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

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

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

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?

Evidence Base for Empowering Women (cont’d.) Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases ( ) The Sonagachi Project (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.

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

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.9 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

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.

My Project Proposal Target: Females ages 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

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

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

“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

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

Questions?