Better Health For All

Finding this project was striking speciality training gold. Combining my love for international public health, and sexual and reproductive health, the project specification could have been copy-pasted from my wish list of ideal jobs.

The UK Faculty of Public Health (FPH) had been working with their Specialist Interest Groups (SIG) to create new training opportunities for Specialty Trainees for the last few years through the FPH Projects Scheme.

Demonstrating incredibly fortuitous timing, Development Media International (DMI), a London-based NGO who create evidence-based mass media behaviour change campaigns to improve health, advertised a Specialty Training project in collaboration with the FPH Film SIG just when I needed it!

The project involved working on a campaign in the southwest of Côte d’Ivoire called “Pour une family saine et prospère”, which translates to “for a healthy and prosperous family”.

After a virtual interview, I felt very lucky to have been selected for the Project Scheme.

“Famille”, as the project was known colloquially, was adapted from a similar DMI campaign in Burkina Faso, which was evaluated using a cluster randomised controlled trial. The results demonstrated a 20% increase in modern contraceptive uptake rate and seemed to be mediated by improvements in attitudes towards modern contraceptives.

For Famille, the Burkina campaign was tailored to the Cote d’Ivoirian context using a thorough literature review and in-person formative research plan to explore barriers, motivators, challenges and enablers to contraception use, and collect any further local intelligence that might be important for our campaign. Having found a fantastic in-country qualitative research consultant, the focus groups and interviews with community members and key informants could begin! What followed was a series of fascinating Zoom calls with the research consultant as she described her findings to us. We learned about changing traditions, as women no longer leave the marital home for a prolonged period of time to give birth and nurse the baby before returning home. The cost of living was putting pressure on families in Côte d’Ivoire too – men wanted their partners at home to help look after other children, and to help with work. This changing tradition, which previously would have ensured a natural and healthy birth spacing between babies, now meant women were more likely to experience high frequency pregnancies, putting both their health and that of their children at risk. We also learned that the unpredictable side effects of hormonal contraception were unacceptable to some couples, where bleeding prohibited women from cooking or sleeping in the marital bed. Differences in side effects experienced by women was fertile ground for rumours and misinformation to spread. Men and women were worried about the risk of lasting infertility following the use of modern contraception.

The report, rich with quotes, together with the literature review provided a strong basis upon which to write the message briefs from which the campaign content was adapted. We focused on three messages for our campaign:

1. Modern methods of contraception are easy, safe, effective, and reversible 
2. Men, family planning is your business too. Talk to your partner about family planning, and accompany your wife to the health centre
3. You can use modern methods of contraception to space child births, and create a healthy, happy and prosperous family

Soon, we had 8 radio spots which conveyed our key messages in a fun, engaging way using humour and storytelling. These were tested with focus groups in Côte d’Ivoire and then recorded in five local languages using local actors. Once approved by the Ministry of Health, broadcasting could begin on the 27 partner radio stations. Each spot aired 10 times per day for up to two weeks based on DMI’s “Saturation+” approach. 

Next it was time to think about the process evaluation. Many hours of discussion ensued whilst we tried to balance ideal research study designs with pragmatism including budgets, access to villages, and weather conditions in the field (it was the rainy season at the time). We developed a protocol – based on the Capability-Opportunity-Motivation (COM-B) model of behaviour to assess women’s access to radio; social networks; attitudes and norms towards modern contraception use and birth spacing; current and intended contraception use; and their recognition of our campaign. Analysis of findings demonstrated that most women held beliefs supportive of their own reproductive autonomy (that they should be able to make decisions for themselves), however, many concurrently (and contradictorily) believed that other women did not share this belief; that other women would not support their views; and that their husbands believed they should make the decisions on contraception. These findings stimulated plenty of ideas for future campaigns – and the positive feedback received by our partners suggests further campaigns would be very welcome indeed. 

This experience provided me with a smorgasbord of learning. Not only have I discovered a huge amount about sexual and reproductive health and practices in Côte d’Ivoire, I have gained experience of the practicalities of designing a research-based radio campaign for behaviour change. Supported by my supervisor, I provided the research input for an international multi-disciplinary team. The importance of stakeholder engagement was really clear throughout the project – Famille was only possible because of the existing trusted relationships between the organisation, the radio stations, and other partners. Approval was needed at all stages of the project from the Côte d’Ivoire Ministry of Health. Collaboration with the Ivorian Midwives Association yielded benefits for us all – I was incredibly grateful for the opportunity to discuss our emerging findings with very knowledgeable professionals. As I reflect on project, it is clear it has been a fantastic immersive experience with many transferable skills that I will bring back to my day job!  

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I would like to say a huge thank you to Development Media International for hosting me, to my supervisor Dr Abbie Clare for all her guidance and support, and to Dr Uy Hoang and Dr Stella Botchway from the FPH Public Health Film Special Interest Group for helping to organise the Project Scheme with DMI.

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For more information about DMI, please visit: https://www.developmentmedia.net

For more information about the project (including one of the spots), please visit: https://www.developmentmedia.net/project/pour-une-famille-saine-et-prospere/

Information on the landmark RCT in Burkina Faso can be found here: https://www.developmentmedia.net/project/familyplanningrct/

For more projects offered through the FPH: https://www.fph.org.uk/training-careers/specialty-training/training-placements/fph-projects-scheme/#:~:text=FPH%20projects%20The%20Faculty%20of%20Public%20Health%20%28FPH%29,a%20Special%20Interest%20Group%20%28SIG%29%20within%20the%20FPH.

Dr Emily Clark

February 2023