What Are The Real Barriers To Contraceptive Uptake?

In December of 2016, an important new study was published, analyzing the barriers preventing women from accessing birth control in the Democratic Republic of Congo’s capital city, Kinshasa. The results reinforced one of PMC’s most long-standing and fundamental insights into the issue of global contraceptive uptake: Whether married or not, women with an unmet need for contraception rarely say that they are unaware of contraception, that they do not have access to a source, or that it costs too much. Rather, fear of health effects and personal or spousal opposition to contraception account for the majority of non-use.

To begin with, the research showed the rate of contraceptive use in Kinshasa at just 19%. The global average is over 60%. Though 19% was actually higher than any other province in the country, it remained much lower than the researchers expected – after all, there were 395 places to access a variety of contraception services in the province. If there was such a high availability of contraceptives, then shouldn’t a higher percentage of women be using contraceptives?

In order to identify the barriers to contraceptive uptake, the researchers created focus groups of men and women. These groups revealed that the main deterrents were the fear of side effects, misinformation, or lack of knowledge, not to mention the sociocultural norms surrounding the use of modern contraceptives: was using birth control normal?

During the focus group sessions, the researchers found that both men and women believed there were inordinate health risks in using contraceptives. One woman explained that “people who use these methods have complications such as cancer and sterility.”

Another significant barrier were social norms. Many participants, both men and women, believed that the decisions regarding family planning are the responsibility of husbands, and do not lay with the couple as a whole. The rationale for this belief was that since the husband provides financial support and is the head of the household, he had complete authority on this topic. Many men also believed that using modern methods of contraceptives would be disrespectful to African culture.

These fears and beliefs, and others like them, exist all over the world – and they are exactly the sort of challenges that Population Media Center (PMC) seeks to combat and change. PMC, a US nonprofit operating internationally, specializes in entertainment that changes lives. Not only does good entertainment draw huge audiences, but it can also relay important, sensitive information in non-threatening ways. When combined with behavior change science, PMC’s entertainment is capable of changing deeply entrenched social norms – like men dominating decisions about contraceptive use.

PMC has produced several radio dramas in the DRC which deal directly with family planning and contraceptive use. Vivra Verra (“Time Will Tell”) showed impressive results after broadcasting 156 episodes over almost two years. Listeners were 2.3 times more likely than non-listeners to consider family planning decisions as a couple. Vivra Verra listeners were also 2.2 times more likely than non-listeners to go to a clinic and obtain information about the side effects of contraceptives. Combating fatalism and social norms that dismiss modern contraceptives, Vivra Verra listeners were 3.5 times more likely than non-listeners to say that a couple does have the right to determine how many children they have.

Cultural norms and misinformation – even if they are founded on strong emotional attachments and learned values – are not immutable. But, it takes specific types of interventions to work on deeply-entrenched beliefs. PMC’s mission-driven story arcs, spread over hundreds of episodes, are designed to impact huge audiences, benefiting countless individuals and sparking sustainable community social norm change.

PMC’s radio show Agashi (“Hey! Look Again!”), which aired in Burundi, further demonstrates the success of PMC’s entertainment strategy. Agashi listeners were 2.3 times more likely than non-listeners to report that their spouse is open to a discussion on family planning. A woman who listened to Agashi relayed its impact, saying “The problem that befell Ngendo’s family, which happened because he had so many children, taught us well. Now, my husband and I trust health professionals, as they give us advice about using contraceptives, which we have used without any problem.” Building on Agashi’s initial success, PMC is now airing Agashi 2.

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