Conversely, receiving less information and counseling about the pill results in poorer pill use. In a European study of over 6,500 current and past OC users, those who said they did not receive enough information about the pill nor enough help from their providers were one and one-half times more likely to miss one or more pills per cycle than women who felt they received adequate information and counseling (182).

Accurate knowledge is the key to making good decisions about one's reproductive health. Studies show that many women are able to make decisions as well as their providers do, as long as they are given and understand the necessary information (29, 250).

While counseling is valuable, a single counseling session with a family planning provider usually cannot cover all of the information that a person needs to make an informed choice among family planning methods. Nor should counselors and other front-line health care providers have to bear all the responsibility for seeing that clients are fully informed.

One way to inform pill users, potential users, and their partners about family planning is through the mass media, including radio, TV, video, and newspapers (157). Mass media bring family planning to people's attention even before they meet a provider and often start the decision-making process that leads people to seek family planning services (158). Because the mass media also reach continuing family planning users, they can provide important reminders about pill use.

Population Services International

In Haiti a billboard advertises Pilplan, a social marketing brand of OCs. Many people obtain information about OCs from the mass media. The more women know about the pill, the better they are able to use it. Accurate knowledge is the key to making good reproductive health choices.

People obtain much of their information about the pill from the mass media, even though the information is not necessarily designed to aid contraceptive choice and use. In Nigeria, for example, among 500 female university students surveyed, 40% received information about the pill from newspapers or magazines, 28% from television, and 26% from radio. Some 44% reported getting pill information from their peers, 42% from providers, and 30% from nurses (1). Typically, however, information in the mass media is not detailed enough to help people choose a specific family planning method and use it effectively.

Because the mass media reach large and diverse audiences, family planning programs can use the media to improve the use of OCs and other contraceptive methods. In Nepal, for example, the Ministry of Health has used mass media to educate radio listeners about different contraceptives and their use. The radio drama, Cut Your Coat According to Your Cloth, airs four times a week and has been broadcast since 1995. This program gives detailed information on how OCs and other methods work, their advantages and disadvantages, and their proper use (104, 105).

The mass media can reach family planning providers as well as the public. Providers can keep up to date with advances in family planning through mass media distance education courses. In Nepal a weekly distance education course for health workers, Service Brings Reward, complements the radio drama for family planning users and has helped to improve the quality of provider-client interaction (104, 106, 214).

• How pills prevent pregnancy,
• Who are good candidates for pill use,
• Cancer prevention benefits of the pill,
• The need to take the pill every day at the same time,
• How to make up a missed pill,
• Common side effects, and
• Where to get pills.

Population Services International

Actors in Nepal prepare to record the radio drama "Cut Your Coat According to Your Cloth." The program, which airs four times a week, gives information about OCs, including advantages, side effects and correct use. Messages about contraception are most effective when they provide accurate information in appealing formats.

The pill is not the best method for everyone. The mass media need to inform people about the existing range of contraceptive choices. The more family planning options available—and the better the range of choices is known—the better each person can find the method she or he can use with satisfaction. The result will be that every contraceptive method, OCs included, will be used more effectively.

Repeat to reinforce. Repeating a message reinforces it. In a study in the Netherlands, even new pill users who at first had the best use practices began missing more pills by their third pill cycle. These women said that they referred to their audiotaped pill use instructions far less by the third cycle than at first (40). Another study on consistent pill use found women missed more pills with each subsequent pack over three months (147).

One implication of more pills being missed over time is that women may need repeated messages about effective pill use. Another is that, rather than depend solely on instructions that users must seek out, messages also need to reach people frequently and easily, as on radio and TV.

The mass media can reinforce messages on effective use in a variety of ways to maintain interest. For example, a character in a radio drama can be depicted taking her daily pill in response to a cue that reminds her. At the same time, short spots can remind listeners: “Have you taken your pill today?”

Portraying the pill accurately. How the mass media portray OCs to the public—be it accurately or inaccurately—strongly affects women's perceptions and use of the pill. Negative portrayals in the news have caused widespread concerns over the safety of OCs and have contributed to irregular use and discontinuation (88, 235).

For example, in the UK and other European countries the mass media gave extensive publicity to reports in the mid-1990s about some types of OCs and risks of cardiovascular disease—reports whose validity continues to be debated. The publicity created a pill scare. Many women switched to other OCs or stopped taking pills altogether. One provider of legal abortions in the UK reported that 61% of women seeking abortions said they had quit taking pills in mid-pack as a result of the media coverage (43, 76). In the months following, the number of unintended pregnancies and abortions increased substantially (9, 26, 27, 101, 171, 242).

Involving men. In most of the world men have greater access to the mass media than women do, and so family planning messages in the mass media may reach men even more than women (238, 239). Often men greatly influence their partners' family planning behavior and can help them use the pill more effectively (see side-bar, Men Can Help).