Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation

Abstract

Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all.

Figure 1.

Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Union and Not Sterilized at Baseline in India Abbreviation: UHI, Urban Health Initiative. Model controls for age group, education, wealth, religion, city of residence, and other country-specific variables.

Figure 2.

Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Kenya Abbreviation: FP, family planning. Model controls for age group, education, wealth, religion, city of residence, marital status, and other country-specific variables.

Figure 3.

Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Union in Senegal Abbreviations: FP, family planning; ISSU, l'Initiative Sénégalaise de Santé Urbaine. Model controls for age group, education, wealth, religion, city of residence, and other country-specific variables.

Figure 4.

Odds Ratios From Random Effects Analysis of Demand Factors Associated With Modern Method Use Among Women in Nigeria Abbreviations: FP, family planning; NURHI, Nigerian Urban Reproductive Health Initiative. Model controls for age group, education, wealth, religion, city of residence, marital status, and other country-specific variables.

A roadside market umbrella in Mapo district in Ibadan, Nigeria, branded with the “Get it Together” NURHI puzzle logo, encourages people to “know” about family planning, “talk” with their partner about it, and “go” for family planning services.