Increasing Women’s Contraceptive Use in Myanmar Using Empowerment & Social Marketing Strategies

1. Increasing Women’s Contraceptive Usein Myanmar Using Empowerment & Social Marketing Strategies By: Michelle Santos MPH 655 Dr. Rhonda Sarnoff May 2, 2013

2. MDG Monitor Goal 5: Improve Maternal Health • 41% any method

3. Why Empower Women? • Implications for health of the whole country • Relationship and program effectiveness is evidence-based

4. Evidence Base for Empowering Women • Women’s Sexual Empowerment and Contraceptive Use in Ghana (2012) • hypothesize that lack of sexual empowerment may pose an important barrier to reproductive health and adoption of family planning methods • 2008 Ghana Demographic Health Survey Questionnaire • Can you say “no” to your husband/partner if you do not want to have sexual intercourse? • In your opinion, is a husband justified in hitting or beating his wife if she refuses to have sex with him? • Could you ask your husband/partner to use a condom if you wanted him to? • If a wife knows her husband has a disease that she can contract during sexual intercourse, is she justified in asking him to use a condom when they have sex? • Is a woman justified in refusing sex if she is tired/not in the mood?

5. Evidence Base for Empowering Women (cont’d.) • Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases (2000-2001) • The SonagachiProject (1992) • Education and leadership development, • Media use and advocacy, • Public education and participation, Organizing associations and unions, • Work training and micro-enterprise, • Enabling services and assistance, and • Rights protection and promotion empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs.

6. Why use Social Marketing? • Women’s cultural role • Men’s attitudes vs. Women’s attitudes • Focused toward men • Effectiveness is evidence-based

7. Evidence Base for Social Marketing Methods • The reach and impact of social marketing and reproductive health communication campaigns in Zambia (1992) • The Zambia Social Marketing Program (ZSMP) was launched in 1992, and is implemented by the Society for Family Health (SFH) • SFH makes extensive use of radio and television to promote healthy behavior, including use of Maximum brand condoms. • For example, SFH's Club NTG (New Teen Generation) is a youth-oriented radio program about issues that affect youth, such as teen pregnancy, HIV/AIDS, sexuality and condom use. Similarly, An Inside Look is an interactive television talk show that addresses health and social issues [9]. SFH also produced and broadcast radio and television public service announcements with Dr. Kenneth David Kaumba, the former President of Zambia. • These public service announcements aim to discourage HIV-related stigma, and promote faithfulness, condom use, and voluntary testing and counseling [8].

8. Evidence Base for Social Marketing Methods (cont’d.) • Reducing Fertility in Bangladesh (1975) • Deployment of young, married women as outreach workers, or family welfare assistants (FWAs) • The provision of as wide as range of methods as possible to meet a range of reproductive needs • The establishment of family planning clinics in rural areas to provide clinical contraceptive services • The provision of information, education, and communication activities

9. Evidence Base for Social Marketing Methods (cont’d.) • Hombres Sanos: evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with men and women (2006) • conducted cross-sectional surveys every other month with independent samples of Latino men before, during, and after implementation of the social marketing campaign • reduced rates of recent unprotected sex with both females and males among heterosexually identified Latino MSMW • increases in perception of HIV risk, knowledge of testing locations, and condom carrying among heterosexual Latinos.

10. My Project Proposal • Target: Females ages 15-49 • Use civil registration data to identify what areas of the country have the most significant problems with maternal mortality • Implementation • 1) Deployment of young, married women as outreach workers • 2) Mass media campaign targeting men’s attitudes toward contraception • 3) Provision of as wide a range of methods as possible to meet a range of reproductive needs • Evaluation - Measure contraceptive use after every six months - Qualitative surveys assessing quality and adherence

11. Deployment of Young, Married Women as Outreach Workers • Allows for broad coverage • Trained to conduct home visits • Offer contraceptive services and information • Facilitates empowerment of women when combined with social marketing campaign to make individual choices on contraception

12. Mass Media Campaign • Target male attitudes toward male contraception • Via radio broadcasts and television programs • Create likeable character/s with roles as a female community outreach worker or character supporting one, to encourage respect and acceptance

13. “Cafeteria Approach” for Reproductive Needs • Include as wide a variety as possible of various contraceptive options for women • Provide referrals to clinics that specialize in long-term or permanent alternatives such as sterilization • Offer informational resources

14. Evaluation • Qualitative surveys every six months for both men and women • Measure contraceptive prevalence rates before and after implementation, every year

15. Questions?