Prosad Roy, Nayanjeet Chaudhury

Background & Objective PSI had four phases of birth spacing campaign programme in Bihar and Jharkhand. This paper based on 4 th phase Programme aim: to generate informed demand for modern spacing method and improve people’s perception towards use of modern spacing methods –oral contraceptive pills (OCP), condom and injectable contraceptives. Objective: To assess the impact of the intervention on use of modern spacing methods and perception towards birth spacing in Bihar.

Methodology: Study Universe Project Area –10 districts Banka, Mumger, Lakhaisarai, Khagaria, Bhagalpur, Begusarai, Samastipur, Patna, Purba Champaran and Pashchim Champaran The sample frame included category villages and all towns – more than 5000 population Target Respondents –Men – 21 to 34 years, currently married, not sterilized (himself and spouse) –Women – 15 to 29 years, currently married, not sterilized (herself & spouse)

Methodology: Sampling Design and sample size Systematic 2 Stage Stratified Sampling Design Selection of PSUs –Villages and urban wards was treated as PSU –PSUs were selected following PPS sampling Selection of Respondents –Listing of households in each sample PSU – this list served as sampling frame –Selection of respondents following systematic random sampling –20 respondents (10 Male & 10 Female) were sampled in each PSU GenderSample size Baseline (Oct 2010) End line (March 2012) Female Male Total

Methodology: statistical tools Bi-variate and multivariate regression Reliability test Segmentation analysis & CIS approach –to finalize the campaign theme UNIANOVA

PSI’s Behavior Change Framework CHANGE/REINFORCE BEHAVIOUR POPULATIONS AT RISK OR NEED HEALTH STATUS OPPORTUNITY Availability Quality of care Brand appeal Brand attributes Social norm ABILITY Knowledge Social support Self efficacy MOTIVATION Attitudes Belief Intention Locus of control Subjective norm Threat Outcome expectation Willingness to pay SOCIAL MARKETING INTERVENTION What is the health problem? POPULATION CHARACTERISTICS What behaviour are we trying to influence? What are the drivers of that behaviour? What is our specific marketing approach?

Data Collection for Determinants of Behaviour Data collected by obtaining opinion of respondents on a 5 point Li-kert scale Strongly disagree 1 Disagree Somewhat 2 Neither Agree nor disagree 3 Agree Somewhat 4 Strongly Agree 5 Communication themes: Availability Spousal Support /social support Programme activities: Mid media Mass media – 2 TV commercials Static media – hoardings/posters/shop signage/wall painting, tin plate Product placement

Research findings

Profile of Respondents Mean age of respondent: male – 28 yrs,female 24 yrs Mean age at marriage: male – 22 yrs, female 17 yrs Level of education: male illiterate -21 %, female illiterate- 38% Main occupation: unskilled worker Monthly household income - less than 7000/month Majority of them are – Hindus and OBCs General Media habit: Television, followed by Radio

Profile of Respondents: family size Mean number of children – 2 Future intention – women respondent -57.4%, male respondent -66%

Awareness about Birth Spacing methods Sig. diff (p<.05) from all categories Adjusted proportions calculated by controlling for key population characteristics

Current Use of Birth Spacing methods Adjusted proportions calculated by controlling for key population characteristics Sig. diff (p<.05) from all categories

page 13 Increase in Mean Score Sig. diff (p<.05) from Baseline Adjusted mean calculated by controlling for key population characteristics

Exposure to Communication Channels

Adjusted proportions calculated by controlling for key population characteristics Dose Response: Key Behaviour-Current use of three spacing methods Sig difference (p<.05) wrt. all other categories

page 16 Dose Response: Key Determinants of perceived availability Adjusted mean calculated by controlling for key population characteristics Sig. diff from Baseline Sig. diff from those exposed twice

page 17 Increase in Mean Score: Perceived Social Support with exposure Adjusted mean calculated by controlling for key population characteristics Sig. diff from Baseline Sig. diff from those not exposed in EL Sig. diff from those exposed twice

Adjusted proportions calculated by controlling for key population characteristics Media Mix: Key Behaviour-Current use of three spacing methods Sig. diff (p<.05) from all categories

Behavioral segmentation of target audience is a pragmatic approach for identifying determinants to design communications The intervention contributed significant increase in current use of modern reversible contraceptives A minimum of 4 exposures is needed to lead to change in behaviour Combination of mass media and mid media contributed significant increase in current use of modern reversible contraceptives than any one media alone Conclusions and Implications