• Editors' Summary
• Credits

1. Why Informed Choice Matters
2. Making Family Planing Decisions
3. Policies for Informed Choice
4. Communication for Choice
• Using Many Communication Channels
• Meeting Information Needs
5. Improving Access
6. Managing for Informed Choice
7. Client-Provider Communication

• Figures
• Table
• Side-bars
• Bibliography

• What can be done?
• Women know what they want
• Why communities matter
• Eliminating targets
• More methods, more choices
• "Your health is in your hands"
• Do clients have choices?
• Please Ask!
• How much guidance?
• Active clients, better choices
• Counseling continuing clients

• POPLINE
• Media/Materials Clearinghouse
• Other Reports
• To Order
• CCP Home Page

Published by the Population Information Porgram, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Using a variety of communication channels increases the number of people and the range of audiences who can receive family planning information. Increasingly, the mass media provide reproductive health messages in entertaining and memorable ways. Communication programs also build on mass media messages and extend them through community social networks and organizations.

Mass-media approaches. Many communication programs use multimedia approaches—radio, television, print, street theater, community fairs, and even the Internet—to inform people and to influence their health behavior in positive ways. Communication programs worldwide have combined radio, television, and other mass media, as well as community-based traditional media, in the Enter-Educate approach to health communication—using such popular entertainment as music and drama to convey family planning and other reproductive health messages.

Print materials provide information to help people make informed choices before, during, and after they see a health care provider. Family planning programs often distribute print materials to clients in waiting rooms or through social service organizations. Illustrations of healthy behavior can be particularly helpful to clients who have little education or cannot read (134).

Many communication campaigns have encouraged people to make decisions for themselves and have informed them of the range of available methods. Still, few have explicitly aimed to improve informed choice. Even fewer have sought to document changes in informed choice as a result of their efforts. Most communication campaigns measure such results as the increase in clinic attendance or family planning use. They do not measure whether more people are able to make their own decisions in an informed way. To evaluate how communication campaigns contribute to promoting informed choice, informed choice should be a stated goal and be measured. Also, communication programs can monitor indicators specific to informed choice (see Evaluating Informed Choice).

Community information networks. Communication programs can build on the way information flows from person to person in social networks and other community channels. For example, research in Nepal between 1997 and 1999 found that women with positive attitudes about family planning but little knowledge of it tended to seek out discussions with others they considered “local experts”—that is, long-term users of contraception in the community (55). Communication programs are a useful source of information for such opinion leaders since people who learn about family planning from the mass media often discuss it with others, who discuss it with still others in turn (56, 158, 263, 309, 471) (see Chapter 2.1).

Sara A. Holtz, Peace Corps

In Togo a health volunteer shows women a poster of contraceptive methods available at the local clinic. Because of such information, many people have a method in mind by the time they see a service provider.

Building coalitions of organizations can help opinion leaders and other influential people in the community know more about family planning and encourage them to help spread this information. In Uganda a project has brought together a wide range of experts representing public and private institutions in reproductive health, human rights, youth issues, journalism, law, and research to established the Coalition in Health on Informed Choice Enhancement (CHOICE) (120). The coalition works at three levels: at the community level with leaders to promote better understanding about health needs and rights; at the policy level with government ministries to focus on policies that affect access to contraceptive choices; and at the clinic and hospital levels to make administrators and health care providers more aware of informed choice.

Another program designed to help people in communities participate actively in their own family planning decisions is the Reproductive Health Awareness (RHA) approach. Developed by the Institute for Reproductive Health at Georgetown University, it emphasizes client empowerment. Through training and community education sessions, people learn to be advocates for themselves, to seek medical attention when needed, and to communicate with health care providers (62, 196, 279, 312, 460).

Family planning providers and others with experience in family planning, including clients, women's advocates, researchers, and teachers, also can reach people who want information about family planning by speaking at social group meetings and schools (103). Community groups, service organizations, nongovernmental organizations (NGOs), employers, schools, and religious groups all can be important venues for sharing family planning information (278).