Communication Helps Women Try and Use Injectables
When interest in a new product is growing, as with injectables, communication by family planning programs can address people who know about the product but are hesitating to try it. These are people who think a long time before trying something new or who are skeptical about innovations. Many need to see satisfied users among their peers or be encouraged by opinion leaders before they try something new (162, 227). Each of the three stages they pass through—being persuaded that the product is good, deciding to use it, and then starting to use it—can be addressed by different messages (140).
At the same time that programs address this main audience, they can also address other important audiences—women who are already using injectables, men, and providers. Women who are using injectables often have questions or concerns about side effects. Some men help their partners choose injectables and use them effectively (227). For example, a 1995 study in the Philippines found that women whose husbands supported DMPA use were more than twice as likely to continue the method as women whose husbands disapproved (143). Providers may need information that addresses their own knowledge and attitudes about injectables (6, 54). Efforts to introduce injectables in public family planning programs should include information for private providers because women may consult them about side effects (227). Audience research—with focus groups, for example—helps programs choose messages, sources, and media that will be effective for the specific audiences they want to address.
Injectables have been controversial in some countries because of health concerns. In India, for example, injectables are not offered in the government family planning program in part because of opposition from women's groups (63, 72, 169). Programs should be ready to respond to groups that publicly oppose injectables specifically or modern contraceptives in general. Making reliable and balanced information available to the public and providers has helped programs both avoid and deal with controversy. Maintaining a good working relationship with the news media and making sure that reporters are well-informed is an important task for family planning programs (161). For example, in Indonesia, when the risk of bone loss among DMPA users was in the news in 2004 and 2005, programs contacted journalists so that stories in the mass media presented information about the benefits of using DMPA along with the risk of bone loss (105) (For information about bone loss, see Questions & Answers About Injectables, Question 10).
In Various Media Trusted Sources Address Benefits and Misinformation
Potential users assess the benefits and drawbacks of a new product before deciding to use it. The important characteristics of a new product are its advantages over current products, its compatibility with a potential user's life (how familiar it seems), and ease of use. Being easy to try or to observe is an advantage for a new product (162).
To help potential users assess injectables, communication programs have pointed out advantages, side effects, and health concerns. Also, programs have corrected misinformation about injectables by pointing out, for example, that women can get pregnant after stopping injections (146). Women may need assurance, if monthly bleeding stops, that they are not pregnant and that blood is not building up in their bodies (18, 61, 79). For women ready to try injectables, programs publicize the location and hours of services (61, 183).
Trusted sources have delivered information about injectables in media or forums that are appropriate for the audience. In sub-Saharan Africa aunts are trusted sources of information about sexuality, and in Côte d´Ivoire "Auntie Fatou" provided information about injectables and other contraceptives in television spots (146). Doctors have been portrayed discussing injectables in television spots in Egypt and radio spots broadcast in several sub-Saharan African countries (51, 82, 134). In Pakistan, where many people own cassette tape players, a social marketing program distributed a cassette recording of a simulated discussion of injectables by a provider and a couple (34).
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When interest in a new product is growing, as with injectables, communication can address people who know about the product but are hesitating to try it.
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For some people, information in the mass media or on the Internet may be enough to get them to try a new method. But for the majority who are hesitating or skeptical, a medium that offers the opportunity to interact can be helpful (162). For example, in social marketing projects carried out by Social Marketing for Change (SOMARC) in Kazakhstan, Turkey, and Uganda, radio and television advertising alleviated concerns about convenience, cost, or availability of injectables and oral contraceptives. To address concerns about side effects, however, women needed to interact with a credible source, such as a doctor or family planning counselor, and be able to ask questions (18). Interactive media and forums have included telephone hotlines, discussions with providers, and community meetings.
Telephone hotlines offer a private connection between contraceptive users and a trained, credible family planning counselor. Among callers to a hotline in Turkey were both women who were using injectables and women who were interested but not using them. DMPA users typically called because they had no monthly bleeding and worried that they might be pregnant. One caller had a pregnancy test every month to make sure she was not pregnant. Some women called the hotline for more information after their doctors had told them about irregular or heavy bleeding caused by DMPA. Health care providers also called the hotline for information. For example, a pharmacist called to confirm that DMPA is given every three months rather than every month as some local doctors had said (18).
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A billboard in Guinea promotes the progestin-only injectable Depo Provera as "effective, reversible, private—a long-acting contraceptive." Communication programs address both women and men, who often help their partners choose and use injectables.
© 2002 Sara A. Holtz, Courtesy of Photoshare
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Discussions with providers. Inviting women to a clinic to discuss family planning has given them a chance to interact directly with providers and let them know where injectables are available (50). In one-to-one discussions in women's homes, village health workers in Ethiopia provide information about the benefits of family planning and the availability of injectables. They refer women to health clinics for more information and services (61).
Coaching can help women talk to providers and get the information they need. In a study of family planning counseling in Indonesia, for example, a patient educator coached women about the importance of asking questions and helped them prepare questions and practice asking them. One practice question concerned injectables: "If women don't menstruate when they use injections, where does the blood go?" (for the answer, see Questions & Answers About Injectables, Question 4). In taped counseling sessions, coached women asked more questions than uncoached women and they expressed more concerns about contraceptive methods. As a result, providers gave the coached women more information specific to their situation (96).
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To address concerns about side effects of injectables, some women need to interact with a credible source, such as a doctor or family planning counselor.
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Community meetings are an interactive and public way to improve knowledge and answer questions about injectables and other methods. They also provide information for women who are unable to travel, and for men (18, 34). For example, in the SOMARC project in Uganda midwives set up one-hour meetings with women interested in family planning by working with local officials, religious groups, trade schools, and factories. About 11% of the approximately 17,000 women who attended community meetings later obtained a contraceptive from a clinic. In the areas where the meetings were held, sales of injectables more than doubled from the six months before the meetings to the six months after the meetings (18).
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A woman carries a model of a needle and syringe to publicize injectables in a family planning parade in Peru. Engaging communities and their leaders in communication activities has been an important part of efforts to increase access to injectables and other contraceptives. © Patricia Poppe/CCP, Courtesy of Photoshare
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Engaging community leaders has helped the introduction of injectables and other methods in Ghana and Vietnam (44, 227). The Navrongo Initiative in Ghana, for example, encouraged support for family planning by enlisting the help of opinion leaders and using men's and women's social networks. Councils of elders formed health care action committees, and village leaders and elders convened regular community gatherings to discuss health and family planning with the men. The goal was to show that village leaders endorse family planning and to encourage couples to discuss their reproductive health. As noted, the vast majority of women starting a modern method of contraception in the Navrongo Initiative chose injectables offered by community providers (44, 138).
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Today injectables are becoming more available and attracting more users. Tomorrow, demand for injectables will likely grow further as these methods are offered in more community programs and as subcutaneous injection of DMPA becomes available. Programs are trying to keep up with demand by keeping supplies in stock, ensuring that providers give injections safely, and informing women about injectables. The result of these efforts will be more satisfied users of this safe and effective contraceptive method.
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