To be effective, a communication campaign must: (1) generate specific effects; (2) affect a large group of people; (3) have a defined time period; and (4) involve an organized set of activities (166). Communication campaigns work best when they are coordinated with services. When services and supplies are not available and people's expectations cannot be met, generating public interest can destroy the credibility of a family planning program. Providing services without effective communication, however, invites misinformation, rumors, and bad advice, from which recovery is difficult (29).

In developing countries communication campaigns have been shown to promote discussion of family planning, increase clinic visits, and raise levels of contraceptive use. In some countries the influence of campaigns on radio and television has helped make family planning a household word and a community norm rather than the taboo subject it had been (129 , 166).

Many project evaluations and audience surveys find that communication campaigns have directly affected people's interest in family planning (127). For example, after a mass-media project in Cebu Province, the Philippines, the number of new family planning clients in government clinics rose from 1,320 in 1988 to 5,163 in 1989, a nearly fourfold increase (162). In Turkey an intensive 3-month national family planning campaign, conducted in 1988 by the Turkish Family Health and Planning Foundation, encouraged 63% of women to talk to their husbands about family planning. In the urban areas studied, use of modern contraceptives increased from 39% before the campaign to 43% immediately afterwards and shifted toward more effective methods (87). In Turkey nationally, modern contraceptive prevalence in 1993 was 35% (62).

In Egypt the government IEC program has helped achieve virtually universal awareness of family planning. Nearly all Egyptian households have television sets, and 90% of Egyptians watch TV regularly. Communication activities, relying largely on television, combined with ready access to services, have helped contraceptive prevalence to rise by 17 percentage points between 1984 and 1992, from 30% to 47% (39, 137).

Engaging, focused. To help people choose healthy behavior, communication must be engaging, relevant, and credible. Communication through entertainment—such as songs, soap operas, dramas, and dances—effectively promotes family planning because it reaches people everywhere, speaks with emotion, depicts role models, and illustrates the consequences of behavior (125).

Successful communication campaigns require focus, both as to audience and as to message. This focus is best achieved through careful planning based on audience research. Communication must suggest to specific audiences both what to do and how to do it. Communication campaigns use audience research to identify audiences, design messages, and choose media that will reach the audiences, and to monitor impact. It is important to test messages with members of the intended audience to ensure that messages are engaging and meaningful (24, 29, 129, 166, 246, 247, 249).

The most effective family planning communication addresses specific groups. For example, in Bangladesh a communication campaign was designed to address rural men because research found that men strongly influence women's reproductive choices and that many men resist family planning (103). In Tunisia the national family planning program addresses young people who are about to marry or who have just married to inform them about the benefits of birth spacing (215). In Zimbabwe a multi-media campaign that focused on educating men about contraceptive use made a substantial difference (129, 246). Following the campaign, 81% of men exposed to the campaign adopted more positive attitudes about participating in family planning; 55% talked to their wives about family planning; 14% visited a family planning service; and 7% began to use contraception (128, 129).